How can I tell the difference between a cold and a sinus infection?

Disclaimer:

If you think this blog constitutes medical advice, you should see a doctor.  If you’re sick and need to be diagnosed you should see a doctor. If you want to be able to text your doctor directly on his personal cell phone you should join Frontier Direct Primary Care!

You feel awful.  There’s snot everywhere, it’s green and yellow, you’ve got coughing fits to wake the dead and it’s been 3 days!  Should you go see the doctor? Will antibiotics help this go away faster?

The age old question of when to treat someone for a sinus infection keeps your doctor lying awake at night.  She wants you to feel better...but she doesn’t want to find out you are pooping your brains out from antibiotic-associated diarrhea after you got treated for that cold that was going to get better in a few days on it’s own.  This article will give you a peek into your doctor’s head when she is evaluating someone with cold and sinus symptoms.

Here are the basics.  The common cold is caused by a multitude of different viruses.  Virus are kind of like the zombies of the microscopic world. They reproduce by attacking living things, no one is sure whether they’re even alive and they’re nearly impossible to kill.  Antibiotics have NO EFFECT on viruses. On the other hand, a sinus infection is caused by bacteria. Bacteria are microscopic, living things and some of them make a living by infecting other living things.  Antibiotics are effective against bacteria and help reduce the duration and intensity of many types of common infections.

The symptoms of the common cold and a sinus infection overlap quite a lot and distinguishing the two can be more art than science.  However, any doctor worth her salt will ask you the following questions to determine whether you are suffering from a sinus infection or the common cold.

  1. How long has this been going on?  The common cold will last 7-10 days with peak intensity of symptoms happening in the first 48-72 hours.  Many sinus infections occur after a viral infection set up the inflammatory environment in the sinuses that disrupts the immune system and creates an opening for bacteria to move in and set up camp.  This usually happens when a person has been sick for longer than a week. If your doctor is a real pro, she will ask if you experienced the double dip: Did you get sick, start getting better and then get worse again?  This is a specific sign that you had a viral infection, your immune system started fighting it off and then bacteria moved into your sinuses and made you even sicker than when you started out.

  2. Where does it hurt?  The common cold can be associated with body aches and headaches.  A sinus infection will cause pain in the sinuses.  Your doctor will tap or press on these areas of your face to see if it hurts.  For some people the pain associated with sinusitis will radiate down to the teeth in the upper jaw.

  3. Is green or yellow snot coming out of your nose, eyes and throat? Did it change colors from orange to purple?  If the answer is ‘yes’ to any of these questions, you’ve got the common cold. A sinus infection is essentially an abscess of your sinus.  If you’ve ever had an abscess in your skin and saw the nasty pus that erupted out of it, you have the picture of the goop that comes out of your nose when you have a sinus infection.  If you’ve never had an abscess, check out this video. Your doctor wants to know whether you’ve got bloody pus leaking out of your nostrils before she diagnoses you with a sinus infection.

If you have been sick for a week or longer, experienced the double dip, have tender sinuses and bloody pus coming out of your nose you have a bacterial sinus infection.  Your doctor will offer you antibiotics to help you get better faster. However, even if you don’t have a bacterial sinus infection there are a number of home remedies and over the counter symptoms that can help alleviate the symptoms of congestion and discomfort associated with both the common cold and sinusitis.

  1. Drink lots of water and get plenty of rest.  Staying hydrated keeps the snot thin and flowing.  This allows it to ooze through the inflamed sinus openings rather than being stuck in the sinus and growing nasty bacteria.  Rest helps your immune system effectively fight off those undead little zombies known as viruses.

  2. Over the counter pain relievers like acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) can relieve some of the aches and pains associated with colds and sinus infections.

  3. Over the counter combination decongestant-antihistamine-pain reliever combination medications (think Tylenol Flu but buy the much less expensive generic equivalent) can provide a lot of relief.  They decrease nasal secretions and provide pain relief. I get sinusitis once every 10 years and these medications are my personal go to for relief.

  4. Throat Coat Tea can soothe some of the irritation caused by thick nasal secretions running down the back of your throat.

  5. Some doctors will prescribe intranasal steroid sprays like fluticasone (Flonase).  The idea is that they work to reduce inflammation and open up the sinus passages to allow snot to drain out.  I think the evidence supporting the use of these medications for sinusitis is overstated and I avoid them in this situation unless you have underlying allergies that may be part of the problem.

  6. AVOID over the counter allergy medications like cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra).  These medications work well for allergies by drying up nasal secretions. However, drying out nasal secretions when you have the common cold will cause the snot to get stuck in the sinuses and predispose you to getting a bacterial sinus infection.


In conclusion, if you have congestion and sinus pressure and wonder if you should get antibiotics please see a doctor.  If you’d like to video chat with your doctor about your symptoms from the comfort of your bed while pantless (please keep the camera above the waist) then you should sign up for Frontier Direct Primary Care.