Sinusitis vs Cold vs COVID: How to Tell Them Apart
Three illnesses that overlap heavily, and the few symptoms that genuinely separate them.
Part of our Sinusitis condition guide.
The headline: All three can block your nose and dull your sense of smell. What separates sinusitis is facial pressure—a heavy ache over the cheeks or forehead, worse when you bend forward. Colds and COVID don't usually produce that.
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View Sinusitis Treatments →The quick answer
| If your dominant symptom is | Most likely |
|---|---|
| Runny nose, sneezing, sore throat, improving within a week | Common cold |
| Facial pressure over cheeks or forehead, blocked nose, lost smell, after a cold | Sinusitis |
| Fever, cough, muscle aches, fatigue, lost smell with a relatively clear nose | COVID-19 |
| Sudden onset, high fever, severe aches, floored for days | Influenza |
7–10 days
typical cold duration
2–3 wks
typical acute sinusitis duration
10 days
before sinusitis treatment is considered
Full symptom comparison
| Symptom | Cold | Sinusitis | COVID-19 |
|---|---|---|---|
| Facial pain or pressure | Uncommon | Characteristic | Uncommon |
| Blocked nose | Common | Common and persistent | Common |
| Runny nose | Very common, clear | Common, often thick | Common |
| Sneezing | Very common | Less prominent | Sometimes |
| Reduced sense of smell | Common, from blockage | Common and often marked | Common, sometimes without blockage |
| Sore throat | Common early | From post-nasal drip | Common |
| Cough | Common | Common, worse at night | Common, often dry |
| Fever | Mild or none | Mild, sometimes higher | Common |
| Muscle aches | Mild | Uncommon | Common |
| Fatigue | Mild | Moderate | Often marked |
| Upper toothache | No | Characteristic | No |
| Worse bending forward | No | Characteristic | No |
| Typical duration | 7–10 days | 2–3 weeks | Days to 2 weeks |
Facial pressure: the sinusitis signature
If you take one thing from this page, take this. Facial pain or pressure is what makes sinusitis sinusitis.
It's a heavy, aching fullness over the cheeks, across the forehead or between the eyes. It gets noticeably worse when you bend forward or lie down, and it's often worst first thing in the morning after a night lying flat.
The reason is mechanical. Your sinuses are air-filled cavities draining through openings only a few millimetres across. When the lining swells, those openings close, mucus accumulates in a sealed space, and the pressure presses on inflamed tissue.
Colds and COVID inflame the nasal passages but don't usually create that sealed, pressurised cavity. That's why they block your nose without producing the same heavy ache over your face.
A practical test: lean forward and touch your toes. If the pressure across your cheeks or forehead intensifies noticeably within a few seconds, that points towards sinusitis rather than a cold.
Loss of smell: sinusitis vs COVID
This is where most comparisons go wrong, so it's worth being precise.
Loss of smell happens in all three. It became strongly associated with COVID during the pandemic, but colds and sinusitis have always caused it. On its own it tells you very little.
What helps is the mechanism, which you can often work out from how your nose feels.
| Sinusitis and colds | COVID-19 | |
|---|---|---|
| Why smell is lost | Physical blockage stops air reaching the smell receptors | The virus can affect the smell system directly |
| Is the nose blocked? | Yes, markedly | Often relatively clear |
| Taste | Dulled because smell drives flavour | Can be genuinely altered, not just dulled |
| Recovery | Returns as blockage clears | Can take longer, occasionally much longer |
| Distorted smells | Uncommon | More often reported |
The single most useful question: is your nose actually blocked? Losing your sense of smell while your nose feels clear points more towards COVID. Losing it while you can't breathe through your nose at all points towards sinusitis or a cold.
This is a pointer, not a diagnosis. A test is the only way to confirm COVID, and the two can coexist. Treat the distinction as a guide to what to do next rather than a conclusion.
How a cold becomes sinusitis
Sinusitis isn't usually a separate illness you catch. It's what a cold turns into when drainage fails.
1
Days 1–3: an ordinary cold
Sore throat, sneezing, runny nose, feeling run-down. Nothing unusual.
2
Days 3–5: the lining swells
Inflammation narrows the sinus drainage channels. Mucus starts backing up behind them.
3
Days 5–7: pressure builds
Facial pain appears, worse bending forward. Sense of smell drops. This is where a cold has become sinusitis.
