A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

The Pediatric Insider

© 2015 Roy Benaroch, MD


We’re heading back into colder weather again, and along with the change in the leaves comes more people with miserable, congested noses. Today’s post is all about telling the difference. Next time, I’ll tell you how to treat them.


The common cold

Captain ColdAlso called an “acute upper respiratory infection”, a “cold” is far and away the most common cause of congestion and cough. It usually starts with a vague ill feeling, followed by a sore throat and then a congested or drippy nose. Sometimes, there’s a fever at the start of the illness (that’s more common in babies and younger children.) A few days later, a cough begins. On average, the symptoms of a cold last about 10 days, though often the cough lingers for 2 or 3 weeks.

Notice: the symptoms grow or develop over several days, and the fever is really only at the beginning. By day 7-10 things are starting to improve.



“The flu” is a specific viral infection, and it’s not just a bad cold. Symptoms including fever, sore throat, body aches, nasal congestion or drip, and cough all pretty much start all at the same time, or within a few hours. Sometimes there are also gastrointestinal symptoms like abdominal pain or vomiting. Fever and aches are usually the worst symptoms – you feel, pretty much, like you’ve been hit by a truck. The worst symptoms last five days, but the congestion and cough often linger for another week or so.

Notice: the symptoms are sudden and severe.



Most common colds, of course, go away on their own, with or without any kind of treatment. But rarely a common cold can turn into a sinus infection. That occurs when the persistent mucus becomes infected with bacteria, leading to worsening symptoms 7-10 days into an ordinary cold, or persistent symptoms 2 weeks after a cold begins. Very rarely, sinusitis can start suddenly and severely, but much more typically there is first a cold that turns into a sinus infection.

Notice: a sinus infection is like a cold, but the symptoms worsen after 7-10 days. A congested nose for less than 7-10 days is unlikely to be a sinus infection, even if it feels really stuffy.


Next up: treating colds, the flu, and sinus infections.

The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths


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3 Comments on “A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis”

  1. wzrd1 Says:

    Wow, that reminds me of when my wife and I both contracted influenza.
    Felt like we were hit by a truck? No, we honestly wondered if we would survive, that was how virulent that specific bug was that year.
    Three months later, we were managing to complete the daily activities of life, still exhausted.
    Six months later, we were approaching something like normal life.

    Some decades later, I read about cytokine storms and was thankful that we only had a cytokine drizzle.

    Nothing has been as severe in our lives, not even my wife’s lupus attacks.
    Not even participating in two wars.

    I can’t recall the year now, either 1983 or 1985 comes to mind though.


  2. Rob Lindeman Says:

    The common cold is a viral sinusitis (hey, I’m a lumper, not a splitter!)


  3. Dr. Roy Says:

    Agree, and I would extend that, Rob– there’s inflammation from the tip on the nose, through the sinuses, the oropharynx, and the bronchi. So: a common cold is a viral rhinosinopharyngobronchitis.


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