It was February, and clinic was teeming with respiratory infections of all kinds: mostly the common cold, but also bronchitis, pneumonia, and sinus infections. The patients were coming in usually thinking that they needed antibiotics for their sinus infection, or another respiratory infection.
The first patient on my schedule was a healthcare provider with “sinus infection” written down as her main issue.* She’d had about two weeks of nasal and sinus congestion which she blamed on a viral upper respiratory infection (URI, also known as the common cold). Her two young kids had been sick with colds all winter, so she wasn’t surprised to have these symptoms, along with endless postnasal drip and a cough.
Her congestion had improved a bit at one point, and she thought that she was finally getting better. But then, the day before her appointment, she awoke with throbbing pain between her eyes, completely blocked nasal passages, and, more concerning to her, green pus oozing from her left tear duct. She had body aches, chills, and extreme fatigue. “Do I maybe need antibiotics?” she asked.
- Most sinus infections don’t require antibiotics
- But sometimes, antibiotics for sinus infections are needed
- What is sinusitis?
- How do you get acute sinusitis?
- What are the symptoms of acute sinusitis?
- How is acute sinusitis diagnosed?
- How long does it take for acute sinusitis to go away?
- What is the best treatment for sinusitis?
- Is acute sinusitis contagious?
- Are there any complications from acute sinusitis?
- Are Sinus Infections Contagious?
- Should I Call Out of Work with a Sinus Infection?
- What is a Sinus Infection?
- Home Treatments for Sinus Infections
- Is It Okay to Go to Work with a Sinus Infection?
- When To See a Doctor About Your Sinus Infection
- Different causes, different answers
- How do I avoid catching (or giving) an infection?
Most sinus infections don’t require antibiotics
Ah, sinus infections. The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.
It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, there’s the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
But sometimes, antibiotics for sinus infections are needed
So how does one judge when it is appropriate to prescribe antibiotics for a sinus infection? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if it’s been less than 10 days, they meet criteria for antibiotic treatment. (That’s referred to as a “double-worsening” and is a common scenario in bacterial sinus infections.)
The authors, however, also suggest that doctors discuss “watchful waiting” with patients and explain that most sinus infections clear up on their own in one to two weeks, and it’s a safe option to hold off on antibiotics. The symptoms can then be treated with a cocktail of over-the-counter medications and supportive care, like nasal saline irrigation, nasal steroid sprays, decongestants, and pain medications.
Of course, many patients expect and demand antibiotics for sinus infections, and even those who are open to watchful waiting may hear about the rare but possible complications of things like, oh, brain abscess, and opt to treat.
In the case of my patient above, she met criteria for treatment. She weighed the watchful waiting option against the potential risks of antibiotics for her sinus infection, and chose the prescription. I can tell you from very close follow-up that she improved quickly, though in truth, we will never really know if she would have gotten better anyway.
*This is a real case, details recalled as accurately as possible, based on my own experience as a patient with a sinus infection, originally posted here.
What is sinusitis?
Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. The cheekbone (maxillary) sinuses are the most commonly affected.
Acute sinusitis means that the infection develops quickly (over a few days) and lasts a short time. Many cases of acute sinusitis last a week or so but it is not unusual for it to last 2-3 weeks (that is, longer than most colds). Sometimes it lasts longer. Sinusitis is said to be acute if it lasts from 4-30 days and subacute if it lasts 4-12 weeks. A mild bout of acute sinusitis is common and many people will have some degree of sinusitis with a cold. However, severe acute sinusitis is uncommon. Most people only ever have one or two bouts of acute sinusitis in their lives. However, some people have repeated (recurring) bouts of acute sinusitis.
Chronic sinusitis means that a sinusitis becomes persistent and lasts for longer than 12 weeks. Chronic sinusitis is uncommon. See the separate leaflet called Chronic Sinusitis for more details.
The rest of this leaflet is about acute sinusitis.
How do you get acute sinusitis?
After a cold or the flu
In most people, acute sinusitis develops after a cold or flu-like illness. Colds and flu are caused by germs called viruses which may spread to the sinuses. The infection usually remains viral before clearing, causing a viral sinus infection. In a small number of cases, germs called bacteria add on to an infection that started with a virus. This can cause a bacterial sinus infection which can make the infection worse and last longer.
Spread from a dental infection
In some cases, infection spreads to a cheekbone (maxillary) sinus from an infected tooth.
