Post-Viral Rhinosinusitis with Persistent Symptoms
You most likely have post-viral rhinosinusitis (viral sinus inflammation following your upper respiratory infection), which is causing your facial and frontal pain along with ongoing cold and cough symptoms at 20 days. The absence of fever makes bacterial sinusitis less likely, and your symptom duration falls within the expected range for viral illness resolution. 1
Understanding Your Symptom Timeline
Your 20-day symptom duration is approaching but has not exceeded the critical threshold for concern:
- Most viral upper respiratory infections resolve within 1-2 weeks, but symptoms can persist up to 21 days without indicating bacterial infection 1
- Up to 90% of viral URIs show CT evidence of sinus involvement, yet these resolve without antibiotics 1
- Approximately 25% of patients continue to have cough, post-nasal drip, and throat clearing at day 14 after a common cold 2
- Only 0.5-13% of viral URIs progress to bacterial sinusitis 1
Key Diagnostic Indicators
Your symptom pattern suggests ongoing viral inflammation rather than bacterial infection because:
- Absence of fever argues strongly against bacterial sinusitis 1
- Facial and frontal pain are typical locations for viral rhinosinusitis 2
- Cold and cough symptoms without "double sickening" (worsening after initial improvement at days 5-7) suggest continued viral course rather than bacterial superinfection 1
Bacterial sinusitis should only be suspected if you develop: 1
- Symptoms persisting beyond 10 days with worsening (not just persistence)
- "Double sickening" pattern (improvement followed by worsening)
- High fever >39°C with purulent nasal discharge for ≥3 consecutive days
Recommended Treatment Approach
For symptomatic relief, use first-generation antihistamine/decongestant combination (such as brompheniramine with sustained-release pseudoephedrine) or naproxen 220-440mg twice daily. 2 These have the strongest evidence for reducing cough and upper airway symptoms in viral URIs.
Avoid these ineffective treatments: 2
- Newer non-sedating antihistamines (ineffective for viral URI cough)
- Antibiotics (not indicated for viral rhinosinusitis and provide no benefit)
When to Seek Further Evaluation
Return for medical evaluation if: 1
- Symptoms persist beyond 21 days total
- Symptoms worsen after initial improvement (double sickening pattern)
- You develop high fever (>39°C) with purulent discharge for ≥3 consecutive days
- Severe unilateral facial pain develops with facial swelling
Important Clarification About "Post Chicken"
The timing relationship to eating chicken is coincidental. Your symptoms represent a typical viral upper respiratory infection that happened to begin around that time. Food consumption does not cause this symptom pattern. 1
Expected Recovery
You should see continued gradual improvement over the next 1-7 days. 1 The inflammatory response triggered by your initial viral infection can be self-perpetuating unless interrupted with the symptomatic treatments recommended above. 2