Sinus infection treatment online, and when antibiotics help

The cold was fine. Annoying, three or four days of it, and then it started to lift. What came next was the problem: a heavy, full feeling across your cheeks and behind your eyes, a nose blocked solid on one side, and a deep ache in your face every time you bend down to put your shoes on. Bending forward is the giveaway.

That is sinusitis, a classic sequel to an ordinary cold. Your sinuses are air filled spaces in the bones of your face, behind your cheeks, between and above your eyes, and behind your nose. They drain into the nose through openings that are genuinely tiny.

Block those openings and the trouble starts. Mucus that should drain away sits there instead, pressure builds inside a space of bone that cannot expand, and you feel every bit of it.

Why it so often follows a cold

A cold virus inflames the lining of your nose. That swelling reaches the drainage openings of the sinuses, which are narrow anyway, and closes them off. The mucus inside has nowhere to go, the lining keeps producing more, and you get the pressure, the blockage and the facial pain. Often it is still the original virus causing all of it, worth holding on to before anyone reaches for a prescription.

Sometimes bacteria take advantage of the stagnant space and add a second infection on top, and that is where an antibiotic may earn its place. Other things narrow those openings too. Hay fever and other allergic reactions keep the nasal lining swollen, nasal polyps get in the way, a deviated septum makes one side worse, and smoking irritates everything.

What it feels like

• Pain, pressure or fullness over the cheeks, the bridge of the nose, the forehead or behind the eyes
• Pain that noticeably worsens when you lean forward or lie down
• A blocked nose, often much worse on one side
• Thick green or yellow mucus from the nose, or running down the back of your throat
• A reduced or absent sense of smell, and food tasting of very little
• Toothache in the upper back teeth, whose roots sit right beneath the cheek sinuses
• A dull headache, a night time cough, bad breath, and a general sense of being wrung out
• Ears that feel plugged, since the same swelling affects the tube draining the middle ear

Short lived, or settling in for months

Acute sinusitis is the common version. It follows a cold, it hurts for a while, and most cases clear on their own in two to three weeks without anybody prescribing anything. Slow, yes. But it goes.

One pattern changes the picture, and it is the one doctors listen for. Symptoms lasting beyond about ten days with no improvement, or symptoms that were clearly getting better and then sharply worsened with a fever and more facial pain, suggest something more than the original virus. That second version, the double worsening, is most likely to benefit from treatment.

Chronic sinusitis is different again. When symptoms grumble on past roughly twelve weeks, with a blocked nose, poor sense of smell and low grade facial pressure, the problem is usually ongoing inflammation rather than fresh infection. Repeated courses of antibiotics do not fix that. Treating the inflammation, often with a steroid nasal spray and nasal rinsing, works better, and persistent cases may need referral to an ear, nose and throat specialist.

What actually helps at home

1. Rinse your nose with salt water, using a sachet kit from the pharmacy. Faintly unpleasant, and the most useful thing on this list.
2. Steam. A bowl of hot water, a towel over your head, ten minutes. Keep children away from the bowl.
3. Sleep propped up on an extra pillow so mucus drains overnight rather than pooling.
4. Warmth on your face. A hot flannel over your cheeks and forehead eases the ache.
5. A painkiller from the pharmacy you know you can safely take, which matters most at night.
6. Decongestant sprays work quickly but should only be used briefly, because longer use makes the blockage worse when you stop. The pharmacist will tell you the limit.
7. Drink more than you think you need.

Antibiotics, honestly

Most sinusitis is viral, and antibiotics have no effect on viruses at all. Taking one for a viral sinus infection will not shorten it by a day. It will give you the possibility of side effects, and it contributes to resistance, which is a real problem.

Where a doctor judges that a bacterial infection has set in on top, an antibiotic may be prescribed if it is clinically appropriate, and that decision usually rests on the pattern of your illness rather than the colour of your mucus. Green mucus is not proof of anything, despite what everyone believes. A doctor weighing this up wants to know when it started, whether you improved and then deteriorated, whether you have a fever and how severe the pain is, and our page on sinus infection treatment sets out what that assessment covers.

When to get urgent help

Complications are uncommon, but the sinuses sit next to the eye and the brain, so the ones that happen are serious. Seek help immediately if you notice:

• Swelling, redness or puffiness around an eye or eyelid
• Any change in vision, double vision, or pain when you move the eye
• An eye that is pushed forward or will not move normally
• A severe one sided headache, especially one unlike anything you have had before
• Neck stiffness, or a strong dislike of bright light
• Confusion, drowsiness, or difficulty staying awake
• Swelling over the forehead, or a high fever with rapidly worsening facial pain

Call 999 for eye swelling with vision changes, neck stiffness, confusion or a rapidly deteriorating headache. If you are worried but it is not that severe, or you cannot judge which side of the line you are on, call 111 and let them decide.

How an online consultation works for this

Sinusitis is one of the conditions where a conversation gets you most of the way, because the diagnosis rests on your story far more than on anything anyone can see. Speaking to a UK registered doctor by video, expect questions about the timeline, whether there was a clear dip after an initial improvement, which parts of your face hurt, and how your sense of smell is behaving. Where treatment is clinically appropriate the doctor can prescribe it, and where a specialist opinion is needed they can write a referral letter.

Read how the appointment process works and check the fees in pounds on the prices page, then book a sinus appointment. If your ears have become the worst of it, with muffled hearing or pain rather than facial pressure, ear infection treatment is the better fit.

Sinusitis or migraine

This one catches people out for years. Migraine often causes facial pain, a blocked or runny nose, watery eyes and pressure around the eyes, which looks exactly like sinusitis to the person experiencing it. The clues pointing towards migraine are attacks that come and go completely, sensitivity to light, sound or smell, nausea, and pain that throbs rather than sitting as steady pressure. Sinusitis normally follows a cold and involves a genuinely blocked nose with thick discharge.

If you have been treated for recurring sinus infections several times a year without anyone finding much, read about headache and migraine assessment. The label may simply be wrong, and that changes the whole approach.

When your face has been aching for over a week and you are tired of guessing whether this needs treatment or more time, get a video consultation booked with a UK registered doctor and come away with a clear answer, plus a plan that fits the version of this you actually have.