Other risk factors for sinus infection
In some people, one or more factors are present that may cause the sinuses to be more prone to infection. These include:
- Nasal allergy (allergic rhinitis). The allergy may cause swelling of the tissues on the inside lining of the nose and block the sinus drainage channels. This makes the sinuses more susceptible to infection. See the separate leaflets that discuss allergic rhinitis, called Hay Fever and Seasonal Allergies and Persistent Rhinitis (Sneezing), for more details.
- Other causes of a blockage to the sinus drainage channels, such as:
- Growths (nasal polyps).
- Objects pushed into the nose (especially in children, such as peas or plastic beads).
- Facial injury or surgery.
- Certain congenital abnormalities in children. (‘Congenital’ means they are present from birth.)
- Cystic fibrosis.
- A poor immune system – for example, people with HIV, people on chemotherapy, etc.
- Inflammatory disorders such as sarcoidosis.
- Pregnancy, which makes you more prone to nasal inflammation (rhinitis).
- Previous injuries to the nose or cheeks.
- Medical procedures involving the nose.
What are the symptoms of acute sinusitis?
Symptoms that commonly occur include:
- Pain and tenderness over the infected sinus. The pain is often throbbing and worse when you bend your head forwards. Chewing may be painful.
- Nasal symptoms. You may have either:
- A blocked nose. This may occur in one or both nostrils, sometimes with loss of smell.
- A runny nose. Yellow or green discharge may mean infection.
- A high temperature (fever).
Other symptoms that may occur include:
- Bad breath.
- A feeling of pressure or fullness in the ears.
In children, symptoms may include:
- Ear discomfort.
- Mouth breathing.
- Feeding difficulty.
- Nasal speech.
How is acute sinusitis diagnosed?
Your doctor can usually diagnose acute sinusitis from listening to your typical symptoms. They may also check to see if you have a temperature or if you have tenderness over your sinuses. They may examine your nose, as often the lining of the nose is swollen in acute sinusitis. Investigations are not usually needed to diagnose acute sinusitis. Occasionally, blood tests, X-rays or scans are advised if the diagnosis is not clear.
How long does it take for acute sinusitis to go away?
Like with colds, the immune system usually clears the infection and symptoms generally go within 2-3 weeks.
What is the best treatment for sinusitis?
Acute sinusitis often clears up without treatment. However, there are several things you can do to treat the symptoms in the meantime.
What is the fastest way to get rid of a sinus infection?
The body’s defence system usually takes at least 10 days to fight the infection. There’s nothing you can do to speed up this process, but self-help treatment of the symptoms will help you feel better in the meantime.
If your symptoms persist for more than 10 days your doctor may consider prescribing a high-dose steroid nose spray such as mometasone.
Are antibiotics needed?
Not usually. Department of Health guidelines recommend that antibiotics should not be used for at least the first 10 days. Most cases of acute sinusitis are due to infection with a germ called a virus. Antibiotics do not kill viruses and they can cause side-effects such as sickness and diarrhoea.
They may be considered if you become very unwell or if your symptoms persist after 10 days and don’t respond to other measures. This is more likely to happen in people who have illnesses which make them prone to bacterial infection, such as cystic fibrosis, heart problems or a weakened immune system.
If needed, what is the best antibiotic?
Phenoxymethylpenicillin is recommended unless you are very unwell, in which case co-amoxiclav may be prescribed. If you are allergic to penicillin, there are other options such as doxycycline.
Treatment to relieve symptoms
Some treatments may help to relieve symptoms whilst you are waiting for your immune system to clear the infection. These include the following:
- Painkillers such as paracetamol or ibuprofen will usually ease any pain. They will also help to bring down any high temperature (fever) that you may have. Sometimes stronger painkillers such as codeine are needed for a short time.
- Decongestant nasal sprays or drops are sometimes used. You can buy these from pharmacies. They may briefly relieve a blocked nose. However, they are not thought to shorten the duration of acute sinusitis. You should not use a decongestant spray or drops for more than 5-7 days at a time. If they are used for longer than this, they may cause a worse rebound congestion in the nose.
- Keeping hydrated can be helpful, so have plenty of drinks.
- Warm face packs held over the sinuses may help to ease pain.
- Saline nasal drops may help to relieve congestion and blockage in the nose.
Steam inhalation is a traditional remedy but is now not usually advised. This is because there is little evidence that it helps. Also, there have been some reports of people burning themselves trying to breathe in steam from a kettle. However, some people say that their nose feels clearer for a short while after a hot shower.
Note: see a doctor if symptoms become severe or do not ease within 10 days. (However, as mentioned, it is common to take 2-3 weeks for symptoms to go completely.) The sort of symptoms you should tell a doctor about include:
- Severe pain and/or swelling at the front of your head.
