When a patient presents with a sinus infection, the cause is not usually determined. The reasoning behind this is that 1). Most sinus infections are caused by viruses 2). The tests to determine the cause would be unnecessarily invasive 3). If it lasts longer than two weeks, it is likely bacterial and will respond to antibiotics. Bacteria is the second most common cause of sinus infections. Thankfully, Dr. David Santos provides top-of-the-line care for all sinusitis patients. Sinusitis In Seattle offers the best care for bacterial sinusitis Seattle, Burien, and Renton make available.

Overview: What Is Sinusitis?

Sinusitis, or a sinus infection, is inflammation and infection of the sinuses. It is a relatively common illness and is often mistaken for the common cold, flu, or other similar viral upper respiratory illnesses. Most people will experience a sinus infection in their lifetime. For most, it will pass without treatment, similar to a cold. Therefore, this is known as acute bacterial sinusitis.

When sinusitis becomes an issue is when it lasts longer than the normal two weeks to one month period, recurs often, or is especially severe. When it lasts more than one month, this is known as subacute sinusitis. More than three months and it will usually be classified as chronic sinusitis. At the point it becomes chronic, specialist care may be required.

Bacterial sinus infections make up a large number of subacute sinus infections. This is largely due to inadequate treatment or diagnosis, which allows the infection to become subacute. Sometimes if antibiotics are not finished, this can also cause a bacterial sinus infection to come back or not go away.


The symptoms of a bacterial sinus infection are largely the same as any other. Though, some symptoms are more frequently associated with bacterial sinusitis, symptoms alone do not indicate the type of sinus infection present. Some of the symptoms that may occur during a bacterial sinus infection include:

  • Stuffy/runny nose
  • Headaches
  • Fatigue
  • Facial pressure/pain (particularly around the eyes and nose)
  • Decreased smell and taste
  • Discolored nasal leakage
  • Bad breath
  • Fever 
  • Postnasal drip (sometimes causing a sore throat)
  • Coughing
  • Pain in teeth
  • Full feeling and/or pain in the ears

Patients with sinusitis may experience various combinations of these symptoms. Sinus infections do not always present with a fever as well as many of the other symptoms. Generally, though, patients can expect to be congested and experience some sort of nasal drainage.

Types Of Sinusitis

Inflammation of the sinuses can have multiple causes. When it comes to sinus infections, there are three types: bacterial, viral, and fungal.


A bacterial sinus infection is caused by bacteria infiltrating the sinus cavities. Around 70% of bacterial sinusitis cases in healthy patients will clear up without antibiotics. However, this is only in patients with a healthy immune system and when the infection is fairly mild. In the other 30% of bacterial sinus infections, antibiotics usually clear up the infection.

Bacterial sinusitis is usually caused by bacteria that already live in the body. Often, a viral infection such as the cold or flu, conditions like asthma, or other variables may cause a person to become more susceptible to a bacterial infection. Next, they may even help move the bacteria into the sinus cavities where it eventually causes the infection.


The most common cause of sinusitis is viruses. Various viruses can cause sinus infections including flu viruses and those that cause the cold. When these viruses get into the sinuses, this can result in a sinus infection. Normally, a viral infection will run its course and clear up within two weeks. Though many patients begin feeling better in a week or so.

Home remedies and overall taking care of yourself are the best ways to treat a viral sinus infection. While it generally clears up quickly, viral infections can last longer and become a chronic problem. In these cases, aspects of your anatomy or health may contribute. Though, Dr. Santos can determine this during an exam.


The rarest–and potentially most dangerous type of sinus infection–is fungal sinusitis. Some fungi irritate like bacteria or a virus would and clears up either on their own or with anti-fungal medications. Certain cases of fungal sinusitis are what are known as “invasive fungal sinusitis”. This type of infection requires immediate care and often surgery to treat. This type of sinusitis is rare in the United States and almost unheard of in the Pacific Northwest. The majority of cases occur in the Southeastern United States.

Some fungal sinus infections are associated with more severe symptoms, though this is not always the case. Since this type of sinus infection is much rarer, it does have a chance of becoming chronic.

Identifying Bacterial Sinusitis

Viral and bacterial sinusitis often carry the same symptoms and are nearly indistinguishable, the main way to tell the difference is how long symptoms last. As previously discussed, viral sinusitis should clear up in two weeks. Bacterial sinusitis will not. If your symptoms do not improve or resolve in two weeks, you will likely need antibiotics to treat a bacterial infection.

There are ways to test for bacteria in the sinus cavities to identify bacterial sinusitis. However, these tests are generally not warranted and too invasive given the severity of symptoms. The only time your doctor may perform one of these tests is if you have particularly severe symptoms or if your sinusitis becomes chronic.

Treating Bacterial Sinusitis

Bacterial sinusitis seldom requires invasive treatment. Typically, a combination of home remedies and prescribed medications should adequately treat a bacterial sinusitis infection. If they do not, more invasive methods may be considered. The two most common treatments for bacterial sinus infection are antibiotics and sinus surgery.


