These are plain-language answers to the questions patients ask most often about sinus and nasal problems. They are general patient education, not personal medical advice. If something here matches your situation but does not feel right, talk with your doctor — and the answers below include guidance on when to do that.
Reviewed by Peter Casano, MD, on May 1, 2026.
When the sinuses are inflamed or full of fluid, lowering your head increases pressure inside them. This is one of the more reliable signs that the pain is actually coming from the sinuses and not from another source like a tension headache or migraine. If bending over does not change the pain, the cause may be something other than the sinuses.
True sinus headache usually comes with other sinus symptoms — congestion, drainage, or a head cold — and the pain often gets worse when you bend forward. Migraines often come with sensitivity to light or sound, nausea, and a one-sided throbbing quality, and they usually do not have nasal symptoms with them. Many people who think they have sinus headaches actually have migraines, which is why a careful evaluation matters.
Sinus pain is usually felt in the cheeks, between the eyes, in the forehead, or in the upper teeth. It can also be felt as a deep ache behind the eyes. Pain at the back of the head can come from the sphenoid sinus, which sits deeper in the skull.
Yes. The roots of the upper back teeth sit very close to the floor of the cheek (maxillary) sinus. When that sinus is inflamed or infected, the pressure can feel like a toothache. If a dentist cannot find a dental cause for upper-tooth pain, a sinus problem is worth considering.
Most short-term sinus infections that follow a cold last seven to ten days and improve on their own. Symptoms that last longer than ten days, or that get clearly worse after starting to improve, may point to a bacterial infection that benefits from antibiotics. Symptoms that drag on for more than twelve weeks suggest a chronic problem that should be evaluated.
Most sinus infections are viral and get better on their own in a week to ten days. A bacterial infection is more likely if symptoms last beyond ten days without improvement, if you start to get better and then suddenly get much worse, or if you have a high fever along with severe one-sided pain. Mucus color alone is not a reliable signal — green or yellow mucus can occur with both.
Antibiotics are usually reserved for sinus infections that have lasted longer than ten days without improvement, that have gotten markedly worse after initial improvement, or that come with severe pain and fever. Most short-term sinus infections do not need antibiotics. Taking them when not needed can cause side effects and can contribute to antibiotic resistance later.
Yes. A common cold causes swelling that can block the small openings the sinuses use to drain. When that happens, fluid backs up and bacteria can grow in it. Most colds clear on their own, but a small percentage develop into bacterial sinus infections that may need treatment.
Not by itself. Mucus changes color as your body fights any kind of infection — including the viral ones that do not need antibiotics. Color alone is not a reliable signal of bacteria. Duration and severity of symptoms matter more.
Chronic sinusitis is sinus inflammation that lasts longer than twelve weeks. Symptoms typically include nasal congestion, drainage, facial pressure, and a reduced sense of smell. It often involves swelling of the lining of the sinuses or polyps, and the underlying cause is usually a mix of infection, inflammation, and structural issues that block normal drainage.
Common reasons include underlying allergies, structural blockage in the natural drainage areas, nasal polyps, environmental triggers like smoke or mold, and sometimes immune-system or genetic conditions. Treating chronic sinusitis well usually means addressing more than one of these factors at the same time.
Endoscopic sinus surgery improves drainage and lets medicated rinses reach the sinus lining, which often gives a big improvement. It is rarely a one-and-done cure, though, because the underlying inflammation usually needs ongoing medical management with sprays or rinses. The combination of surgery plus continued medical treatment is what produces the best long-term results.
Fungal sinusitis covers several different conditions. Most are not dangerous and respond to surgical clearance and ongoing care. One rare form (invasive fungal sinusitis) is a medical emergency that occurs almost exclusively in people with weakened immune systems. The common forms are allergic fungal sinusitis and fungal balls, both of which are treatable but tend to recur if not followed long term.
Allergy symptoms tend to be itchy — itchy nose, eyes, throat — and sneezing is common. Drainage is usually clear and watery. Sinus infections more often bring facial pressure or pain, thicker drainage, and a feeling of being unwell. Allergies last as long as you are exposed to the trigger; sinus infections have a clearer beginning, middle, and end.
Post-nasal drip is mucus draining from the back of the nose into the throat. Everyone has some — it is part of how the nose normally works. It becomes a problem when there is more of it than usual, or when it is thicker than usual. The most common causes are allergies, low-grade chronic sinusitis, reflux, and side effects of medications.
The most common reasons are post-nasal drip and reflux. Either one can leave a steady awareness of mucus or irritation at the back of the throat. Treating the underlying cause — allergies, sinus inflammation, or reflux — usually helps more than cough drops or throat-clearing itself.
Yes, for many people. Allergy shots (immunotherapy) gradually train the immune system to react less to specific allergens. They take months to start working and a few years for the full effect, but they can produce lasting improvement that does not depend on taking daily medication. They are most useful when allergies are clearly identified and significantly affecting daily life.
Sudafed (pseudoephedrine) is a pill that affects the whole body and decongests the nose. Afrin (oxymetazoline) is a spray that works directly in the nose and acts much faster. Afrin works very well for short-term use but should not be used for more than three days in a row, because longer use causes rebound congestion that can be hard to break.
Three days is the standard safe limit. After that, the nose becomes dependent on the spray and gets stuffier when the spray wears off, leading to a cycle that is hard to escape. If you have already gone past three days, the cycle can usually be broken with a steroid nasal spray and a careful taper.
