It's respiratory virus season — and between RSV, the flu and COVID-19, there’s no shortage of contagious viruses making people cough, sneeze and ache right now. And if you've got a stuffy nose, you might be wondering whether it's a cold vs. a sinus infection. Kids are being hit particularly hard by the recent surges in respiratory illness in the United States, and children’s hospitals around the country are overwhelmed with an influx of sick pediatric patients.
“We went two years without people getting sick, really — and now there’s this huge tsunami of illness that’s happening, and kids are getting not just a cold with a single virus but (sometimes) even three at the same time,” Dr. Steven Goudy, division chief of Otolaryngology at Children’s Healthcare of Atlanta and professor at Emory University School of Medicine, tells TODAY.com.
These include respiratory syncytial virus (RSV), rhinovirus, enterovirus, adenovirus, influenza, SARS-CoV-2 or any of the 200-plus viruses that can cause the common cold, per the U.S. Centers for Disease Control and Prevention.
“Each of those viruses by themselves cause inflammation, so all of your immune cells get revved up, and you start making lots of mucus,” says Goudy. That’s why you become a stuffed up, snotty mess when you get a bad cold.
Sometimes, this can lead to a sinus infection or an inflammation of the sinuses, which can become severe if left untreated.
“A lot of times it’s hard to know if your kid has a sinus infection,” says Goudy, adding that it can be especially hard with young children who can’t communicate about what they are feeling. So as more kids get sick with colds and other viruses, it's important for parents to know how to recognize symptoms.
What is a sinus infection?
The sinuses are like “little rooms” in the skull, says Goudy, which are hollow and filled with air. “The thought is that you have sinuses or these pockets within the bone that allow your head to be lighter so you can lift it up and look around,” Goudy says. Mucus flows through the sinuses and drains out through the nose.
“If the mucus gets so thick that it blocks up those doors or points of (exits) from the sinuses, then fluid backs up, and it can sit around and get infected,” says Goudy, adding that sinus infections can be bacterial or viral.
The sinuses are lined with tiny hair-like structures called cilia, says Goudy, which work to move the mucus (along with bacteria and debris) out of the sinuses and the airway so it can drain out through the nose. “When there’s so much mucus, and/or there’s an infection, that prevents the cilia from working normally,” says Goudy. As a result, these “little rooms” fill up with mucus and pus, Goudy adds, and then bacteria grows because it can’t drain out.
Not every cold results in a sinus infection — in fact, the vast majority don’t. “When you get a bad cold, about 10% of the time you’re going to get some type of an infection, either an ear infection or a sinus infection,” says Goudy, adding that the ear is a cavity that can also become blocked due to a buildup of mucus and pus.
Recurrent sinus infections can also be a result of enlarged or inflamed adenoids, tissue located behind the nose that can block off the flow of mucus, Goudy adds.
Cold vs. sinus infection: What are the symptoms?
A sinus infection typically starts out with a viral infection (RSV or rhinovirus, for example), which can cause sneezing, coughing, a runny nose, aches and a fever, says Goudy. The virus is what causes the initial inflammation and buildup of mucus, which can then become infected and lead to a sinus infection.
“We start to get concerned about a sinus infection when after five, six, seven days, you see some of the viral symptoms going away, then all of a sudden they start rebounding,” says Goudy, adding that a fever may return and be even higher than it was the first time.
The signs of a sinus infection are typically congestion, facial pain and pressure around the sinuses. “The reason why there’s pain and pressure is because those little rooms (the sinuses) are filling up with pus, almost like a pimple,” says Goudy.
Other symptoms include headache, fatigue, aching in the teeth, pressure or pain in the ears, and mucus dripping down the back of the throat (or postnasal drainage), per the Mayo Clinic.
Contrary to the old wive's tale, green or yellow mucus from the nose is not indicative of a sinus infection, says Goudy — but if this is accompanied by symptoms like sinus pain and a fever, that would be a cause for concern.
A sinus infection can also cause a bad smell and taste in the mouth, says Goudy, which are closely linked. Certain bacteria have a foul smell, Goudy adds, especially anaerobic bacteria which causes many sinus infections.
“The nerves that provide your sense of smell are in the roof of your nose, so if they’re all bathed in slimy guck that gives off certain odor molecules, it’s going to smell bad, and things are going to taste weird,” says Goudy. This may also cause bad breath. Sometimes, a sinus infection clogs up the nose so much that you can’t smell or taste at all, Goudy adds.
There are other less common symptoms parents should look out for because they may indicate a severe infection.
Sometimes the facial pain can extend to the back of the head and down into the neck, says Goudy. The inflammation from the sinus infection can even cause trouble swallowing or breathing, difficulty moving the head and neck stiffness, Goudy adds.
A sinus infection can also lead to changes in mental status, says Goudy, including fatigue and irritability.
Another warning sign is swelling of or around the eyes, says Goudy, which are located very close to the sinuses. When the infection extends from the sinuses into and around the orbit (or eye socket), this is called periorbital cellulitis, says Goudy, which commonly affects younger children.
What are the complications of a sinus infection
“It spreads into the tissue around the eye, which then causes your eyes to be very swollen and pushes your eye out,” says Goudy, adding that this can lead to vision loss in severe cases. In addition to swelling, the eyes may be red or the white part of the eye can become irritated and swollen which is called chemosis, Goudy says.
If left untreated, the infection can erode the paper-thin bone around the eye, says Goudy, or cause an abscess, which may require surgery. “Very occasionally, it will actually spread into the brain and cause a brain abscess,” says Goudy, adding that sinus infections can be deadly, but this is very uncommon.
Most sinus infections can be treated with antibiotics, such as amoxicillin, says Goudy, but more severe cases may require surgery to drain the infection. Early treatment is key, which is why it’s important for parents or guardians to stay in close contact with their child's pediatrician when a child is sick. Sinus infections can evolve quickly, says Goudy, so children should be monitored closely for any change or progression in symptoms.
If a child develops a high fever, severe headache, swollen eyes or a notable change in mental state, they should go to the emergency room, Goudy adds.
“Most of the patients that we see don’t have a life-threatening or brain-threatening illness. It’s more that they need antibiotics and close observation in a children’s hospital,” Goudy says.
Nasal hygiene is very important, says Goudy, which means keeping your sinuses and nose clean and moisturized. Goudy recommends routinely using a sterile saline spray or rinse to flush out the nose, which are available over the counter. “The saline not only physically pushes it away, but actually pulls some of the swelling out so those little rooms can open up and drain,” says Goudy.
Parents can also try nasal suctioning using a bulb or device that helps remove mucus, Goudy adds, which can be especially useful for babies. Finally, it’s important to stay hydrated, says Goudy, and always talk to your doctor if you have any concerns.
It may not always be possible to avoid a sinus infection, but you can take steps to protect yourself and your family from respiratory viruses. These include getting an annual flu shot, staying up to date with your COVID-19 vaccines and boosters, avoiding contact with sick people and hand-washing, TODAY previously reported.