Sinus Infection vs. Cold: How to Tell the Difference - Verywell Health

In most cases, when you have a runny nose, headache, and persistent cough, you have a common cold. As the name suggests, this illness is so contagious and widespread that it's the single most common cause of doctor visits in the United States. On average, adults have two to four colds a year, with infants and young children experiencing six to eight.

While sinus infections (also known as "sinusitis") share many symptoms with the common cold and can be a complication of it, there are some key differences. Occurring in an estimated 11.6% of American adults, these infections of the nasal passages tend to be more severe. And unlike the common cold, sinus infections can be of both viral and bacterial origin.

This article covers the key similarities and differences between the common cold and sinus infection, as well as what care looks like for these respiratory diseases.     

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Sinus Infection vs. Cold

Distinguishing between the common cold and sinus infections can be challenging for patients and healthcare providers alike. The two conditions share many characteristics, and in some cases, sinus infections arise as a complication of colds. However, there are several key differences:

• Causes: The common cold arises due to infection from any of 200 viruses, with rhinovirus being the most common. While viral infections also cause most sinus infections, more severe types arise due to bacteria exposure. Additionally, allergies and nasal polyps (growths) in the sinuses may increase the risk of developing sinusitis.   
• Duration: Whereas cold symptoms generally start to improve after three to five days, sinusitis, especially if it's bacterial, lingers longer or doesn't resolve at all. If symptoms last 10 or more days without getting any better, it's likely your cold is a sinus or other kind of infection.
• Sinus pressure/facial pain: While you may experience some sinus pressure with common colds, this is a frequent sign of sinus infection. Facial pain and tenderness can also arise due to this congestion.
• Mucus: While the mucus produced when you have a cold is typically clearer, sinus infection produces thicker, yellowish, or green discharges. Bacterial sinus infections cause your nose to produce a pus-like discharge.
• Symptoms: In addition to cold symptoms, sinus infections can cause loss of sense of taste or smell, higher fever, fatigue, and aches in the body. Fever is more prominent with sinus infections and may or may not occur with common cold cases. Halitosis (bad breath) is another sign of sinus infection.

Sinus Infection

Primarily, sinus infection arises when the sinuses—the passages connecting the mouth, ears, and eyes—are exposed to a virus, bacteria or fungi. This causes an inflammation of the tissues, preventing mucus from exiting the body, and making the sinuses a kind of breeding-ground for germs.

The most common risk factors for sinus infections include:

While many sinus infections are complications of a common cold due to a virus, sometimes bacteria and fungi can cause a superimposed infection that is more difficult for the body's immune system to fight off. Basically, when your immune system is already fighting off a disease, it's easier for other pathogens to infect. Bacterial and fungal sinus infections often arise this way.

Chronic Sinus Infection

Cases of sinus infection that last longer than 12 weeks are considered chronic. These cases may require additional treatment or surgery.  

Symptoms

The primary symptoms of sinus infections include:

• Post-nasal drip (mucus in the throat)
• Fever
• Facial pressure and/or pain
• Congestion and runny nose
• Headache
• Loss of sense of taste and smell
• Halitosis (bad breath)
• Sore throat

Treatment

In a majority of cases, sinus infections resolve as your body's immune system attacks and destroys the infecting pathogens. Proper diagnosis is essential, and the doctor will need to know whether you have viral or bacterial sinusitis. Whereas antibiotics will not work for viral cases, they may be prescribed in bacterial cases.

Often the focus of treatment involves managing the severity of symptoms as natural immunity takes over. For milder cases and those within the first 10 days, over the counter medications and at-home treatments include:

• Analgesics (pain relievers) such as Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen)
• Allergy medications like the antihistamines Claritin (loratadine), and Benadryl (diphenhydramine)
• Getting plenty of rest and staying hydrated
• Nasal saline rinse 

What About Decongestants?

Decongestants are not recommended for adults or children with acute sinusitis and should not be used for more than three to five days in order to prevent rebound congestion.

If symptoms persist or worsen after 10 days, doctors may prescribe:

• Antibiotics (for bacterial sinus infection), such as Moxatag (amoxicillin) or Augmentin (amoxicillin/clavulanate potassium)
• Stronger topical or oral decongestants
• Intranasal steroids, such as Flonase (fluticasone propionate) and Nasonex (mometasone furoate)

Chronic sinus infection requires additional treatment focused on managing the severity of symptoms. Leukotriene antagonist drugs may be prescribed, and surgery may be considered in cases of a deviated septum.

Cold

The common cold is a minor viral infection of the upper respiratory system that's caused by a wide range of viruses. Rhinovirus is the most common pathogen, though there are over 200 others, of which certain coronaviruses and respiratory syncytial virus (RSV) are more often seen.

