A doctor can prescribe antibiotics, recommend steroid nasal sprays, perform imaging or endoscopy to check for blockages, and in chronic cases, refer you to a specialist for procedures that open up your sinus drainage pathways. What your doctor actually does depends on how long you’ve had symptoms, how severe they are, and whether the infection keeps coming back.
Most sinus infections start as viral infections that clear up on their own. The key question your doctor is answering is whether yours has become bacterial, whether it needs medication, and whether something structural is keeping your sinuses from draining properly.
How a Doctor Decides If You Need Treatment
Doctors don’t diagnose a bacterial sinus infection with a test in most cases. Instead, they use your symptom timeline. A sinus infection is likely bacterial, and worth treating with antibiotics, if it meets one of three patterns: your symptoms have lasted at least 10 days without improving, you have a fever of 102°F or higher along with facial pain and nasal discharge lasting three to four days, or your symptoms improved after four to seven days and then got worse again (sometimes called “double worsening”).
If your symptoms don’t fit those patterns, your infection is most likely viral. In that case, a doctor will typically recommend supportive care rather than antibiotics: saline rinses, over-the-counter pain relievers, and time. This isn’t dismissiveness. Antibiotics won’t help a viral infection, and using them unnecessarily contributes to antibiotic resistance.
Antibiotics for Bacterial Sinus Infections
When your doctor confirms a bacterial sinus infection, the first-line treatment is usually an antibiotic that combines amoxicillin with a second ingredient that helps it work against resistant bacteria. A typical course runs 7 to 10 days. You should start feeling better within three to four days. If you don’t improve after a full course, your doctor may try a different antibiotic or investigate whether something else is going on.
If you’ve already completed two rounds of antibiotics without improvement, that’s generally the point where your doctor will order additional workup or send you to an ear, nose, and throat specialist. At that stage, the question shifts from “what bug is causing this?” to “why aren’t your sinuses draining?”
Steroid Sprays and Saline Irrigation
One of the most effective things a doctor can do for a sinus infection, whether it’s acute or chronic, is prescribe a corticosteroid nasal spray. These sprays reduce swelling inside your nasal passages, decrease mucus production, and help your sinuses drain. For people with nasal polyps (small growths that block the sinuses), steroid sprays moderately reduce symptoms and shrink polyp size. After surgery, they also cut the risk of polyps coming back by about 40%.
Your doctor will likely also recommend high-volume saline irrigation, meaning a squeeze bottle or neti pot that flushes warm salt water through your nasal passages. Clinical guidelines from both the UK and US recommend combining saline irrigation with steroid sprays as the first-choice treatment for chronic sinusitis. Together, they do more than either one alone: the saline physically clears out thick mucus and debris, while the steroid spray reduces the inflammation that caused the blockage in the first place.
When You’ll Be Referred to a Specialist
Your doctor will refer you to an ENT specialist if your sinus infections keep returning or won’t resolve with standard treatment. The formal threshold is four or more episodes of bacterial sinusitis per year, or symptoms that persist after two courses of appropriate antibiotics. Chronic sinusitis, where symptoms last 12 weeks or longer, also warrants specialist evaluation.
An ENT specialist has tools your primary care doctor doesn’t. They can pass a thin, flexible camera (an endoscope) into your nasal passages to directly visualize your sinus openings, look for polyps, and take a culture from the infected area to identify the exact bacteria involved. They’ll also order a CT scan of your sinuses if one hasn’t been done, which reveals structural problems like a deviated septum, bone growths, or polyps that are physically blocking drainage.
Surgical Options for Persistent Problems
Surgery becomes an option when medications haven’t worked and imaging shows a structural reason your sinuses can’t drain. There are two main approaches.
Balloon sinuplasty is a less invasive procedure appropriate for most patients who have blocked sinus drainage pathways without extensive polyps. A small balloon is threaded into the blocked sinus opening and inflated to widen it. It can often be done under local anesthesia, making it a good option for people who aren’t candidates for general anesthesia. Recovery is relatively quick.
Functional endoscopic sinus surgery (FESS) is reserved for more extensive disease, particularly large nasal polyps that need to be physically removed to restore drainage. It’s done under general anesthesia and involves removing small amounts of bone or tissue to permanently open the sinus pathways. Recovery takes longer, but it addresses problems that balloon sinuplasty can’t.
To determine which procedure fits your situation, your specialist will evaluate your CT scans and medical history, looking specifically at whether you have polyps, abnormal bone growth, or other anatomical issues that would require the more involved approach.
Biologic Treatments for Chronic Cases With Polyps
For people with chronic sinusitis and nasal polyps that keep coming back despite surgery and steroid treatment, a newer class of medications called biologics can help. These are injectable drugs that target specific parts of the immune system driving the inflammation. They’re reserved for refractory cases, meaning the disease hasn’t responded to standard treatments.
Biologics work best in patients whose inflammation is driven by a specific immune pattern (called type 2 inflammation), which a doctor can identify through blood tests measuring certain markers. Several biologics are now available, and they’re especially useful for patients who also have severe asthma alongside their sinus disease, since the same inflammatory process often drives both conditions.
Symptoms That Need Emergency Attention
Most sinus infections are uncomfortable but not dangerous. However, infection can occasionally spread to the eye socket or the brain. Go to an emergency room if you develop swelling or redness around your eye, double vision or reduced vision, pain when moving your eyes, a bulging eye, severe headache that won’t respond to medication, a stiff neck, confusion, or a high fever that persists beyond 24 hours. These symptoms suggest the infection has moved beyond the sinuses and requires urgent imaging and treatment.