Sinusitis vs. COVID: How to Tell the Difference

By Sarah Malka, MD
Medically reviewed
September 1, 2021

Stuffy nose, headache, sore throat?

It’s easy to jump to conclusions, especially during a pandemic. Many of the symptoms of COVID-19 are actually similar to those of other illnesses, like a sinus infection, also known as sinusitis.

In this article, I’ll discuss the difference between sinusitis and COVID-19, the symptoms of each, how they’re diagnosed, and next steps if you are infected with either condition.

Is it Sinusitis or COVID-19?

While they can present with similar symptoms, sinusitis and COVID-19 are very different illnesses.

Sinusitis is the inflammation of your sinus cavities, the air-filled cavities around your face and nose.

There are different types of sinus infections, including bacterial infections, chronic sinusitis, recurrent sinus infections, and acute infections, which are usually viral—these viral sinus infections are the most common.

Conditions like allergies and the common cold can cause sinus infection symptoms, or lead to bacterial sinusitis in some cases.

COVID-19 is an infectious disease affecting the respiratory tract caused by a new type of coronavirus, also called a novel coronavirus. It is highly contagious, and can easily spread through droplet particles in the air. 

Symptoms of Sinusitis

Symptoms of a sinus infection are often similar to those of a common cold, with some specific additional symptoms.

Common symptoms include: 

  • Postnasal drip
  • Congestion
  • Facial pain or swelling in the sinus area (on your cheeks and forehead)
  • Fever
  • Yellow or green nasal discharge
  • Nasal congestion or stuffy nose
  • Sneezing
  • Sore throat
  • Toothache
  • Bad breath
  • Cough
  • Fatigue

Symptoms of COVID-19

Symptoms of COVID-19 can show up gradually following an exposure and infection.

Common symptoms include: 

  • Fever or chills
  • Dry cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Symptoms Unique to COVID-19 

While some symptoms overlap, COVID-19 has a few unique symptoms.

One might experience skin rashes that may occur on your finger and toes, including swelling and discoloration.

It’s estimated that between 1-3% of people will get conjunctivitis, also known as pink eye, with COVID-19.

In some older people, confusion or delirium may be their only COVID-19 symptom. Some people with COVID-19 may also lose their sense of smell and taste.

Thick nasal discharge and significant sinus and facial pain are less common with COVID-19, but can occur.

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Diagnosis

Sinus infection

To diagnose a sinus infection, your health care provider will perform a physical examination and analysis of your symptoms.

They’ll determine if you’re experiencing inflammation of the sinuses. Sinus infections can be caused by allergens, by having a cold or the flu, or nasal polyps.

Your healthcare provider will keep this in mind when diagnosing your condition. 

COVID-19

In order to diagnose COVID-19, you will need to get a test.

This test is performed using a nasal swab to collect specimens, and is widely available

Treatment

Sinus Infection

Without the use of antibiotics or other prescription treatments, close to 50% of all sinus infections improve within a week, and 70% resolve within two weeks.

There are effective home remedies and over-the-counter treatments to help with the symptoms.

Staying hydrated will help clear congestion and loosen mucus. Get rest and help your body heal. Over-the-counter analgesics like ibuprofen and acetaminophen can help with sinus pressure and pain. 

Over-the-counter nasal decongestant and antihistamines can provide short-term relief of sinus infection symptoms, and help the infection resolve.

Afrin (oxymetazoline) can be used twice a day for three days, and Flonase (fluticasone), as well as oral antihistamines ,can be used as long as there are symptoms.

Guaifenesin, found in Mucinex, can also help thin mucus and reduce congestion and cough.

In rare cases, when symptoms are severe and worsening after 10-14 days, antibiotics may be needed, but they are of no use in early illness or mild illness.

If your symptoms get worse or are not improving after 10-14 days, talk to a healthcare provider. 

COVID-19 

If you are experiencing a COVID-19 infection, the Centers for Disease Control and Prevention advises that you stay home, except to seek medical treatment, to prevent the spread of the virus.

If you are experiencing a fever, you can take medications like acetaminophen or ibuprofen to reduce it.

Drink water to stay hydrated, and get plenty of rest to fight off the virus. Over-the-counter cough and cold medications are safe to try. 

Some studies suggest that vitamin D, zinc, and vitamin C may be helpful in fighting off the infection.

Some advertised treatments, like Ivermectin and hydroxychloroquine, have been well-studied and have not been shown to have any effect on treating COVID-19 in high-quality studies.

These can also have dangerous side effects, and are not helpful or recommended. 

Monoclonal antibody treatment may be used for COVID-19 for those with underlying health conditions that put them at higher risk for severe disease.

Speak with your healthcare provider if you have any underlying risk factors that may qualify you for this treatment.

Complications

Sinus Infection 

In almost all cases, sinus infections will go away with no lasting effects, but if worsening bacterial sinusitis is left untreated, there can be rare but serious complications.

A sinus infection can spread to the eyes, causing a serious infection that requires antibiotic treatment and possibly medical imaging.

Infectious sinusitis can also, uncommonly, lead to meningitis, or osteomyelitis, an infection to the bones. 

COVID-19

The long-term complications of COVID-19 are still largely unknown, but you should seek medical advice if you experience trouble breathing, chest pain or pressure in the chest, or if you’re unable to wake or stay awake.

Those with a weakened immune system are at greater risk of complications from the virus, which may include pneumonia, organ failure, heart problems, lung conditions, blood clots, and acute kidney injury.

The best way to avoid serious COVID complications is to get a COVID-19 vaccine. Vaccination will provide you with antibodies that can help fight off COVID-19 and prevent severe disease and complications. 

How K Health Can Help

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Sarah Malka, MD

Dr. Sarah Malka is a board certified emergency medicine physician with K Health. She completed her residency at Harvard Medical School.