Sinus Infection Won't Go Away: What to Do

How long is too long for a sinus infection to last?

The timeline helps clarify what type of sinusitis you are dealing with 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Classification of sinusitis by duration (acute/subacute/chronic/recurrent); first-line medical management: saline irrigation, intranasal corticosteroids, and targeted antibiotics for bacterial acute sinusitis:

• Acute sinusitis: symptoms lasting up to 4 weeks. Most viral cases resolve within 7–10 days. Bacterial acute sinusitis is diagnosed when symptoms are severe from the start, worsen after initial improvement, or persist beyond 10 days without getting better.
• Subacute sinusitis: symptoms lasting 4–12 weeks
• Chronic rhinosinusitis (CRS): symptoms lasting 12 weeks or more, despite treatment — characterized by nasal congestion, facial pressure or fullness, reduced sense of smell, and often thick nasal discharge
• Recurrent acute sinusitis: 4 or more acute episodes per year with clear symptom-free intervals between them

If you are still symptomatic at the 10-day mark and not improving, or if this is your third or fourth infection in a year, it is time to see a clinician rather than wait it out.

Why do some sinus infections keep coming back?

Recurring infections usually point to an underlying factor that is not being addressed. Common reasons include:

• Anatomical factors: a deviated nasal septum, nasal polyps, or narrowed sinus drainage pathways that obstruct mucus flow and create an environment where bacteria grow more easily
• Allergic rhinitis: uncontrolled allergies cause chronic inflammation and swelling of the nasal lining, narrowing the same drainage pathways 2Ref 2Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. (2015).Clinical Practice Guideline: Allergic Rhinitis.Allergic rhinitis as a driver of recurrent sinusitis through chronic nasal inflammation obstructing sinus drainage; treatment of underlying allergies reduces sinus disease burden
• Inadequate treatment: stopping antibiotics early, treating with the wrong antibiotic for the specific bacteria involved, or taking antibiotics for viral infections (which they do not treat)
• Environmental exposures: cigarette smoke, dry air, occupational dust or chemical exposure — all irritate the nasal and sinus mucosa chronically
• Immune system factors: people with reduced immune function are more susceptible to recurrent respiratory infections
• Dental infection: the roots of upper back teeth sit close to the maxillary sinuses; an infected tooth can directly cause or perpetuate maxillary sinusitis

What does treatment for chronic or recurring sinusitis involve?

The AAO-HNS Adult Sinusitis Guideline emphasizes that treatment should be matched to the type and likely cause of sinusitis rather than automatically reaching for antibiotics 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Classification of sinusitis by duration (acute/subacute/chronic/recurrent); first-line medical management: saline irrigation, intranasal corticosteroids, and targeted antibiotics for bacterial acute sinusitis.

For most cases — whether acute, chronic, or recurrent — the evidence supports starting with:

• Nasal saline irrigation (see the article on nasal rinse technique) to remove mucus and allergens and reduce inflammation — this simple step has good evidence for improving sinus symptoms 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Classification of sinusitis by duration (acute/subacute/chronic/recurrent); first-line medical management: saline irrigation, intranasal corticosteroids, and targeted antibiotics for bacterial acute sinusitis
• Intranasal corticosteroid sprays — prescribed or OTC (fluticasone, mometasone, budesonide) — to reduce mucosal inflammation; these are a cornerstone of CRS management
• Treating underlying allergies — antihistamines, allergen avoidance, and potentially immunotherapy if allergic rhinitis is a major driver 2Ref 2Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. (2015).Clinical Practice Guideline: Allergic Rhinitis.Allergic rhinitis as a driver of recurrent sinusitis through chronic nasal inflammation obstructing sinus drainage; treatment of underlying allergies reduces sinus disease burden

Antibiotics are appropriate for bacterial acute sinusitis (not viral), typically a 5–7 day course of amoxicillin-clavulanate per current guidelines 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Classification of sinusitis by duration (acute/subacute/chronic/recurrent); first-line medical management: saline irrigation, intranasal corticosteroids, and targeted antibiotics for bacterial acute sinusitis. If symptoms genuinely do not improve, your clinician may consider culturing nasal discharge to identify the specific bacteria and its antibiotic sensitivities.

For chronic or anatomically-driven sinusitis, an ENT (otolaryngologist) evaluation is often the most productive next step. They can perform nasal endoscopy to directly visualize the sinuses and determine whether structural issues — polyps, obstruction, septal deviation — are contributing. Functional endoscopic sinus surgery (FESS) is effective for select patients with CRS who have not responded to adequate medical therapy.

What can I do at home that actually helps?

Several self-care measures have genuine evidence supporting their role in managing sinusitis:

• Saline nasal irrigation (neti pot or squeeze bottle) once or twice daily reduces mucus, clears allergens, and improves sinus drainage 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Classification of sinusitis by duration (acute/subacute/chronic/recurrent); first-line medical management: saline irrigation, intranasal corticosteroids, and targeted antibiotics for bacterial acute sinusitis
• Nasal corticosteroid sprays — available OTC — reduce inflammation; they take several days to reach full effect
• Staying well hydrated helps mucus remain thin enough to drain
• Humidifying dry indoor air during winter heating season reduces mucosal irritation
• Elevating the head during sleep can improve drainage and reduce overnight congestion
• Avoiding cigarette smoke and secondhand smoke — smoke significantly impairs the cilia that clear mucus from the sinuses

Over-the-counter oral decongestants (pseudoephedrine) can relieve pressure short-term but are not recommended for more than a few days; nasal decongestant sprays (oxymetazoline) cause rebound congestion if used more than 3 consecutive days and should be used sparingly.

When should I see a doctor versus an ENT specialist?

See your primary care clinician if: - Symptoms have lasted more than 10 days without improving - You have fever and worsening facial pain or swelling - You have had more than 2 or 3 sinus infections in the past year

Ask for an ENT referral if: - Chronic symptoms persist despite appropriate medical treatment (nasal steroids, saline rinses) - Imaging or endoscopy is needed to understand the anatomy - You may have nasal polyps - Surgery is being considered

A Gale primary care clinician can evaluate your sinus history, assess whether antibiotics are appropriate, start you on evidence-based medical management, and refer you to an ENT if the picture warrants it. 3Ref 3Centers for Disease Control and Prevention (2025).Antibiotic Use and Stewardship in the United States, 2025 Update: Progress and Opportunities.Most sinusitis is viral and resolves without antibiotics; CDC antibiotic stewardship guidance underpins antibiotic-sparing recommendations for acute sinusitis