What are the key clinical features that differentiate acute sinusitis

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Key clinical features differentiating acute sinusitis from a common cold include:

Duration and progression: Acute sinusitis symptoms typically last longer than 10 days without improvement or worsen after 5 days (double sickening), whereas common cold symptoms usually peak around 3 days and start improving after 5 days, with symptoms rarely lasting beyond 7–14 days except for mild cough ,.
Symptom severity and type: Acute sinusitis often presents with severe localized pain, often unilateral and over the teeth and jaw, and may include fever greater than 38°C, purulent or discoloured nasal discharge, and marked deterioration after an initial milder phase . In contrast, the common cold usually causes milder symptoms such as nasal congestion, rhinorrhoea, sneezing, sore throat, and malaise without severe localized pain or high fever .
Systemic features: Sinusitis may cause more significant systemic illness, including fever and facial pain, whereas the common cold is generally milder and self-limiting ,.
Response to treatment: Sinusitis symptoms may respond to nasal corticosteroids and analgesics, while common cold symptoms are mostly managed with symptomatic relief and tend to resolve spontaneously ,.

What are the key clinical features that differentiate acute sinusitis from a common cold?