While many people confuse the symptoms of a cold with having sinus disease, it does make some sense because acute sinusitis is often preceded by having a cold. If your cold symptoms last longer than ten to fourteen days, you are probably developing a sinus infection. Occasionally, sinusitis follows an allergic flare-up. Take, for example, my patient Benson, who every spring and fall begins with his typical allergy symptoms of sneezing and watery eyes, which require a short course of allergy medications for relief. However, during one season, this progressed to severe headaches, thick, yellow drainage and fevers, which only cleared after three weeks of antibiotics for what had become a sinus infection. Sometimes, sinusitis can occur without a prior cold or allergy attack.

Early in the course of an acute sinus attack, there is nasal blockage and congestion, excessive mucus in the nose and throat, sneezing (especially when there is an allergic component), and some malaise and fatigue. If fever is present, it is usually low-grade. The presence of facial pain or headache suggests that a sinus infection is developing. If the symptoms of a common cold last more than a week, you should begin to suspect a sinus infection. Fever may elevate, and mucus in the nose and throat may become thicker and discolored, usually yellow or green. The postnasal drip will cause throat discomfort, occasional hoarseness, and often a cough. Cough from the postnasal drainage of sinusitis tends to be worse in the morning and at night, as mucus trickles into the windpipe or bronchial tubes. Although my four-year-old son, Sam, was unable to tell me about the postnasal drip he was experiencing last fall, I knew he had a sinus infection, since every night he would begin with a wet, productive cough from the phlegm dripping into his throat when he was in bed. Once I gave him an antibiotic for the sinus infection, the cough stopped. With an acute sinus infection, there may be a feeling of ear blockage. Sinus infection may also lead to swelling of the glands (also known as the lymph nodes) in the neck.

Acute sinusitis is often recognized by pain and tenderness of the sinuses or by facial pressure. This facial pain is probably the most bothersome symptom, and usually brings those with a sinus infection to my office for help. Remember that most people have four sets of sinuses: Maxillary, ethmoid, frontal, and sphenoid. Each sinus -- or group of sinuses in the case of the ethmoids -- is represented on the right and left side of the head. These tend to cause symptoms of pain in different locations of the face. Maxillary sinusitis causes pain in the mid-face (below the eyes), cheek, or upper teeth. This dental pain may cause confusion; I have even seen patients who had extensive dental work done on their upper teeth for what was really a maxillary sinus infection. Some have even had teeth pulled! More often, however, I see the patient with tooth pain who brings dental x-rays showing that he actually has a maxillary sinus infection. Ethmoid sinus infection triggers pain between the eyes, near the bridge of the nose. Frontal sinusitis usually causes forehead pain. Pain behind the eyes or at the back of the head may indicate sphenoid sinusitis. Table 3.1 will help you figure out which sinuses are involved in your infection, based on the location of your symptoms.