Your Symptoms Suggest Acute Viral Rhinosinusitis with Eustachian Tube Dysfunction
You're experiencing classic symptoms of a viral upper respiratory infection that has progressed to involve your sinuses and eustachian tubes—this is not yet bacterial sinusitis and does not require antibiotics at this stage. 1, 2
What's Happening to You
Your symptom progression is textbook for viral rhinosinusitis:
- Days 1-2: Fever and sore throat (initial viral infection) 2
- Days 3-4 (now): Nasal congestion, ear fullness, and positional headache 1
The ear fullness and headache that worsens when you lean down are caused by:
- Sinus pressure and inflammation blocking normal drainage pathways 1
- Eustachian tube dysfunction from mucosal swelling, creating the "full" sensation in your ears 3
- Increased pressure in your sinuses when you bend forward, which explains why the headache intensifies with position changes 1, 4
Why This Is Still Viral (Not Bacterial)
You do NOT meet criteria for bacterial sinusitis because: 1, 3
- Your symptoms have only been present for 2-3 days total (bacterial sinusitis requires symptoms persisting beyond 10 days without improvement) 1, 2
- You haven't experienced "double worsening" (initial improvement followed by worsening within 10 days) 1, 5
- You don't describe thick, purulent (colored/cloudy) nasal discharge—just congestion 1
What You Should Do Now
Symptomatic management is the appropriate treatment: 2, 5
- Pain relief: Acetaminophen or ibuprofen for headache 2, 6
- Nasal saline irrigation: Helps clear congestion and improve sinus drainage 3
- Oral decongestants (pseudoephedrine): Can reduce nasal congestion and eustachian tube swelling 2, 6
- Sleep with head elevated: Reduces positional congestion 1
- Adequate hydration: Thins secretions 2
Red Flags: When to Seek Care
Return for evaluation if you develop: 2
- Symptoms persisting beyond 10 days without improvement 1, 2
- Worsening symptoms after initial improvement (double worsening pattern) 1, 5
- High fever (>101°F/38.3°C) 5, 4
- Severe unilateral facial pain or swelling 1, 4
- Vision changes, severe headache, or neck stiffness (signs of complications) 1, 7
- Thick, colored nasal discharge that persists 1
Why Antibiotics Would Be Wrong Now
The number needed to treat with antibiotics in acute rhinosinusitis is 18, while the number needed to harm is 8—meaning you're more likely to experience side effects than benefit at this stage. 2 Only 0.5-2% of viral upper respiratory infections progress to bacterial sinusitis. 1
Your symptoms should improve over the next 3-7 days with supportive care alone. 2, 6