It’s really starting to feel like Fall in Alabama, and in case you haven’t noticed, everyone is sick! While we have seen a significant decline in COVID cases over the past few months, we’ve seen a surge of other viral upper respiratory infections and the good old common cold. The words “sinus infection” get thrown around a lot this time of year, but is that really accurate? What is a sinus infection, and how can we tell the difference between true bacterial sinusitis and a regular cold? Let’s take a closer look.
What is a common cold?
First, let’s understand what we mean when we talk about a cold. A cold is an infection of the upper airways (ears, nose, throat, sinuses) by one of a number of different viruses. There are lots of viruses that can cause it, but rhinovirus, coronavirus (not the COVID19 one), and RSV are the most common. Another term for a cold is Upper Respiratory Infection,or URI, which sounds much scarier, but means essentially the same thing.
And the symptoms?
Symptoms of a cold, or URI include
- Runny nose
- Sinus congestion and pressure
- Ear pressure
- Sore throat
- Cough
- Low grade fever (101 or lower for adults typically).
- Green and yellow mucus production. This is normal and does not indicate a bacterial infection.
Here’s another important thing to remember: Colds last an average of 7-10 days. I don’t know who started the myth that colds are supposed to go away after 3 days, but I’d like to have some stern words with them…
Can you fix it?
There’s no cure for a cold, so the treatment involves managing the symptoms as well as possible. This might include mucinex to help thin mucus out, tylenol or ibuprofen for aches, pains, and fever, pseudofed or other decongestants to open up the sinuses, and nasal sprays to reduce inflammation and mucus production. If we want to be very aggressive with the symptoms, we might also use a steroid shot or pill pack. It’s also important to stay well hydrated, get plenty of sleep, and eat healthy foods to give your body what it needs to fight off the infection. Repeat after me: Antibiotics do not treat viral infections.
What about sinus infection?
Well, technically a cold is a sinus infection- It’s just a viral one. But when most folks mention a sinus infection, what they really mean is bacterial sinusitis- a bacterial infection of the sinuses. Bacteria are totally different from viruses, and these infections can sometimes get fairly severe. The good news is, bacterial sinusitis is much less common than viral URIs. We as a society have developed an overly inflated sense of how common sinus infections are. I blame urgent care centers for this mostly. Unfortunately, in many urgent care settings, providers will call anything that sneezes a sinus infection and throw antibiotics at it in order to 1. Get the patient out the door and 2. Avoid a bad online review because they didn’t give the patient what they wanted.
So what does real bacterial sinusitis look like?
In addition to many of the normal cold symptoms, symptoms of a true sinus infection typically include
- Pain in the front of the face and/or upper teeth, often on one side only
- Swelling on one side of the face
- Thick, pus-like mucus production, often brown and chunky
- Symptoms that last longer than 7-10 days, especially if they are continuing to worsen
Sinus infections typically do not develop over just 2-3 days. It takes a week or so for them to get established.
How do we treat a sinus infection?
Once we’ve established the diagnosis of true bacterial sinusitis, the treatment is typically antibiotics. We also want to use all the symptomatic treatments we talked about earlier, but the antibiotic is what actually kills the infection. There are several different antibiotics that work well for this, and your doctor will help determine which one is best based on your allergies, other meds, and treatment history.
A word on Z-pak: If I had a nickel for every time a patient asked me for a Z-pak, I’d have a lot of nickels. This goes back again to the trends set by urgent care centers. Z-paks are easy to understand and easy to prescribe. They are not, however, very effective for sinusitis. Over the years, Z-pak (Azithromycin) has been so heavily prescribed that many bacterial strains have become resistant to it, so it’s usually not a great choice any more.
What’s the takeaway?
Common colds are… common. Most adults are going to get 2-3 colds per year, and kids get 5 or so a year. You can expect your symptoms to last a week or more, and there is typically no need to see a doctor about it. Just manage the symptoms at home, and let your body do what it was built to do. Of course, this is all general information, and you should always contact your doctor with anything that worries you. We here at New Leaf Online are wishing everyone clear sinuses, easy breathing, and a safe and happy holiday season!
-Kyle Adams, MD
