Facial pressure and pain over the cheeks, eyes, or forehead with nasal congestion and thick discharge is sinusitis — inflammation of the sinuses. Most cases are viral and resolve on their own, so the first step is symptom relief with saline rinses, decongestants, and rest rather than immediate antibiotics. Antibiotics help mainly when symptoms last beyond 10 days, are severe, or worsen after an initial improvement. A licensed clinician can determine whether you need a prescription and send it to your pharmacy the same day.
Seek emergency care if: you develop swelling or redness around the eye, vision changes, a severe headache unlike your usual ones, a stiff neck, or confusion — these can indicate orbital cellulitis or meningitis and need the ER immediately.
See a clinician nowWhat is sinusitis?
Sinusitis is inflammation of the sinuses — the air-filled cavities in the skull behind the forehead, cheeks, and eyes. It typically follows a viral upper respiratory infection that causes swelling of the sinus lining, blocking normal drainage and creating an environment where bacteria can overgrow.
Acute sinusitis lasts less than 4 weeks. Subacute sinusitis lasts 4–12 weeks. Chronic sinusitis persists beyond 12 weeks and usually has a different management approach. This page addresses acute sinusitis, which is what most people mean when they say they have a sinus infection.
The vast majority of acute sinusitis cases — about 90–98% — are caused by viruses, not bacteria. Antibiotics are appropriate only for bacterial sinusitis, which accounts for a minority of cases. Distinguishing the two is the key clinical task.
Symptoms of sinusitis
Common symptoms of both viral and bacterial sinusitis include:
What causes sinusitis?
Most acute sinusitis follows a viral upper respiratory infection (cold) that causes mucosal swelling and impairs sinus drainage. When bacteria multiply in the blocked sinus, bacterial sinusitis develops. Common bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Risk factors for developing sinusitis include allergic rhinitis (which causes chronic mucosal swelling), nasal polyps, deviated nasal septum, immune deficiency, dental infections (which can spread to the maxillary sinuses), and cigarette smoke exposure.
The yellow or green color of nasal discharge does NOT mean bacterial infection — viral sinusitis commonly produces colored discharge. Duration and symptom pattern matter most.
Can sinusitis be treated online?
Yes — uncomplicated acute bacterial sinusitis meeting clinical criteria can be diagnosed and treated by telehealth. The clinician assesses symptom duration, severity, pattern (particularly whether symptoms lasted 10 or more days without improvement, or initially improved then worsened), and any risk factors for complications.
Telehealth is NOT appropriate for sinusitis if: you have swelling around the eye or orbital cellulitis, severe headache or stiff neck (possible meningitis), visual changes, focal neurological symptoms, immunocompromised status, or symptoms suggesting a complication. These require urgent in-person or emergency evaluation.
How sinusitis is treated
For confirmed or likely bacterial sinusitis, first-line antibiotic treatment is amoxicillin-clavulanate (Augmentin) for 5–7 days. For penicillin-allergic patients, alternatives include doxycycline or a respiratory fluoroquinolone. In mild cases meeting criteria, watchful waiting for 3–5 days before prescribing is also a guideline-supported option.
Supportive care — effective for both viral and bacterial sinusitis — includes:
- Saline nasal irrigation (neti pot, squeeze bottle, or spray): reduces congestion and clears discharge; strong evidence for symptom relief
- Intranasal corticosteroid sprays (fluticasone, budesonide): reduce mucosal swelling; available OTC and with prescription
- Oral decongestants (pseudoephedrine): help open nasal passages; use with caution in hypertension
- Pain relievers (ibuprofen, acetaminophen): for facial pain and headache
- Steam and humidification: may provide temporary comfort
Self-care while you recover
- Use saline nasal rinses 2–3 times daily to keep sinuses clear and moist
- Stay well hydrated — thin mucus drains more easily
- Sleep with head slightly elevated to improve drainage
- Apply warm compresses to the face over painful areas
- Avoid flying if possible — pressure changes worsen sinus pain significantly
- Avoid tobacco smoke, which impairs mucociliary clearance
How long does sinusitis last?
Viral sinusitis typically peaks at 3–5 days and resolves over 1–2 weeks. Bacterial sinusitis treated with antibiotics usually begins improving within 2–3 days, with resolution typically by 7–10 days. If you are not improving after 3 days of antibiotics, contact a clinician — the bacteria may be resistant or the diagnosis may need reconsideration.
Frequently asked questions
Can I get antibiotics for a sinus infection online?
Yes, for bacterial sinusitis with appropriate clinical criteria. However, most acute sinusitis is viral and resolves without antibiotics. A clinician will assess your symptom duration, severity, and pattern before prescribing.
How do I know if my sinus infection is bacterial?
Bacterial sinusitis is suggested by symptoms lasting 10 or more days without improvement, symptoms that initially improved and then worsened (double sickening), or severe symptoms with high fever and unilateral facial pain. Viral sinusitis typically peaks at days 3–5 and gradually improves.
Will I need imaging?
Not for typical acute sinusitis. CT scanning is reserved for recurrent sinusitis, suspected complications, or when surgery is being considered. A clinical diagnosis based on symptoms is standard for uncomplicated cases.
What can I do to feel better while I wait?
Saline nasal irrigation, steam inhalation, staying well-hydrated, and OTC decongestants and pain relievers all help with symptoms. Nasal steroid sprays reduce inflammation and are available OTC.
Does sinusitis spread to others?
The bacterial infection in the sinuses itself is not contagious, but the underlying viral cold that often triggers sinusitis can spread to others through respiratory droplets. Practice good hand hygiene and avoid close contact when actively symptomatic.
