The hallmark symptoms of a sinus infection are facial pain or pressure, nasal congestion, and thick nasal discharge that persists well beyond a typical cold. Most sinus infections start as a regular upper respiratory infection, but the symptoms either linger past 10 days or suddenly worsen around day 7, just when you’d expect to be getting better.
The Core Symptoms
Sinus infections produce a recognizable cluster of symptoms. The most common include a blocked or stuffy nose, thick nasal discharge (which may drain down the back of your throat), facial pain or pressure, and a cough that tends to get worse at night. You may also notice redness across your nose, cheeks, or eyelids.
Facial pain is often the symptom that distinguishes a sinus infection from a lingering cold. The pain typically sits over the cheeks and can radiate to your forehead or teeth. It gets noticeably worse when you bend forward or strain, because changing position shifts the pressure of trapped fluid inside the inflamed sinuses. Some people feel referred pain at the top of the head, the temples, or the back of the skull, depending on which sinuses are affected.
Why Your Teeth Might Hurt
Upper tooth pain during a sinus infection catches many people off guard. The largest pair of sinuses sits directly above the back teeth of your upper jaw, and the roots of those teeth are so close to the sinus floor that they sometimes extend into the cavity itself. When the sinus lining swells, it presses on those roots and creates pain that can feel exactly like a toothache. If the pain spans several upper teeth rather than one specific tooth, your sinuses are the more likely culprit.
Changes to Smell and Taste
Swollen sinus tissue can block the scent receptors high inside your nasal passages, reducing or temporarily eliminating your sense of smell. This is usually reversible once the infection clears. Because taste relies heavily on smell, food and drinks often seem bland or flavorless during a sinus infection. Your tongue still detects basic flavors like sweet, salty, and sour, but the subtle differences between foods largely disappear. Beyond being annoying, reduced smell and taste can make it harder to notice spoiled food, so it’s worth being extra careful about expiration dates while you’re sick.
Viral vs. Bacterial: How to Tell the Difference
Most sinus infections are viral and don’t need antibiotics. Telling them apart from bacterial infections matters because the treatment is different. Two timing patterns suggest bacteria have moved in:
- The 10-day rule. If your symptoms haven’t improved at all after 10 days, a bacterial infection is more likely.
- The double worsening. You start to feel better, then around day 7 your symptoms suddenly get worse again. Most ordinary colds resolve in 5 to 7 days, so a rebound at that point is a red flag.
Purulent (thick, opaque) nasal discharge combined with facial or dental pain makes a bacterial cause more likely, but mucus color alone isn’t reliable. Greenish or yellowish mucus is commonly assumed to mean bacteria, yet both viral and bacterial infections produce the same color changes. Viruses cause the vast majority of upper respiratory infections in both adults and children, and antibiotics do nothing against them regardless of how green the mucus looks.
Even among patients that primary care doctors initially suspect have bacterial sinusitis, only about 40 to 50 percent actually do.
When Symptoms Become Chronic
Acute sinus infections typically resolve within a few weeks. About one in four patients, however, has symptoms lasting longer than 14 days. If your symptoms persist for 12 weeks or more, even with treatment, the condition is classified as chronic sinusitis. Chronic sinusitis shares the same core symptoms (congestion, facial pressure, reduced smell, postnasal drip) but tends to be less intense day to day and more grinding over time. The causes often shift from simple infection to ongoing inflammation, nasal polyps, or structural issues that keep the sinuses from draining properly.
Symptoms in Children
Kids don’t always present with the classic adult pattern. Children are more likely to show a persistent cough, bad breath, crankiness, low energy, and swelling around the eyes alongside thick yellow-green nasal drainage. Headache is less reliable as a symptom in young children and generally only becomes a useful indicator around age six or older. Nausea or vomiting from swallowing postnasal drip is also more common in kids than adults.
The key signal is a cold that drags on for more than 10 to 14 days, sometimes with a low-grade fever. A child who seems to have one endless cold rather than a series of short ones may actually have sinusitis.
Symptoms That Need Immediate Attention
Sinus infections rarely become dangerous, but the sinuses sit close to the eyes and brain, so infection can occasionally spread. About 75 percent of orbital or periorbital infections originate from sinusitis. Go to an emergency room if you develop any of the following alongside sinus symptoms:
- Pain, swelling, or redness around the eyes
- High fever
- Double vision or other vision changes
- Stiff neck
- Confusion
These can signal that the infection has moved beyond the sinuses into surrounding tissue, the eye socket, or the central nervous system, all of which require prompt treatment.