4
Days 7–21: gradual resolution
Most cases settle with self-care. Symptoms that are static at day 10, or that improve then clearly worsen, are the ones to get assessed.
The awkward part is that the cold appears to be improving just as the sinusitis begins. People describe feeling better, then worse again. Our guide on bacterial or viral sinusitis covers what that pattern means.
Timeline comparison
| Day | Cold | Sinusitis | COVID-19 |
|---|---|---|---|
| 1–3 | Sore throat, sneezing, building | Indistinguishable from a cold | Fever, aches, cough, fatigue |
| 4–7 | Peak, then improving | Facial pressure appears, smell drops | Often peaking |
| 7–10 | Largely resolved | Still unwell—this is normal | Usually improving |
| 10–14 | Gone, cough may linger | Should be improving. If not, get assessed | Mostly recovered; fatigue and smell may persist |
| 2–3 weeks | Gone | Usually resolved | Most recovered |
| Beyond | Reconsider the diagnosis | Beyond 12 weeks is chronic sinusitis | Persistent symptoms need review |
Can you have more than one at once?
Yes, in a few different ways.
A cold and sinusitis together is the normal sequence, not a coincidence. For several days the two overlap while one becomes the other.
COVID and sinusitis together is entirely possible. COVID is a respiratory virus, and like any other it can inflame the sinus lining and trigger sinusitis as a complication.
Two viruses in succession is common in winter, particularly in households with young children. Catching a second cold before recovering from the first produces an illness that seems to drag on for weeks. This is worth distinguishing from genuinely persistent sinusitis—see sinusitis that will not go away.
What each one needs
| What helps | What doesn't | |
|---|---|---|
| Cold | Rest, fluids, paracetamol or ibuprofen, time | Antibiotics. Colds are viral. |
| Sinusitis, under 10 days | Saline rinsing, steam, regular pain relief, head elevated | Antibiotics. Steroid sprays too, at this stage. |
| Sinusitis, past 10 days | A steroid nasal spray. Antibiotics only if bacterial infection is likely | Repeated antibiotic courses |
| COVID-19 | Rest, fluids, paracetamol. Antivirals for some higher-risk people | Antibiotics, unless a bacterial complication develops |
Where sinus symptoms have persisted past day 10, Access Doctor supplies mometasone nasal spray for sinusitis and beclometasone nasal spray for sinusitis, with phenoxymethylpenicillin where a bacterial infection is genuinely likely.
Should you test for COVID?
Worth considering if:
- Your symptoms fit COVID better than sinusitis—fever, new cough, muscle aches, marked fatigue
- You've lost your sense of smell but your nose feels relatively clear
- You are in contact with someone vulnerable, since the result would change what you do
- You work in health or social care
- You are at higher risk yourself and might be eligible for antiviral treatment
UK testing guidance has changed repeatedly since 2020—who should test, who can access free tests, and what to do with a positive result have all shifted. Check the current NHS advice rather than relying on what applied during an earlier wave. This section reviewed August 2026.
Where flu fits in
Influenza is the fourth possibility and usually the easiest to spot, because of how it starts.
A cold builds over a day or two. Flu arrives. People often remember the hour they became ill. It brings high fever, severe muscle aches, headache and exhaustion that puts you in bed rather than merely making you uncomfortable. Nasal symptoms are usually less prominent than the whole-body illness.
Like any respiratory virus, flu can be followed by sinusitis as a complication—the same drainage failure, a different trigger.
Red flags for any of them
Call 999 or go to A&E for difficulty breathing or breathlessness at rest, swelling or redness around an eye, a bulging eye, double or reduced vision, a severe headache unlike your usual headaches, neck stiffness, confusion or drowsiness, a rash that doesn't fade under a glass, or blue or grey lips. These apply whichever illness you think you have.
Contact NHS 111 or your GP the same day for a very high temperature you can't control, rapid deterioration, inability to keep fluids down, or if you have a weakened immune system.
For sinus symptoms specifically, arrange assessment if you reach 10 days with no improvement, or if you improved and then clearly worsened. Our guide on antibiotics for a sinus infection explains what happens then.
Frequently Asked Questions
What is the difference between sinusitis symptoms and a cold?
