The hallmark symptoms of a sinus infection are thick nasal discharge, nasal congestion, facial pain or pressure, and a reduced sense of smell. Most sinus infections start as a common cold, so the early days can feel identical. The key difference is that sinus infection symptoms persist beyond 10 days without improvement, or they get worse after initially seeming to get better.
The Core Symptoms
Four cardinal symptoms define a sinus infection: facial pain or pressure, nasal drainage (often thick and discolored), nasal obstruction or congestion, and reduced or lost sense of smell. You don’t need all four. Having at least two of these, lasting long enough, is what separates a sinus infection from a regular cold.
The nasal discharge is often yellow or green, though it can also be clear. It may drain from your nose or drip down the back of your throat, causing a sore throat, the urge to clear your throat constantly, or a cough that’s worse at night when you lie down. Bad breath is another common sign, caused by the infected mucus draining into your throat and mouth.
Fatigue is nearly universal but easy to overlook. Your body is fighting infection, and the combination of disrupted sleep from congestion, constant low-grade discomfort, and immune activation leaves most people feeling wiped out.
Where the Pain Shows Up
You have four pairs of sinuses, and the location of your pain depends on which ones are inflamed. The most common pattern is pain in the cheeks just below the eyes, which comes from the maxillary sinuses. This type often causes upper tooth pain on one side, which people sometimes mistake for a dental problem. Tooth pain is actually one of the strongest clinical predictors of a bacterial sinus infection.
Infection in the frontal sinuses (above your eyebrows) produces a headache across the forehead. The ethmoid sinuses, located between your eyes, cause deep pain behind the bridge of the nose, sometimes with tearing and a splitting headache. The sphenoid sinuses sit deeper in the skull and produce vaguer pain that can be felt in the front or back of the head, making it harder to pinpoint.
Facial pain from a sinus infection typically worsens when you bend forward, because the shift in position increases pressure in the inflamed cavities.
Is It Viral or Bacterial?
Most sinus infections are viral and resolve on their own. But three patterns suggest a bacterial infection that may need antibiotics:
- The 10-day rule: Symptoms persist for 10 days or more with no sign of improvement.
- Severe onset: A fever of 102°F or higher along with facial pain and thick nasal discharge lasting 3 to 4 days.
- Double sickening: You start to feel better after 4 to 7 days, then suddenly get worse again. This worsening after initial improvement is a strong indicator of bacterial infection.
If your symptoms follow any of these patterns, that’s when treatment with antibiotics becomes appropriate. A sinus infection that clears up within 10 days is almost certainly viral, and antibiotics won’t help.
Symptoms in Children
Children get sinus infections too, but they show up differently depending on age. Younger children rarely complain of facial pressure. Instead, the main sign is a runny nose lasting longer than 7 to 10 days with thick green or yellow discharge. A persistent nighttime cough, sometimes with occasional daytime coughing, is another telltale sign.
Older children present more like adults: headaches, facial discomfort, bad breath, sore throat, and swelling around the eyes that’s often worse in the morning. The swelling happens because the thin bones separating the sinuses from the eye sockets allow inflammation to spread easily, particularly in kids whose bones are still developing.
Smell and Taste Changes
Reduced or lost sense of smell is one of the four defining symptoms and affects a significant number of people with sinus infections. It happens because swollen tissue and mucus physically block odor molecules from reaching the smell receptors high in your nasal cavity. Since taste depends heavily on smell, food often tastes bland or “off” during a sinus infection.
With acute infections, smell typically returns as congestion clears. Chronic sinusitis is a different story. When sinus inflammation lasts 12 weeks or longer, smell loss can become persistent, especially when nasal polyps are present. In those cases, targeted treatment can sometimes restore smell within a couple of weeks, though recovery varies.
Chronic vs. Acute Sinus Infections
An acute sinus infection lasts less than four weeks. If symptoms persist for 12 consecutive weeks or longer, the condition is classified as chronic rhinosinusitis. The symptoms are the same core four (facial pain, drainage, congestion, smell loss), but they tend to be less intense and more grinding. Instead of sharp facial pain and high fever, chronic sinusitis feels like months of low-grade congestion, post-nasal drip, and dulled senses.
Chronic sinusitis requires objective confirmation, usually through a nasal exam or a CT scan, because other conditions like allergies and migraines can mimic the same symptoms for months.
Symptoms That Need Urgent Attention
Sinus infections very rarely spread beyond the sinuses, but when they do, the consequences are serious. The sinuses sit close to the eyes and brain, and infection can extend into those areas.
Seek immediate medical care if you develop swelling or redness around the eye, vision changes or double vision, pain when moving your eyes, a severe headache unlike your usual sinus pressure, high fever with a stiff neck, or confusion. These symptoms can signal that infection has reached the eye socket or the lining of the brain. Early-stage spread to the eye area typically shows up as noticeable swelling and redness of the eyelid, sometimes with changes in color perception or pupil response.