Sinusitis, or a sinus infection, will afflict everyone at some point. Though, for 11% of the adult population in the United States, sinus problems become chronic. Chronic sinus issues usually start with typical sinus infection symptoms. By the time it becomes chronic, it is not always clear what is causing the chronic issues. Determining the cause of your sinus problems will allow for more effective treatment. Dr. David Santos of Sinusitis In Seattle can help find the cause of your sinusitis. Let’s look at the most common cause of sinus issues: viral sinusitis.


Sinusitis is an illness that causes dysfunction of the sinus. The sinus cavities then become filled with fluid–usually mucus–and inflamed. Generally, it is not a serious condition and will resolve without major treatment within two weeks. More commonly, this is known as a sinus infection. They occur just as frequently (and are often mistaken for) the common cold.

However, in some situations, the inflammation and symptoms may last longer than two weeks. Even when this happens, most cases will go away with antibiotics and basic treatment. For a small number of people every year, symptoms become chronic and last at least three months.

While sinusitis rarely causes major issues, constant, chronic sinusitis symptoms can begin to interfere with daily life and activities. It lowers quality of life, may cause headaches, and can even influence productivity. Once sinusitis interferes with your life and/or becomes chronic, it is likely time to see a sinus specialist like Dr. Santos.

Causes Of Sinusitis

Several factors can make a person more susceptible to developing sinus infections. For instance, allergies, nasal polyps, a deviated septum, and even the structure of the nose and sinuses can contribute. However, on the biological and microscopic level, there are three causes of sinusitis: viruses, bacteria, and fungi.


  • Viral: Viruses are the most common cause of sinus infections. Similar to colds and the flu, viruses tend to run their course in about two weeks. Symptoms also should improve within five to seven days. Antibiotics do not have any effect on viruses. Generally, patients are advised to drink plenty of water, rest, and allow it to run it’s course. It should resolve within two weeks.

  •  Bacterial: Caused by bacteria, bacterial sinusitis has nearly identical symptoms to viral sinusitis. The main way doctors differentiate them is when symptoms do not begin to improve symptoms last more than two weeks. Bacterial sinus infections are generally treated with antibiotics and resolve soon after the medication is started. Though, due to misdiagnosis and other factors, bacterial sinus infections do account for many subacute sinusitis cases.

  • Fungal: Fungal sinusitis comes in many forms. Overall, it is the rarest type of sinusitis. The one seen most in the United States is an allergic response to fungus in their home or environment. In this case, the fungus does not necessarily infiltrate their sinuses. If a fungus does get into the sinuses, it then presents either as a non-invasive or invasive infection. In most cases, the best treatment for fungal sinusitis is surgery.


Whether your sinusitis is caused by a virus, bacteria, or fungus, they typically have similar symptoms. Though, some occur more frequently or severely depending on the cause. With viral sinusitis, the main difference is that symptoms should start improving within a week, if not sooner. The symptoms of viral sinusitis can include:

  • Congestion
  • Postnasal drip
  • Runny nose
  • Headaches
  • Cough
  • Sore throat
  • Fever

The severity of symptoms can range based on if only one sinus cavity is infected or multiple. In those with autoimmune diseases or susceptible to sinus infections, symptoms may present more seriously. Still, viral sinusitis is rarely serious and can usually be managed with over-the-counter medications and home remedies.


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. 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.


Patients sometimes become frustrated when not given antibiotics for a sinus infection. However, since most cases are viral infections, the antibiotics would have no effect and may cause side effects. So, what can you do for a viral sinus infection?

Rest & Recovery

The first thing you can do to ease symptoms is to rest and take care of yourself. Get plenty of sleep, drink lots of water, and call in sick to work. While not a serious infection, you will likely feel better faster if you let yourself rest.

Decongestants & Medication

Over-the-counter decongestants and pain relievers can ease symptoms and make them easier to get through. While they will not cure it, they usually adequately treat the symptoms. Combined with enough rest, this often gets people feeling better. Sometimes you may be prescribed or recommended a nose spray.

Sinus Irrigation

If your congestion is especially bad, your doctor may instruct you to rinse out your nasal cavity and sinuses. This is done using one of the various tools including a neti pot or pre-prepared bottles. Sinus irrigation flushes out mucus and can relieve facial pain, runny nose, and other symptoms. It is usually done once a day or so during an active infection.

Home Remedies

Countless home remedies have been shown to improve sinusitis symptoms. Just a few include:

  • Use a humidifier
  • Steam
  • Warm compresses
  • Eat well
  • Spicy food
  • Elevate head while sleeping

Sinus Surgery

In extreme cases, viral sinusitis can become chronic or recurrent. It is not always clear what causes chronic sinusitis, especially when symptoms do not get better or respond to antibiotics. When this happens, sinus surgery may be the best solution. Dr. Santos–an otolaryngologist with three decades of experience–performs non-invasive sinus surgery to relieve long term chronic sinusitis, including viral sinusitis.

The three procedures most commonly used for sinus surgery include:


What Virus Causes Viral Sinusitis?

Many viruses can cause a sinus infection. Among the viruses that most frequently cause sinusitis are those that also cause the common cold. It is not uncommon to see a cold form into a sinus infection. Some of the viruses that can cause sinusitis include:

  • Rhinoviruses (cause of the common cold)
  • Influenza viruses (cause of the flu)
  • Parainfluenza viruses (cause of various illnesses like severe colds and bronchitis)

Can A Viral Sinus Infection Last For Weeks?

It can, though it is not common. The vast majority of viral sinus infections will go away in two weeks or less. It is possible to get recurrent viral sinus infections that may occur back to back. Though, occasionally, viral sinusitis can become chronic. 

It is important to note that in most cases of chronic sinusitis, there are multiple factors at play. For example, a deviated septum can make you more susceptible to infection, or nasal polyps may be permanently obstructing your sinuses.

Is It Contagious?

Yes, most forms of viral sinusitis are contagious. Much like the cold or the flu, if you contract one of these viruses and it spreads to the sinuses, it can cause a sinus infection.

When Do I Need Surgery For Viral Sinusitis?

The line for when a patient considers surgery is different for everyone. In a medical sense, if Dr. Santos determines that nasal polyps, a deviated septum, or other structures are contributing to recurrent or chronic sinusitis, surgery is likely warranted. Otherwise, if patients are not finding adequate relief from symptoms, they may look to surgery.

How Can I Tell If I Have Viral vs. Other Types Of Sinusitis?

You can’t. A deep nasal swab can be used to determine the type of sinusitis you have. Nonetheless, this is not warranted in most situations and just causes discomfort. The best way to tell is to wait it out and see how long symptoms last, how severe they are, and what treatments they respond to. This is the best way to determine whether you have viral sinusitis or another type of sinus infection.


Dr. David Santos is a Seattle sinus surgeon with thirty years of experience as a sinus surgeon. With board certifications in both otolaryngology and facial plastic surgery, his knowledge of the facial structure goes beyond the sinuses. He treats a variety of sinus related problems including polyps, sinusitis, and deviated septums. 

Using the newest advancements in sinus surgery, Dr. Santos offers the best non-invasive sinus surgery in Seattle. He uses all major techniques such as balloon sinuplasty, endoscopic surgery, and image guided sinus surgery.

To schedule a consultation with Dr. David Santos at Sinusitis In Seattle, call us at 206-242-3696. You can also connect with us online using our contact form or via email.

Contact Us