woman sitting outside and blowing her nose because sinus infection season

Louisville is consistently ranked in the top three worst cities for allergy sufferers. With the weather drastically changing, this can lead to a spike in allergy and sinus symptoms. Ultimately, inflammation is the cause of these symptoms, but when do you need an antibiotic or even systemic steroids? It can be difficult to diagnose a sinus infection versus allergy exacerbation in these conditions.

Allergic Rhinitis (Commonly Know as Hay Fever)

Acute inflammation of the nose and sinuses is in response to inhaled allergens. Facial pain and pressure are infrequent, and secretions are primarily clear, thin and watery. There is typically nasal and eye itching accompanied by sneezing and watery eyes. Nasal congestion can lead to a decreased sense of smell as well as fatigue due to poor sleep. Finally, ear pressure, popping and decrease hearing can be present due to eustachian tube (a small passageway that connects your throat to your middle ear) inflammation and dysfunction.

Sinus Infection

Bacterial sinusitis is classified as either acute or chronic. Chronic implies inflammation or infection lasting longer than three months. Acute bacterial sinusitis is less than three months, but beyond the typical five to seven day course for viral sinusitis (common cold). Patients typically experience facial pain and pressure, nasal obstruction, pus-like nasal discharge, dental pain, decreased smell and persistent coughing and throat irritation. Fever and fatigue may also be present.


  • Nasal allergies are best treated with topical steroids, oral or nasal antihistamines, decongestants and nasal saline irrigations to remove mucous and offending allergens. If symptoms are severe, systemic steroids can be helpful in improving symptoms. Patients with chronic, year-round symptoms or symptoms that are present for two seasons or greater may benefit from allergy testing and possible immunotherapy (allergy shots).
  • Acute viral sinusitis can be treated with supportive care, topical or systemic decongestants, nasal saline and systemic steroids if symptoms are severe.
  • Acute bacterial sinusitis is typically managed with appropriate antibiotics in addition to measures used to treat viral sinusitis.
  • Chronic sinusitis frequently requires proper analysis (CT scan), a prolonged course of antibiotics (21+ days), systemic and topical steroids, and symptomatic therapy for the excess secretions and congestion.

Thirty-five million Americans suffer from allergies and over seven million suffer from chronic sinus infections, yet most people can’t tell the difference between these two conditions. Due to the overuse of antibiotics and the potential impact of undiagnosed sinus infection, understanding sinonasal symptoms and proper diagnostic evaluation is of paramount importance.

For help with your allergies and sinus issues, please contact UofL Physicians – Ear, Nose & Throat at 502-583-3687.

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Article by: Kevin L. Potts, M.D., MBA

Kevin Potts, M.D., MBA, is a native of Louisville and has been with UofL Physicians – Ear, Nose & Throat (EN&T) for nearly 10 years. He is fellowship certified in EN&T Allergy and trained in advanced sinus and skull-base surgery. He is a member of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. His interests are expanded endonasal skull base surgery, endoscopic sinus surgery for chronic sinus disease and management of allergic disorders. He is currently accepting new appointments for both adult and pediatric patients.

All posts by Kevin L. Potts, M.D., MBA