Sorting out sinusitis- a Q&A post

After my recent series about antibiotic use a reader asked a question about sinus infections.

“How do I know if I need an antibiotic for a sinus infection?”

It’s really a 2-part answer, so I’ll answer the second part first, it’s easier.

If you have a bacterial sinus infection with more than mild symptoms, an antibiotic may relieve symptoms and help you recover sooner. 

So, you’re probably asking-

“How do I, or my doctor, know that I have a bacterial sinus infection?”

That is the more difficult question. Like so many things in medicine, maybe even most, figuring out what is wrong is the hard part. Once we know that, choosing one or more possible treatments is often rather straight forward.



If you think you have a sinus infection, you may have one of these alternate conditions

The common cold, the most likely diagnosis- this is more correctly called acute viral rhinosinusitis. The medical prefix “rhino” refers to the nose, for obvious reasons.

Allergic rhinitis, commonly called just “allergies” or hay fever; again, a more correct diagnosis is allergic rhinosinusitis

Since the nose and sinuses are directly connected, problems in one part affect the other.

diagram of the nose and sinuses

small passageways connect the nose and sinuses



An abscessed tooth, or other dental problem

Cellulitis, an infection of the deeper layer of the skin

Zoster, known by its common name shingles; prior to the onset of the rash, there may be pain alone

Migraine– the headache of migraine can cause pain in the sinus area

Angioedema – You may not be familiar with this, it’s an uncommon type of allergic reaction characterized by swelling, mostly in the facial area. Once a patient called me requesting an antibiotic for a sinus infection. My office nurse wisely scheduled an appointment for her to see me. Rather than a sinus infection, she was experiencing angioedema from her blood pressure medication. These reactions can progress into life threatening swelling of the throat; I’m glad I didn’t try treating this with an antibiotic.


How do doctors diagnose a bacterial sinus infection?

The gold standard for diagnosing any bacterial infection is to identify the bacteria by growing it in a lab, a test called a culture. For that, we need a sample of the tissue or fluid from the infected area. Since the sinuses are deep in the face, there is no easy way to do this. So most of the time we rely on symptoms and exam.  We look for



We consider prescribing an antibiotic when

  • Symptoms have been present 10 or more days, and/or are worsening
  • Severe symptoms, such as pain not relieved with mild pain meds or persistent fever,
  • People with conditions that impair their immune systems, like cancer and its treatment, or people with diabetes
  • People with allergic rhinitis often seem to be more prone to bacterial sinus infections or take longer to get better

These of course are all general guidelines; every patient, every illness is different, so different approaches may be needed. This is a framework for us to work from, not hard and fast rules.


“rhino” is a medical term that refers to the nose; rhinitis means a runny nose


Other ways to feel better when treating sinus infections as well as colds,  allergic rhinitis , bronchitis and influenza include rest, increasing oral fluids ,and moisturizing the nose and sinuses.


Portable humidifiers are an easy way to relieve dryness in the nose and sinuses.

A Neti pot or sinus rinse bottle are safe, easy ways to relieve dryness, congestion and clear out excess mucous from the nose and sinuses. Always use distilled or boiled water and ask your doctor before using.



Here is a link to a list of resources from the National Library of Medicine


6 thoughts on “Sorting out sinusitis- a Q&A post

  1. Kelsey Ferguson

    This is really good information. Thanks for sharing with us. My little ones have been fighting colds for weeks now, but they haven’t developed a fever and seem to be improving. This time of year is rough with children passing illnesses back and forth.


    1. Aletha Cress Oglesby, M.D. Post author

      I remember those days well when my sons were kids. I stay a lot healthier now that they are grown. But some would say it’s good for kids to get exposed to germs, it stimulates their immune systems and makes them more resilient in the long run. Hang in there, you will all get through these difficult years.


    1. Aletha Cress Oglesby, M.D. Post author

      I agree, I have allergic rhinitis as do my son and grandchildren. I am glad there are more effective meds available now than when I and even my son were children. Still, it can be a difficult problem to control, especially if you like to be outdoors much. I hope you have found treatments that keep it controlled for you. Thanks for visiting.


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