Once it is clear that you likely have a bacterial infection, your doctor will likely prescribe antibiotics. The exact medication will vary based upon your provider, allergies, and medical history. Generally, patients begin feeling better within two to three days of beginning antibiotics. Then, usually are completely free of the infection in one to two weeks.

Sinus Surgery

On rare occasions, a bacterial infection may not respond to antibiotic therapies or may continue to recur. In these cases, there may be other factors contributing to their infection that may require sinus surgery. This is usually a last resort. 

Dr. Santos can evaluate your need for sinus surgery and the ideal surgical technique. With over thirty years of experience, Dr. Santos is an expert sinus surgeon and among the best in Seattle. He is the ideal otolaryngologist to address your sinus problems.

Viral vs. Bacterial Sinusitis

As previously mentioned, viral and bacterial sinusitis have similar symptoms. However, many patients want to know which type of infection they have because bacterial sinusitis can cause complications. Unfortunately, the best way doctors currently have to distinguish between them is the amount of time it takes for symptoms to improve or resolve. Although, with bacterial sinusitis, if symptoms fail to get better after a week or resolve in two, doctors usually try antibiotics.

Sometimes, subtle differences in symptoms can give you clues into whether you have a viral or bacterial infection. However, viral sinusitis can also last longer on occasion. There is no definitive way to determine the difference without invasive testing or unnecessary procedures. Let’s look at some of the known and purported differences between viral and bacterial sinusitis.

Viral Bacterial
  • Symptoms will resolve often without medical intervention
  • Improvement in severity of symptoms within one week
  • Lower grade fever, sometimes not present
  • Facial pain and headaches can occur, though usually mild and short lived
  • After a few days, new symptoms usually do not occur before they start getting better
  • Infection will not fully resolve without antibiotics
  • Symptoms do not improve on their own
  • Fever is often higher and more persistent
  • May be more likely to cause facial pain and involve worse headaches
  • New symptoms may appear days or a week into the illness and do not get better


These subtle differences do not present for every patient. Conversely, it also does not necessarily mean that you have one type over the other. Ultimately, the only way to tell is through a nasal swab or simply by waiting out the symptoms.

Frequently Asked Questions


How Serious Is A Bacterial Sinus Infection?

Generally, a bacterial sinus infection is no more serious than a viral sinus infection. However, unlike a viral infection, a bacterial infection is less likely to clear up without treatment. If you do not receive the proper treatment, a bacterial sinus infection can spread and become much more serious. While these complications are rare, bacterial sinus infections may require treatment to avoid becoming more serious.

What Are Some Home Remedies?

Sinus infections–even when needing antibiotics–can benefit from home remedies to help alleviate uncomfortable symptoms. Many of the remedies that are recommended for viral sinus infections can treat the symptoms of a bacterial infection. Some of these home remedies include:

  • Nasal irrigation
  • Humidifiers
  • Warm compresses
  • Drink lots of water
  • Nasal sprays (over-the-counter or prescription)
  • Get plenty of sleep

When Will I Start Feeling Better With Bacterial Sinusitis?

It depends. Some minor bacterial infections may clear up without treatment. If you require antibiotics, generally, patients begin to feel better within a few days of starting antibiotics. Usually, after a week, patients will feel back to normal.

Can Bacterial Infections Cause Chronic Sinusitis?

Yes, bacterial sinusitis can cause chronic sinusitis. While one single bacterial infection is unlikely to become chronic, the effects of a bacterial sinus infection can worsen, prolong, or make you more susceptible to chronic sinus infections. 

During sinus surgery for chronic sinusitis, it is not uncommon to find some bacteria in the sinuses that contribute to inflammation. Though, this does not always mean that there has been one continuous bacterial infection.

When Should You See An ENT About Sinus Problems?

Deciding to see an Ear, Nose, and Throat doctor often comes with a referral from a primary care physician. However, there are times when you should seek out ENT specialists. Usually, you do not need to see an ENT for a routine sinus infection, but you may consider ENT care if:

  • Sinus infections become recurrent
  • Symptoms are severe
  • Chronic sinusitis develops
  • It is believed your infection has spread, is invasive, or otherwise higher risk than an average sinus infection
  • You have a referral
  • Sinus surgery is necessary
  • Require nasal polyp removal
  • Have a deviated septum that needs treatment

The Best ENT In Seattle, Burien, And Renton

Dr. David Santos is an otolaryngologist with over thirty years of experience in treating sinus disorders and performing sinus surgery. He served as the Chief of Staff at Valley Hospital for eight years and has performed hundreds of successful sinus procedures. Dr. Santos is a highly regarded sinus surgeon who caters his technique and surgical approach to each individual patient. 

The Sinusitis In Seattle facility is located just south of Seattle in Burien, WA. Easily accessible from the freeway, Sinusitis In Seattle serves the Greater Seattle area. Dr. Santos is proud to provide the best sinus surgery and treatment for bacterial sinusitis in Seattle, Burien, and Renton.

To learn more and schedule an appointment with Dr. Santos, call us at 206-242-3696. You can also reach out online via our contact form.

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