Is my sinus pain an allergy, cold or sinus infection?

Woman holding her nose

Christie Barnes, MD, ear, nose and throat specialist

Sinus problems are one of the most common reasons people go to a doctor. With tree pollen allergy season starting soon, it can be difficult to tell if you are developing a sinus infection or suffering from a cold or allergies. Chronic allergies can lead to inflammation that can predispose you to getting sinus infections as can colds. If you also have a deviated septum, these conditions can really block up your nose.

So how do you know if it’s a cold, allergies or sinus infection? If it’s related to allergies, you will more likely have sneezing, itchy eyes, throat or ears. Additionally, your nasal drainage will tend to be clear. You might also have symptoms of fatigue and fogginess. 

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Sinus infections and colds are sometimes harder to tell apart as their symptoms are very similar.

A cold will typically last about 10 days. We therefore use time and a few other factors to distinguish between them. If your symptoms continue to linger past 10 days, you may have a sinus infection. Common symptoms of a sinus infection include persistent nasal drainage that has turned a gray-yellow or green hue, a loss of smell and taste, facial pain or pressure, a productive cough, fever and an inability to breathe through your nose. Many people will try to treat their symptoms for weeks with over-the-counter allergy medications or nasal sprays. While they may provide some relief, these self-medicating therapies are not getting to the underlying problem.

We can confirm whether it’s a sinus infection in the office by performing a nasal endoscopy. This is a simple procedure that involves inserting into your nose a thin, tube with a light and camera attached to the end, which allows your doctor to see your nasal passages and sinuses. In most cases, we can manage sinus infections medically. This typically includes antibiotics, in combination with a nasal steroid spray, nasal irrigation and anti-inflammatories. However, in about a quarter of cases, people will suffer from recurrent problems or they become chronic and surgery will be needed to resolve the issue.

The most common types of sinus surgery include two minimally invasive procedures called balloon sinuplasty and endoscopic sinus surgery. Unlike traditional sinus surgery, neither of these minimally invasive procedures require incisions. They also have a faster recovery and healing time and sometimes may be done in the office.

Most candidates for sinuplasty include people who have experienced repeated episodes of sinusitis in a year and are not able to get relief with other sinus therapies. This procedure involves using a balloon to dilate the sinus openings and can be performed in the office under local anesthesia. The procedure involves inserting a guide through the opening of the sinuses, then inserting a balloon and inflating it. The high pressure balloon opens up the closed sinuses, remodeling the bone to provide a larger space for the sinuses to drain.

If the blockage is more severe, you may be a candidate for endoscopic sinus surgery, which involves opening the blocked sinuses with small instruments that go through the nostrils. The instruments can be used to remove tissue, shave away a polyp that's causing nasal blockage or enlarging a narrow sinus opening to promote drainage.

With both procedures, you can go home the same day in most cases but should stay home from work for the next week to minimize increased pressure to the head, which can increase your nosebleed risk. The majority of people have very good results with surgery but still may need ongoing therapy like a nasal steroid to maintain healthy sinuses.