Sinusitis or commonly called sinus infection is one the most common reasons people search for “why won’t my congestion go away?” In the United States, 28.9 million adults have diagnosed sinusitis. People who have asthma, allergies, or structural blockage in the nose are typically at greater risk.
Sinus infection can be of various types. Some are viral and improve with time and supportive care. Some are bacterial and may require antibiotics. And a smaller subset are fungal, which can range from mild to rare infections that need urgent specialist treatments. At Sinusitis in Seattle, we help patients across Seattle understand what’s actually driving their symptoms. Dr. David Santos, a renowned sinus surgeon and ENT doctor, a certified Otolaryngologist, is at the forefront of medical and surgical advancements providing best sinusitis surgery in Seattle.
What is Sinusitis?
Sinusitis is inflammation and sometimes infection of the sinus cavities. When the lining of the sinuses swells, the spaces can fill with fluid, often mucus, causing pressure, facial discomfort, congestion, and drainage. Many cases feel similar to a cold, and many resolve without major treatment within about two weeks.
Where sinusitis becomes more disruptive is when symptoms:
- last longer than expected (often described as subacute when they persist beyond a typical acute period),
- recur frequently, or
- become chronic (commonly defined as symptoms lasting 3 months or more).
Several factors can make sinus infections more likely or harder to shake. These can be allergies,
- nasal polyps,
- a deviated septum, and
- structural narrowing that affects drainage.
Viral vs. Bacterial vs. Fungal: Key Differences
A viral sinus infection often starts as a typical upper respiratory virus- the common cold or flu. It usually improves with time, and antibiotics won’t help because antibiotics don’t treat viruses.
In many viral cases:
- symptoms start improving within 5-7 days, and
- illness often resolves within about two weeks.
Bacterial sinusitis can look almost identical to viral sinusitis at first. That’s why doctors don’t usually run invasive tests on day one for an uncomplicated sinus infection, symptoms and time course matter most.
Clinical clues that raise suspicion for acute bacterial rhinosinusitis include:
- Persistent symptoms lasting more than 10 days without improvement
- Severe symptoms for 3-4 days (high fever plus thick/purulent drainage or facial pain)
- Double worsening (you start to get better, then get worse again)
Some practices also use a practical rule of thumb. When symptoms do not improve by about 2 weeks and may be more consistent with bacterial infection, there’s worsening congestion, pressure, and discolored drainage.
Fungal sinusitis is less common, but it’s important because it comes in multiple forms:
- allergic fungal sinusitis (more chronic/allergy-driven)
- fungal ball (a clump of fungus that can obstruct a sinus)
- saprophytic fungal growth (surface crusting)
- invasive fungal sinusitis (rare, can be dangerous, common in immunocompromised patients)
Fungal sinusitis can resemble other sinus infections, but certain severe symptoms may raise concern.
How Doctors Diagnose Different Kinds of Sinusitis?
1) Symptom Timeline & Pattern
Because viral and bacterial symptoms overlap, doctors often diagnose based on:
- how long symptoms have lasted
- whether you’re improving or worsening
- whether you’re having severe fever/facial pain
- whether symptoms rebound after initial improvement
This approach is also why many people aren’t given antibiotics immediately, most sinus infections are viral, and antibiotic exposure can cause side effects and contribute to resistance.
2) Physical Exam
A standard exam may include evaluating:
- nasal swelling and drainage
- throat irritation from post-nasal drip
- sinus tenderness and facial pressure patterns
- ear fullness, which can occur with congestion
3) When Tests are Used
For typical acute sinus infections, invasive testing often isn’t needed. However, testing becomes more important when symptoms are severe, persistent, recurrent, or suspicious for fungal disease.
Depending on the situation, a doctor may consider:
- Imaging (CT or MRI) to evaluate chronic disease, complications, or unusual cases (MRI may be used when fungal disease is suspected).
- Culture/deep nasal sampling in select cases (mostly chronic, severe, or nonresponsive cases), because routine sampling is uncomfortable and usually unnecessary for uncomplicated infections.
- Biopsy (rarely, but important for suspected invasive fungal sinusitis).