- Swelling around the eye.
- Swelling of the face.
- Bloodstained discharge coming from the nose.
You should also see a doctor if you have recurring bouts of sinusitis, as this may indicate an underlying problem.
Is acute sinusitis contagious?
Acute sinusitis may be contagious if the infection is due to a virus, but not if the cause is bacterial. You can pass it on like a cold. Sneezing, for example, can send virus-containing droplets into the air, which can then be breathed in by a person nearby.
Are there any complications from acute sinusitis?
Chronic sinusitis can sometimes develop from an acute sinusitis. This is the most common complication. Chronic sinusitis causes similar symptoms to acute sinusitis but lasts longer.
Other complications are rare. However, they can be serious. For example, infection may spread from a sinus to around an eye, into bones, into the blood, or into the brain. These severe complications are estimated to occur in about 1 in 10,000 cases of acute sinusitis. They are more common with infection of the frontal sinus. Children are more prone than adults are to complications. Swelling or redness of an eyelid or cheek in a child with sinusitis should be reported to a doctor urgently.
Are Sinus Infections Contagious?
The sinuses are a series of bony cavities in your skull designed to keep foreign particles like dust and germs out of your body. They’re lined with mucus to trap those particles; then, little hair-like projections called cilia sweep back to front to jettison the invaders from your body.
But inflammation can cause the mucus to get trapped, Dr. Liberatore says, and then germs can grow, which can lead to a sinus infection, or sinusitis.
RELATED: 10 Signs You Could Have a Sinus Infection
Anything that can cause your sinuses to narrow or get blocked can also cause sinusitis. Most acute sinus infections (those that last only seven to 10 days) are caused by viruses. But bacteria and fungi are also sometimes culprits. Meanwhile, people with chronic sinusitis (infections that last longer than 10 days and/or recur) can have risk factors like nasal polyps, allergies, immune system problems, and anatomical features like a deviated septum.
Whether or not a sinus infection is contagious can depend on the underlying cause. “Allergies, inflammatory conditions, and other issues leading to inflammation can result in all the symptoms of a sinus infection without the contagious component,” says Noah Stern, MD, program director of otolaryngology at Detroit Medical Center’s Harper University and Hutzel Women’s and Detroit Receiving Hospitals.
Other causes, especially viruses, are transmissible. “The viral pathogens are the same as those that cause the common cold,” Dr. Stern explains. Rhinoviruses are common viral causes of both colds and sinus infections.
Droplets of virus that spread through the air or are transferred by hand contact can pass the germ to someone else. That unsuspecting person is more likely to come down with a cold, if that happens—but the cold could morph into a sinus infection.
While a quick internet search turns up claims that bacterial sinusitis is not infectious, that may not be entirely true, according to Dr. Stern. “The bacterial pathogens behave like other infectious bacteria and can be spread.”
RELATED: Is It a Cold or Sinus Infection? How to Tell the Difference
How to stop the spread
You can prevent spreading sinus infections the same way you would prevent passing along a cold or the flu.
“Good hand hygiene is sufficient to dramatically decrease the spread,” says Dr. Stern. “One should wash their hands after touching or blowing their nose and prior to contacting objects or others to decrease the likelihood of transmission.”
Dr. Stern also recommends nasal irrigation with a saline solution. That, he says, is the nasal equivalent of hand-washing.
It also keeps your nasal passages moist, which will help prevent sinusitis. Other ways to do this include using nasal spray throughout the day, using a humidifier at home (especially in your bedroom), drinking plenty of water, inhaling steam (try a long hot shower), and sleeping with your head elevated to prevent mucus from collecting in your sinuses.
Also make sure you’re up to date on your vaccinations, especially the annual flu shot. The influenza virus can also lead to sinus infections.
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter
Should I Call Out of Work with a Sinus Infection?
Winter is a season for sinusitis and sinus infections, and that often means lost productivity, as workers either call in sick or try to power through. It’s difficult to be at your best when you’re suffering from the symptoms of a sinus infection, and your productivity will almost always take a hit as a result. But is it necessary to call out of work, for the sake of your own health as well as that of others?
What is a Sinus Infection?
A sinus infection is an infection in the sino-nasal passages where the sinuses end up being obstructed or backed up. Common symptoms include drainage, pressure, and fatigue. Discharge from the nose becomes thicker, with a yellow or green coloration. Discharge can also be somewhat bloody.
Sometimes a sinus infection can be difficult to discern from a cold. But, if your cold symptoms last longer than 7 to 10 days it’s likely you’ve developed a sinus infection.
