The hallmark symptoms of sinusitis are thick, discolored nasal discharge combined with nasal congestion, facial pain or pressure, and a reduced sense of smell. Most cases start as a viral infection and clear up within seven days, but symptoms lasting 10 days or longer, or symptoms that worsen after an initial improvement, suggest a bacterial infection that may need different treatment.
The Core Symptoms
Sinusitis, also called rhinosinusitis, inflames the lining of the sinus cavities around your nose, eyes, and forehead. That swelling traps mucus that would normally drain freely, producing a predictable set of symptoms:
- Thick, discolored mucus. Yellow or green discharge from the nose, or mucus dripping down the back of the throat (postnasal drip).
- Nasal congestion. A blocked or stuffy feeling that makes it hard to breathe through your nose.
- Facial pain and pressure. Tenderness or swelling around the cheeks, eyes, nose, or forehead. The pain often worsens when you bend forward.
- Reduced sense of smell and taste. Congestion and inflammation dull your ability to detect odors, which also blunts flavor.
Beyond these four primary symptoms, sinusitis commonly causes headaches, ear pain, aching in the upper teeth, sore throat, cough, bad breath, and general fatigue. The tooth pain catches many people off guard, but it happens because the roots of your upper molars sit just below the floor of your maxillary sinuses. When those sinuses swell, the pressure pushes directly onto the nerve endings in your teeth.
Acute vs. Chronic Sinusitis
The symptoms of acute and chronic sinusitis overlap almost entirely. The difference is duration. Acute sinusitis lasts less than four weeks and usually follows a cold. Chronic sinusitis persists for 12 weeks or longer, even with treatment. The symptoms may be less intense day to day than in an acute episode, but they grind on: low-grade congestion, postnasal drip, facial pressure that never fully lifts, and a persistent cough, especially at night.
Chronic sinusitis can also cause a lingering sense of tiredness that people don’t always connect to their sinuses. Months of disrupted sleep from congestion, mouth breathing, and postnasal drip take a real toll on energy levels.
Viral vs. Bacterial: How to Tell the Difference
This is trickier than most people expect. Yellow or green mucus, fever, and headache are not reliable markers of a bacterial infection. All of those can show up with a standard viral sinus infection too. Even a physical exam alone can’t distinguish the two with certainty.
The most useful clue is the timeline. A viral sinus infection typically starts improving after five to seven days. A bacterial sinus infection often persists for seven to 10 days or longer and may actually get worse after the seven-day mark. Clinicians look for two specific patterns when suspecting bacterial sinusitis: symptoms that haven’t improved at all after 10 days, or what’s called “double sickening,” where you start to feel better and then get noticeably worse again. A fever above 100.4°F alongside severe facial pain and discolored discharge leaning to one side of the nose also raises the likelihood of a bacterial cause.
How Symptoms Differ in Children
Children get sinusitis frequently, but their symptoms look different from adult presentations. Kids are more likely to have a persistent cough, bad breath, irritability, low energy, and swelling around the eyes, along with thick yellow-green nasal drainage or postnasal drip. They’re less likely to report the classic facial pressure adults describe, partly because younger children can’t articulate that sensation clearly.
The timeline matters here too. A cold lasting more than 10 to 14 days in a child, or thick yellow-green drainage for at least three consecutive days, points toward sinusitis rather than a lingering virus. Postnasal drip in children often triggers a sore throat, cough, nausea, and sometimes vomiting, especially when mucus accumulates overnight and is swallowed in the morning.
Where the Pain Shows Up
The location of your facial pain can hint at which sinuses are involved. Pressure and tenderness across your forehead typically points to the frontal sinuses. Pain between and behind the eyes involves the ethmoid sinuses. Aching in the cheeks and upper teeth suggests the maxillary sinuses. Deep pain behind the eyes or at the top of the head can indicate the sphenoid sinuses, though sphenoid sinusitis is the least common type.
Many people with sinusitis report that the pain intensifies in certain positions, particularly when bending over, lying flat, or first thing in the morning after mucus has pooled overnight. The pressure tends to feel dull and constant rather than sharp or throbbing, which helps distinguish it from migraines or tension headaches.
Symptoms That Signal Something More Serious
Sinusitis rarely causes dangerous complications, but the sinuses sit close to the eyes and brain, so certain symptoms warrant urgent attention. Swelling or redness around an eye, vision changes like double vision or reduced sight, a stiff neck combined with high fever, severe headache that doesn’t respond to typical pain relievers, or confusion are all signs that infection may be spreading beyond the sinuses. In children, swelling around the eye is particularly concerning and can progress quickly.