Treatment by Type
Viral Sinusitis Treatment
For a viral sinus infection, treatment focuses on symptom relief while the virus runs its course. Common options include:
- Rest, hydration, and recovery
- Over-the-counter decongestants and pain relievers, when appropriate
- Nasal spray support
- Nasal/sinus irrigation, saline rinses to clear mucus and reduce congestion
- Home comfort measures like humidification, steam, and warm compresses
Because antibiotics don’t treat viruses, they generally won’t speed recovery in viral sinusitis. If sinus infections become recurrent or chronic, we often evaluate for underlying contributors such as nasal polyps, deviated septum, or structural drainage issues, and discuss advanced care options.
Bacterial Sinusitis Treatment
For bacterial sinusitis, treatment depends on severity and how long symptoms have persisted.
Watchful Waiting
Clinical guidelines allow watchful waiting, no immediate antibiotics for uncomplicated acute bacterial rhinosinusitis when follow-up is assured, with antibiotics started if symptoms fail to improve or worsen.
Antibiotics
When bacterial sinusitis is likely, based on persistent symptoms, severe presentation, or double worsening, doctors may prescribe antibiotics. Patients often start feeling better within a few days after beginning appropriate antibiotics, though full resolution can take longer.
Supportive care still matters even when antibiotics are used:
- nasal irrigation
- humidification
- hydration and sleep
- symptom-relief medications when appropriate
When Sinus Surgery is Considered?
Most bacterial sinus infections don’t require surgery. But when infections recur, don’t respond to appropriate treatment, or become chronic, we evaluate whether anatomical or inflammatory issues are preventing drainage. In those cases, sinus procedures may be considered to restore airflow and drainage pathways.
Fungal Sinusitis Treatment (non-invasive vs. surgical)
Fungal sinusitis treatment depends on which subtype is present.
Non-invasive Options
For minor fungal sinus issues, nasal irrigation may help wash away irritants and support sinus hygiene. In select cases, doctors may prescribe antifungal medications, often as part of a broader treatment plan.
Surgical Treatment
Many fungal sinusitis cases, especially fungal balls or allergic fungal sinusitis, are best treated with sinus procedures that remove fungal material and restore drainage. Less invasive approaches may work for localized disease, while more extensive surgery may be needed if infected tissue must be removed.
Invasive Fungal Sinusitis
Invasive fungal sinusitis is rare but serious. It can damage tissue and surrounding structures and may require urgent surgery plus aggressive antifungal therapy, seen in patients with compromised immune systems.
When Sinusitis Is Urgent?
Seek urgent medical evaluation if you have:
- severe headache or facial pain
- symptoms that worsen after improving
- symptoms lasting more than 10 days without improvement
- fever lasting longer than 3-4 days
- swelling around the eye, vision changes, or eye protrusion
- facial numbness, skin color changes near the sinuses, or neurological/behavior changes
These signs don’t always mean something dangerous is happening, but they do mean you should be evaluated promptly.
How to Prevent Recurrence of Sinusitis?
Not every sinus infection is preventable, but reducing inflammation and improving drainage can help lower frequency and severity. Helpful strategies include:
- manage allergies consistently (a major driver of chronic congestion)
- use saline nasal irrigation during colds/allergy seasons
- avoid smoke exposure and other nasal irritants
- address structural issues (like deviated septum or nasal polyps) when they contribute to repeated infections
- treat recurrent or chronic sinusitis with a long-term plan, not just repeated short-term fixes
Best Sinusitis Treatment at Seattle
At Sinusitis In Seattle, we provide comprehensive care for patients dealing with viral, bacterial, and fungal sinusitis. Moreover, you get treatment for complex sinus conditions, led by Dr. Santos with more than 30 years of clinical expertise. His extensive background allows for a deeper understanding of both sinus anatomy and surrounding facial structures.
We use the latest advancements in all our procedures to offer the most effective and minimally invasive treatment options available in today’s time. Our techniques include balloon sinuplasty, endoscopic sinus surgery, and image-guided sinus surgery. All designed to improve sinus drainage, reduce inflammation, and restore comfortable breathing with minimal downtime.
If you are seeking one of the best places in Seattle for sinus treatment, our team is here to help. To schedule a consultation with Dr. Santos, call 206-242-3696 or reach out through our online contact form.
