When Is a Sinus Infection Serious? Signs You Should See a Doctor

Sinus infections are really common. Almost 30 million people a year get a sinus infection in the U.S. This happens when your sinuses — the spaces in the bones of your face — get infected and filled with mucus. And if you’ve ever had one, you know the symptoms can be pretty uncomfortable.

Most commonly, the same viruses that cause common colds also cause sinus infections. But some sinus infections are caused by bacteria and can last a bit longer. So we’ll help you decide when it’s time to see a healthcare professional for treatment.  

When should you see a doctor for a sinus infection?

Many sinus infections will go away on their own. But, you should see a doctor for sinusitis if:

• Symptoms of nasal congestion, headache, and facial pain last for more than 7 to 10 days.

• You experience initial improvement, but then symptoms get worse again within the 10 days.

• You have a fever that lasts more than 3 to 4 days.

• You have diabetes or any condition that weakens your immune system.

There are also times when your primary care provider may refer you to an otolaryngologist for treatment. This is a doctor who specializes in the ear, nose, and throat (also called an ENT). This is more likely if:

• You have more than three episodes of sinusitis in 6 months.

• Your symptoms aren’t getting better with antibiotic treatment.

• A healthcare professional is concerned that your symptoms are due to something else than just a sinus infection.

You may also need to see a specialist, or require more serious treatment, if you develop a complication from a sinus infection. 

How do you know if you have a sinus infection?

Let’s review how to know if you have a sinus infection in the first place. Since the symptoms can feel similar to a cold, it can be hard to tell the difference. Some symptoms that set a sinus infection apart include:

• Feeling like you can’t get mucus out of your nose 

• Facial pain, pressure, or fullness

• Headache

• Pain over teeth

• Nasal drainage, usually green in color

• Postnasal drip (when the mucus drips down the back of your throat)

• Fever

• Bad breath

Do you need antibiotics for a sinus infection?

Not usually. Since most sinus infections are caused by a virus, antibiotics aren’t needed for treatment. In fact, 85% of sinus infections will resolve in 2 weeks without using antibiotics.

Antibiotics are only helpful if a sinus infection is caused by bacteria. In these cases, a healthcare professional may prescribe you a generic antibiotic, usually amoxicillin or amoxicillin-clavulanate (Augmentin). Sometimes a Z-Pak is used to treat a sinus infection. 

If your symptoms still don’t get better, a healthcare professional may need to do a nose swab to see what’s causing the infection and what antibiotic will be best to treat it.

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That being said, many healthcare professionals will prescribe antibiotics for most people who come in with symptoms of a sinus infection — regardless if they really need it. This is in part due to patient preference and expectations. But also because people do see an improvement (although a small one) in their symptoms the first few days after starting antibiotics. 

Many healthcare professionals still recommend people to hold off on antibiotics to avoid:

• Serious allergic reactions

• Unwanted side effects, like a rash or diarrhea

• The development of drug-resistant bacteria, which can cause infections that are much harder to treat 

How long does a sinus infection last?

Sinus infections can be divided into two types: acute and chronic. Acute sinus infections can last a few days up to 8 weeks. Chronic sinus infections can last even longer than 8 weeks, sometimes for many months. 

On average, an acute sinus infection will clear up on its own within about 7 to 10 days without antibiotics. If you are prescribed antibiotics, it may take 2 to 4 days to start feeling some relief. It may still take up to a week or more to feel fully recovered.

What happens if a sinus infection goes untreated?

Whether you take antibiotics or not, 70% of people see an improvement in their symptoms after 7 days. So it’s reasonable to hold off on treating your sinus infection, at least in the beginning. 

But if your symptoms suggest you could have a bacterial infection, then going without treatment can lead to serious complications. This can include:

• Meningitis, an infection around your brain and spinal cord

• An abscess close to your brain

• Orbital cellulitis, an infection around your eyes

• Sinus venous thrombosis, a blood clot in the veins near the brain

These conditions need immediate treatment, usually in a hospital setting. So you should get emergency medical care if you have:

• An intense headache

• Neck pain or stiffness

• Extreme lethargy

• Confusion or change in consciousness

• Swelling around your eyes

• Difficulty moving your eyes, or severe pain when you do

• Changes in vision

• Any stroke-like symptoms

Even though this can sound pretty scary, these complications are very rare. As mentioned, most people will recover from a sinus infection without a problem — with or without antibiotics.

How do you treat a sinus infection at home?

It’s definitely possible to treat a sinus infection at home. Options for at-home treatments are:

• Taking over-the-counter (OTC) pain medications like acetaminophen (Tylenol) and ibuprofen (Advil)

• Rinsing your nose with a saline solution, like with a neti pot

• Using a saline nasal spray, like Xlear or Ayr

• Using a nasal spray with a steroid in it like fluticasone (Flonase) or one with a decongestant like oxymetazoline (Afrin) 

• Taking OTC decongestants like pseudoephedrine (Sudafed) or Mucinex D

• Placing a warm compress over your forehead and nose

• Breathing in steam from a hot shower or bowl of water

Keep in mind that these are mainly to help you feel better. These treatments don’t change the course of the infection.

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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