Sinus infections are not contagious. However, the virus that precedes them (such as the common cold) often can be. Anything that causes swelling in the nose, such as a virus or allergies, can end up causing a sinus infection. But the bacteria of a sinus infection is not itself contagious.
Home Treatments for Sinus Infections
Because allergies can be a common source of sinus infections, it’s a good practice to manage them as best you can. Over-the-counter allergy remedies, nasal steroids, and sinus rinses can all help mitigate your allergy symptoms.
For the common cold, try to ward off the possibility of a sinus infection with decongestants and nasal sprays such as applying Afrin for three days. You might also try neti-pot sinus rinses, or other over-the-counter medicines like Advil Cold and Sinus, Mucinex (to thin the mucus in the nose) or generic antihistamines. These treatments may prevent the chance your cold will develop into a sinus infection.
Is It Okay to Go to Work with a Sinus Infection?
In many cases, it’s a judgment call on whether or not you should work with a sinus infection. You are likely to be fatigued and less productive, and it may be wiser to stay home, get some rest, and work from home if you can. Rest and hydration will allow you to get back to baseline faster, so you can return to work at full strength.
The only time you should definitely not go to work with a sinus infection is if you also have a fever. This may be a sign of something more contagious, as it isn’t very common with a sinus infection alone. If you’re suffering from a fever, do yourself (and your co-workers) a favor, and stay home to recover.
When To See a Doctor About Your Sinus Infection
If you’re dealing with a sinus infection, it’s generally best to wait a week and treat your symptoms with over-the-counter remedies before seeing a doctor. Why? In general, medical guidelines advise waiting to make sure symptoms like these aren’t a sign of a viral infection to avoid the chance of antibiotic resistance. If symptoms persist after a week, then the condition may be bacterial and a doctor can often prescribe antibiotics.
However, in the case of additional symptoms, such as a persistent headache or bad fever, you should see a doctor right away, as this might be a sign of something more serious (such as the flu).
When our work colleagues or family members come down with sinus symptoms, one of the first things that crosses our minds is often “I hope I don’t catch that!” So we often try to steer clear—we don’t want to wind up coughing, sneezing, wheezing, or having headaches. But sinus infections aren’t always contagious—the thing is, it can be difficult or impossible to know just by looking at someone.
Different causes, different answers
The answer to the question “are sinus infections contagious?” depends on what’s causing the infection. There are several different causes of sinus infections, and some of these can be transmitted. Here are some of the main causes of sinus infections:
- Viruses. Most sinus infections are caused by viruses, which are organic things tinier than bacteria (more below). They are “genetic entities that lie somewhere in the grey area between living and non-living states,” as a University of California website puts it.
Viruses are passed from one person to another, so if someone has a viral sinus infection, they can pass the bug to you. However, you may not develop the same symptoms. The common cold is caused by viruses, and these viruses can cause a sinus infection to develop. Viruses can be contagious for as little as a few days or as long as a week or more, and you can pass a virus even before you’re showing any symptoms of being sick.
- Bacteria. Bacterial infections can grow when the sinuses are blocked and full of mucus. These infections often last longer. Bacterial sinus infections can’t be spread from person to person. While there is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, the Infectious Diseases Society of America (IDSA) has noted that a sinus infection is likely caused by bacteria if:
- symptoms last for 10 days or more and are not improving; or
- symptoms are severe, including fever of 102° or higher, nasal discharge and facial pain lasting 3-4 days in a row; or
- symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.
- Environment, allergies, other reasons. If a person has a deviated septum (when the wall separating the nostrils is crooked) or nasal polyps (growths inside the nostrils), experiences allergic reactions, or breathes dry, polluted, or smoky air, they may get sinus infections as a result. These things can’t be passed on, but if something in the sufferer’s environment is causing symptoms, they should think about evaluating their environment and making positive changes.
If you are experiencing symptoms of a sinus infection it is best to visit a healthcare professional to distinguish your symptoms between a viral and bacterial sinus infection. An ear, nose and throat (ENT) doctor is specially trained and has passed a certification examination for the American Board of Otolaryngology, making them experts in treating the sinuses. Find an ENT doctor using this physician locator.
How do I avoid catching (or giving) an infection?
It’s important to practice good hygiene as an everyday preventative measure. Wash your hands regularly and thoroughly, and don’t touch your face; steer clear of people who are coughing, sneezing, and stuffed up. If you have a sinus infection, wash your hands often, and cover your mouth and nose when you cough or sneeze.