A cold produces a runny nose, sneezing, a sore throat and a general run-down feeling, and it improves within about a week. Sinusitis usually develops a few days into a cold or just as it seems to be settling, and its defining features are facial pain or pressure over the cheeks, forehead or between the eyes, plus a reduced or absent sense of smell. Facial pressure and lost smell are the combination that separates the two.
How do I know if I have sinusitis or COVID?
Both can cause a blocked nose and a reduced sense of smell, which is why they get confused. The useful difference is what accompanies the lost smell. In sinusitis it comes with nasal blockage and facial pressure, because mucus and swelling physically obstruct the nose. In COVID it can occur with a nose that feels relatively clear. COVID also more often brings fever, cough, muscle aches and marked fatigue without the facial pressure sinusitis produces.
Can a cold turn into sinusitis?
Yes, and this is the usual way sinusitis starts. A cold inflames the lining of the nose and sinuses, which narrows the small channels that drain each sinus. Mucus then accumulates behind the blockage, pressure builds and facial pain develops. It typically happens a few days into the cold or just as the cold seems to be improving. Most cases remain viral and settle without antibiotics.
Does losing your sense of smell mean COVID?
No. Loss of smell is common in sinusitis, in ordinary colds and in COVID, so on its own it does not identify any of them. What helps is the context. In sinusitis and colds, smell is reduced because the nose is physically blocked, and it returns as the blockage clears. In COVID, smell can be lost even when the nose feels clear, and it sometimes takes longer to recover. A test is the only way to confirm COVID.
How long does each one last?
A cold typically lasts seven to ten days and improves steadily throughout. Acute sinusitis usually takes two to three weeks to resolve fully, with symptoms peaking in the first week. COVID varies widely, from a few days to a couple of weeks for most people, though fatigue and altered smell can persist longer. If sinus symptoms have not improved at all by day 10, that is the point at which treatment is considered.
Can you have a cold and sinusitis at the same time?
Effectively yes, and it is the normal sequence rather than bad luck. Sinusitis usually develops as a complication of the cold you already have, so for a few days you may have both sets of symptoms overlapping. It is also possible to catch a second virus while recovering from the first, which is one reason some people describe an illness that seems to go on for weeks.
Should I test for COVID if I think I have sinusitis?
Testing is worth considering if you have symptoms that fit COVID more than sinusitis, particularly fever, a new cough, muscle aches or loss of smell without a blocked nose. It is also worth testing if you are in contact with someone vulnerable, since that changes what you would do with the result. UK testing guidance has changed several times, so check the current NHS advice rather than relying on what applied previously.
When do any of these need medical attention?
Seek emergency care for swelling or redness around an eye, a bulging eye, vision changes, a severe headache unlike your usual ones, neck stiffness or confusion, whichever illness you think you have. Seek same-day advice for difficulty breathing, a very high temperature you cannot control, or rapid deterioration. For sinus symptoms specifically, arrange assessment if you reach 10 days with no improvement or if you improved and then clearly worsened.
Completing the treatment
Colds and COVID need rest and time. Sinusitis needs self-care for the first 10 days, and treatment beyond that if symptoms aren't improving. Access Doctor supplies steroid nasal sprays and, where genuinely indicated, antibiotics, after a short online consultation reviewed by a GPhC-registered pharmacist independent prescriber. See the range on the sinusitis treatment page.
Steroid spray · Rx
Mometasone Nasal Spray for Sinusitis
For sinus symptoms persisting past day 10.
View product →Steroid spray · Rx
Beclometasone Nasal Spray for Sinusitis
Alternative steroid nasal spray for persistent inflammation.
View product →Antibiotic · Rx
Phenoxymethylpenicillin for Sinusitis
Where a bacterial sinus infection is genuinely likely.
View product →Antibiotic · Rx
Doxycycline Capsules for Sinusitis
Alternative where penicillin cannot be used.
View product →References
- NHS. Sinusitis (sinus infection). nhs.uk
- NHS. Common cold. nhs.uk
- NHS. COVID-19 symptoms and what to do. nhs.uk
- NHS. Flu. nhs.uk
- NHS. Lost or changed sense of smell. nhs.uk
- National Institute for Health and Care Excellence. Sinusitis (acute): antimicrobial prescribing (NG79). nice.org.uk
- NICE Clinical Knowledge Summaries. Sinusitis. cks.nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.