Ever wake up with a sore throat, and then notice the nasal congestion and sneezing? How do you know when it’s a cold, allergy, or sinus infection?
So you’re not feeling your best. The symptom list can include a sore or scratchy throat, throat clearing, hoarseness, cough, wheezing, post-nasal drip, headaches, ear congestion, and a runny nose that can extend the gamut from clear to yellow-green to even bloody . . . get the picture? Any and all of these symptoms can be seen in patients with the common cold, allergy or sinus. The real way to understand what is happening is to look at it over time.
A cold, or what we doctors call an upper respiratory infection, often starts with one symptom, say a scratchy throat, and then morphs into a series of different symptoms. During these viral infections, cilia (the tiny hairs that coat the lining from the nose to the lungs) stop functioning. We get sick for up to 7 days. As the cilia return function, we produce all sorts of colored stuff that we either blow out of our nose or cough out from our lungs and throat. In most cases, we get better without medications.
Allergy is a rapid brief inflammatory response. The target tissues swell and itch, and those cilia again stop functioning. If the allergen disappears or we take an antihistamine, the swelling resolves and the cilia recover. So allergy symptoms come and go repeatedly over several weeks, characteristically with good days and bad.
Sinusitis and pneumonia are complications of allergy or upper respiratory infections that do not resolve after 7 to 10 days, and that’s when antibiotics are helpful. Take the antibiotics too early, and you kill the good bacteria leaving only the resistant ones to get you really sick.
– Dr. Steven Levine of ENT and Allergy Associates in Trumbull
Dr. Levine,
I came across your blog while researching ENT’s. I often wonder this exact thing whenever I get a sore throat or feel under the weather. It’s difficult to discern sometimes what it actually is.
So for sinusitis, are you saying you should not take antibiotics until after you have had symptoms for 7-10 days? I often find I have a tough time getting rid of sinus infections and wine seems to make them worse, at least in the cold weather months.
Regards,
Matthew
Matthew, most viral infections resolve without antibiotics but can take 7-10 days to do so. If towards the end of that period you start getting worse, then antibiotics may be reasonable. Taking an antibiotic too soon wipes out the easy bacteria leaving the resistant ones to get you really sick. Dr L