Yes, especially for chronic sinus problems and after sinus surgery. Saline rinses physically wash away mucus, allergens, and irritants, and they help medicated rinses reach the sinus lining. Use distilled, sterile, or previously boiled water — never tap water straight from the faucet.
If you have allergies or chronic nasal inflammation, daily use of a steroid nasal spray is one of the most effective treatments available, and modern sprays are safe for long-term daily use in most people. The benefit builds up over a few weeks, so consistency matters. If you only use it when symptoms flare, it will not work as well.
Modern non-sedating antihistamines (loratadine, cetirizine, fexofenadine) are considered safe for daily long-term use in most adults. The older sedating antihistamines (diphenhydramine, brompheniramine) are best used occasionally, because they can cause drowsiness, dryness, and cognitive effects, especially in older adults.
The septum is the wall down the middle of the nose that separates the left and right sides. A deviated septum is one that is bent or crooked, which can narrow one or both nasal airways. Most people have some degree of deviation; it only needs treatment when it actually causes blocked breathing or other problems.
Turbinates are scroll-shaped structures inside the nose that warm, moisten, and filter the air you breathe. They naturally swell and shrink throughout the day. They become a problem when they stay enlarged long-term — most often from chronic allergies, ongoing inflammation, or as a response to a deviated septum on the opposite side.
A polyp is a soft, teardrop-shaped growth that develops from inflamed sinus or nasal lining. Polyps are not tumors and they are not contagious. They often shrink with steroid medication, and large or stubborn polyps may need to be surgically removed. The underlying cause of polyps usually needs ongoing treatment to keep them from coming back.
Sinus surgery is considered when chronic sinus inflammation does not respond to medical treatment over time, when polyps are blocking the airway or sinus drainage, or when there is structural blockage that medication cannot fix. It is not the first step — it is what gets considered after the right medications, rinses, and time have not been enough.
The surgeon uses a thin tube-like camera (endoscope) to look inside the nose and sinuses through the nostrils — there are no cuts on the face. The natural drainage openings of the sinuses are gently widened, and inflamed tissue or polyps are removed. The surgery is usually outpatient under general anesthesia.
Most patients return to light activity within a few days and to normal activity within a week or two. The inside of the nose continues to heal for several weeks, and saline rinses are usually started within a day or two of surgery to help the healing process. Full benefit from the surgery often takes a few months as the lining recovers and inflammation calms down.
No. Modern endoscopic sinus surgery is done entirely through the nostrils with no incisions on the face. There is no change to the shape of the nose or the appearance of the cheeks or forehead. The exception would be if the surgery was specifically being combined with a cosmetic procedure, which is a different conversation.
Sinus surgery improves drainage and access for medical treatment, but the underlying inflammation can still flare. People with significant allergies, polyp-forming conditions, or aspirin sensitivity are more likely to need revision. Careful follow-up and continued medical management reduce the chances of needing repeat surgery, and revision results have improved markedly with newer techniques.
See your primary doctor when sinus symptoms last longer than ten days without improvement, when they get clearly worse after seeming to improve, when there is high fever with facial pain, or when the same problem keeps coming back. Earlier visits are also reasonable for severe pain or symptoms that disrupt sleep or daily activity.
An ENT (otolaryngologist) is the right doctor when sinus symptoms keep coming back, when chronic symptoms have not responded to treatment, when polyps are suspected, when there has been a previous sinus surgery, or when the diagnosis is unclear. ENT specialists have tools — like in-office endoscopy — that primary doctors do not.
Yes. Get prompt care for any of the following: high fever with severe one-sided facial pain, a forehead or eye area that is red, hot, or markedly swollen, vision changes, severe headache that is different from your usual, mental status changes, or symptoms that follow a known weakened immune system. These can signal complications that need urgent attention.
In most cases yes — most ENT practices accept patients without a referral, though some insurance plans require one. Calling ahead with your insurance information is the easiest way to find out. Many people are surprised to learn that an ENT visit can sometimes cost less than a primary-care visit and can save time when the problem is clearly in the ENT specialist's area.
Common causes include nasal swelling that blocks air from reaching the smell area at the top of the nose, a recent viral infection (including COVID-19), nasal polyps, chronic sinusitis, certain medications, head injury, or aging. Many causes are reversible if treated, especially if the cause is swelling or polyps that can be reduced or removed.
Yes. The same lining that covers the sinuses also lines the eustachian tube, which connects the back of the nose to the middle ear. Inflammation from allergies or sinus problems can cause ear pressure, popping, fullness, or fluid buildup in the middle ear. Treating the underlying nasal or sinus problem often resolves the ear symptoms too.
It can. Rapid changes in barometric pressure, very dry indoor air in winter, and high pollen or mold counts can all worsen symptoms in people who are prone to sinus or allergic problems. Humid coastal regions can also support more mold growth, which is a common allergic trigger. The weather itself does not cause sinus disease, but it can flare an existing tendency.
Yes, though many things in children that look like sinus infections are actually prolonged colds. Children's sinuses develop over years — the cheek and ethmoid sinuses are present from birth, while the forehead sinuses develop later in childhood. True bacterial sinus infections in children are diagnosed by symptoms that last longer than ten days, that are unusually severe, or that worsen after initial improvement.
If you have a question that is not on this list and you think other patients would benefit from the answer, you can send it to info@petercasano.com. Questions about your own care should be directed to your physician.