Colds are usually transmitted via coughed or exhaled droplets or infected surfaces. They are highly contagious, with younger children, seniors, those with respiratory conditions, and those with compromised immunity more prone. In most cases, they resolve without the need for medical care. You can expect to experience many colds throughout your life.

Symptoms

The symptoms of the common cold arise within one to two days of infection. They usually resolve within seven to 10 days, with most feeling improvement after a couple days. Typical signs of the common cold include:

• Runny nose
• Sinus pressure
• Sore throat
• Sneezing
• Coughing
• Headache
• Body aches

If the symptoms last longer than 10 days, it's likely your cold has progressed to a complication or another illness is causing them.

Fevers and Colds

While mild fever may accompany early onset of the cold and is common in children or infants with it, it's not a typical feature of this illness in adults.

Treatment

Most people don't require special treatment for the common cold, and there's no vaccine or outright cure. As with sinus infections, symptom management as your body develops immunity and fights off the infection is central to care. If you're sick, the following is recommended:

• Get plenty of rest and sleep
• Stay home from work or school
• Drink fluids
• Quit or temporarily stop smoking
• Steer clear of alcohol and caffeine

Additionally, some medications can help, many of which are also used for sinus infections:

• Pain relievers
• Decongestants
• Cough suppressants
• Antihistamines
• Expectorants

Diagnosis

Making sure your symptoms are more than a cold, and could be those of sinus infection, can be critical for managing the condition. It's also important for doctors to ascertain whether you're experiencing a viral or bacterial infection as that can influence treatment.

So how are respiratory diseases like this diagnosed? Here's a quick breakdown:

• Medical status and history: Your healthcare provider will talk to you about your symptoms and take a look at past or current conditions you have.   
• Physical evaluation: They will evaluate your nasal passages, throat, and ear canals to assess mucus build-up as well as any inflammation or other signs of infection.
• Endoscopy: In some cases, you may need to see an ear nose and throat (ENT) specialist. Among other techniques used is rhinoscopy, in which they use an endoscope—a specialized camera on a retractable tube—to access and assess the sinuses.
• Allergy and blood tests: Since they can also bring on cold or sinus infection symptoms, diagnosis may involve tests for allergies of skin or blood. Some cases call for certain blood tests, such as sedimentation rate and CBC.  
• Cultures: A sample of your mucus may be taken for testing at a clinical laboratory to assess whether an infection is viral or bacterial in nature.
• Imaging: In some cases, doctors will need a more thorough sense of issues within the sinuses. Imaging techniques, such as computerized tomography (CT) or X-ray may be used.  

When to Talk to Your Doctor

While most colds—and even sinus infections—clear up on their own, it's important to know when you need medical help. If you're having symptoms, here's when you should call a doctor:

• Your symptoms are persisting or worsening after 10 days.
• Pain and discomfort are severe.
• You have a stiff neck or swelling around the eyes.
• You're experiencing changes in vision or mental function.
• Symptoms go away but then come back.
• You have a fever (over 100.4 degrees) that persists beyond a few days.

Summary

Distinguishing between the common cold and sinus infections can be challenging for patients and healthcare providers. However, there are a few key differences. Colds are more common than sinus infections and symptoms tend to improve quicker. Sinusitis has a tendency to linger and cause sinus pressure, facial pain, and yellow or green mucus. Sinus infections can also cause loss of sense of taste or smell, higher fever, fatigue, and aches in the body.

Thankfully, both of these conditions are treatable. Rest, relaxation, and fluids are great home remedies. Medicinal treatment methods vary depending on if the infection is caused by a virus or bacteria.

 A Word From Verywell

We've all experienced a cold before and it is no fun. While it's easy to try and work through it, symptoms of respiratory illnesses like the common cold and sinus infection should never be taken lightly. Taking the time to properly rest and recover will help ensure your illness doesn't progress into something worse. While the chances are much better that you won't need medical attention, you shouldn't hesitate seeking it out if or when you need it.

Frequently Asked Questions

• Some viral sinus infections, as when the condition is a complication of a common cold, can be contagious. However, bacterial sinusitis can't be transmitted from person to person.
  

• Sinusitis generally lasts longer than a cold; while cases can resolve within 10 days, symptoms can last up to a month. If symptoms don't go away after three months, you're considered to have a chronic sinus infection.

• Loss of your sense of taste and smell sometimes accompanies a sinus infection. In most cases, they come back on their own, and treating the underlying cause of the sinusitis will usually bring them back. If this persists, smell training therapy can help, though sometimes (rarely) this loss is permanent.

• Most sinus infections are caused by viral infections, such as those that cause the common cold, including the rhinovirus and respiratory syncytial virus (RSV). Bacteria can also cause sinusitis; these cases tend to arise when there's an existing cold, as the immune system is weakened. Additionally, people with allergies and nasal polyps (growths) in the nasal and facial cavities are at greater risk of developing a sinus infection.