Sinusitis vs common cold: telling facial pain from a cold

If you have a runny or blocked nose, sneezing, a sore throat and a cough that came on gradually over a couple of days, it is most likely a cold. If, on top of the blocked nose, you have pain or tenderness around the cheeks, eyes or forehead, a reduced sense of smell and thick yellow or green mucus, sinusitis is more likely. The two are not rivals: the NHS says sinusitis is common after a cold or flu, so a cold can be the start of it.

The practical difference is mostly where the symptoms sit and how long they last. A cold affects mainly the nose and throat and settles within about 1 to 2 weeks. Sinusitis involves the air-filled spaces behind the cheekbones and forehead, and can drag on for up to 4 weeks, sometimes needing medicine to help.

A cold is an infection by a virus that affects the nose and throat. The NHS says symptoms come on gradually over 2 to 3 days and include a blocked or runny nose, sneezing, a sore throat, a hoarse voice, a cough and feeling tired and unwell. You may also have a high temperature, aching muscles, a loss of taste and smell, and a feeling of pressure in your ears and face. You are infectious until all symptoms have gone, which the NHS says usually takes 1 to 2 weeks.

The sinuses are small empty spaces behind the cheekbones and forehead that connect to the inside of the nose. The NHS explains that sinusitis makes the lining of the sinuses swell, which stops mucus draining into the nose and throat properly and leaves you feeling blocked up. It is usually caused by an infection and is common after a cold or flu.

Pressure in the face appears in the NHS cold list, so it does not settle the question by itself. What counts is the combination, the intensity and the time course.

The NHS cold advice gives clues that a simple cold is not behaving as expected. It says to see a GP if your cold symptoms get worse, do not get better after 10 days, you have a high temperature for more than 3 days, or you feel short of breath or have chest pain. A cold that is dragging on with a new sore face and thick coloured mucus is the pattern in which sinusitis is considered.

The NHS sinusitis page also mentions symptoms that are not typical of a cold: toothache, bad breath, a feeling of pressure in the ears, snoring at night and sounding nasal when you speak. Young children may be irritable, have difficulty feeding and breathe through their mouth. If your symptoms mainly affect one side of the face only, the NHS says that is a reason a GP might refer you to an ear, nose and throat (ENT) specialist if it persists.

There is no cure for a cold, and the NHS says antibiotics will not relieve symptoms or speed recovery because colds are caused by viruses. It suggests rest, plenty of fluids, a hot lemon and honey drink (not honey for children under 12 months), a salt water gargle for adults, steam from a hot shower and paracetamol or ibuprofen for aches and a temperature. Decongestant nasal sprays should not be used for more than a week as this can make symptoms worse, and decongestants should not be used by children under 6.

Mild sinusitis can be treated in a similar way, with rest, fluids, painkillers, avoiding allergy triggers, not smoking and cleaning the nose with a salt water solution. The NHS gives a recipe for this using boiled and cooled water, salt and bicarbonate of soda, repeated up to 3 times a day. A pharmacist can give the same treatments as a GP for sinusitis in people aged 12 and over. If treatment is needed, this may include steroid nasal sprays or drops, which can be used for a few months, and antihistamines if an allergy is causing symptoms. Antibiotics are rarely needed.

For sinusitis, the NHS says to see a GP if you do not get better after 7 days of treatment from a pharmacy or GP, if you do not get better after 3 weeks of treating symptoms yourself, if you keep getting sinusitis, or if the person is a child aged 11 or younger. Ask for an urgent GP appointment or call NHS 111 if you are very unwell, painkillers do not help or symptoms get worse, or you have a weakened immune system, for example because of chemotherapy. Call 111 for advice about a child under 5.

A GP may refer you to an ENT specialist if you still have sinusitis after 3 months of treatment, keep getting it or only have symptoms on one side of the face. Surgery for chronic sinusitis is called functional endoscopic sinus surgery (FESS) and is carried out under general anaesthetic.