Symptoms of the different strains are so similar that doctors typically recommend patients wait seven to 10 days before seeking treatment. Viral infections — the common cold — usually work themselves out in that period of time with nothing more than liquids, rest and supportive care (including things like acetaminophen or ibuprofen), Dr. Sindwani says.
“If you don’t get better, we start thinking there’s a bacterial component,” he says. “That’s when we pull the trigger on an antibiotic.”
When antibiotics are in order
The main reason to prescribe antibiotics is for patient comfort, Dr. Sindwani says. The medical field used to be more convinced than it is today than untreated sinusitis would inevitably become a chronic issue, he says.
“We don’t think that way as much,” he says. “We don’t know that an untreated acute sinusitis, if left untreated, will grumble along and cause people to have a chronic sinus infection.”
“Some people think that’s two separate things,” with chronic sinusitis more likely due to “underlying issues like allergies or immune problems.”
Rare cases can turn serious
Antibiotics also can help ward off rare but potentially dangerous complications that arise when a sinus infection spreads to the eyes or brain, Dr. Sindwani says.
Complications around the eyes are the more common of the two. These complications can cause redness, swelling around the eyes and reduced vision, and even lead to blindness — in a severe form known as cavernous sinus thrombosis. Serious cases are immediately treated with IV antibiotics. Patients are usually admitted to the hospital for a CT scan to see if fluid needs to be drained, Dr. Sindwani says.
Also in rare cases, sinus infections in the rear center of one’s head can spread into the brain. This can lead to life-threatening conditions like meningitis or brain abscess, Dr. Sindwani says.
“Before antibiotics, people would die from sinusitis,” he says. But he emphasizes that such complications are unlikely. “In most cases, the bacterial infection goes away, especially if you don’t have underlying medical problems.”
It’s important to monitor your symptoms if you suspect a sinus infection. If the condition lingers or worsens, call your doctor.
What to do about sinusitis
There are many things you can do to reduce your chance of developing sinusitis or to relieve early sinusitis symptoms. One of the most important is to promote drainage and keep nasal passages clear. Here are some suggestions:
- Bathe your nasal passages daily. Run water gently into the nasal passages to help clear excess mucus and moisten membranes. (See “First line of defense: Nasal irrigation.”) Good times to do it are in the morning and at night, when you brush your teeth. “Brush, then flush,” is Dr. Metson’s motto. During the day, use nasal saline spray to moisten nasal passages.
- Drink lots of water. Good hydration helps keep the mucus thin and loose. Have a bottle of water at your desk at work or put a glass near the kitchen sink to remind you to drink water throughout the day.
- Inhale steam. Linger in a hot shower. Or bring water to a boil and pour it into a pan; place a towel over your head, and carefully bend over the pan to inhale the steam. To avoid burns, keep your distance at first and move in gradually to a comfortable zone.
- Avoid dry environments. A humidifier in your home (in particular, by your bed) and where you work can help prevent nasal passages from drying out. Keep humidifiers clean and free of bacteria and mold.
- Sleep with your head elevated. Mucus pools in your sinuses at night when your head is down, so have your head propped up with pillows or a wedge during sleep.
- Be nice to your nose. Blow your nose gently, one nostril at a time. Forceful blowing can irritate the nasal passages and propel bacteria-laden mucus back up into your sinuses.
- Avoid antihistamines unless prescribed. Antihistamines make mucus thick and hard to drain. But if your sinusitis is triggered by allergies, your clinician may still want you to take an antihistamine along with other medications.
- Be careful with decongestants. Tablets containing pseudoephedrine act on blood vessels to shrink membranes and keep nasal passages open. Nasal sprays containing phenylephrine or oxymetazoline also work well — and quickly. But using topical nasal decongestants for more than a day or two runs the risk of setting off a spiral of dependency as a result of rebound — increased swelling after the medication wears off. (According to Dr. Metson, a shorter-acting spray, such as 0.25% or 0.5% Neo-Synephrine, is less likely to cause rebound than longer-acting ones like Afrin.) Oral decongestants can cause jitters and increase blood pressure, so if you have high blood pressure, don’t use them without consulting a clinician first.
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By: Allen Adinoff, MD
Hollow cavities in the skull bone surrounding the nasal passages form the sinuses. Normally, the sinuses drain into the nose. Although their function is a bit of a mystery, the sinuses cause plenty of problems. When they become inflamed and infected, the term “sinusitis” is used. Acute sinusitis often follows a respiratory infection or “cold” and lasts a week or two and many people refer to this as a “Sinus Infection”. Chronic (long term) sinusitis refers to nasal-sinus symptoms that last for many weeks or months. Chronic sinusitis is the topic of this discussion.
What is Chronic Sinusitis?
Millions of individuals in the US suffer from chronic sinusitis. It causes significant illness, loss of work, and discomfort. People with this condition experience persistent nasal drainage (often discolored), nasal blockage, facial pain, and loss of smell. Generalized symptoms of fatigue, poor sleep, and generally feeling “crummy” are common. Recurrent episodes of acute sinus infections are also common.
There are many causes of chronic sinusitis. Recent thinking suggests that chronic irritation (called inflammation) and low grade infection are the most common causes. The inflammation is often related to allergies. The infection is often “low grade”. The bacteria hide themselves in “biofilms” making it difficult for the immune system or antibiotics to attack them.
The evaluation of chronic sinusitis is best done by an allergist skilled in this condition. Asking detailed questions about your nasal-sinus symptoms is most important. It’s also essential to examine the nasal passages thoroughly. This is best done with a flexible nasal scope that can look into the deep passages of the nasal cavity. Samples of sinus mucus can determine the cause of infection. Laboratory tests include looking for evidence of allergy, and to check for problems with the immune system. Often it’s important to get a detail sinus X-ray, called a CAT scan.
Treatment is geared toward treating the allergic causes, restoring free sinus drainage, reducing the nonspecific inflammation, and treating the infection. If allergies are felt to be a strong trigger for your sinusitis, allergy shots (immunotherapy) may be helpful. Irrigation of the nasal passages with gentle salt water (saline) is often extremely effective in flushing out irritated mucus and allergens, adding moisture, and reducing inflammation. Nasal steroid sprays help reduce the inflammation. Often a nasal steroid can be mixed with the saline irrigations. Nasal steroids are extremely safe and don’t get into the general blood stream. A small amount of baby shampoo can be mixed with the saline and can have a “detergent” effect on those nasty biofilms. Occasionally, nasal antibiotics, anti-fungal medicines, or even probiotics can be helpful. This intense approach is usually effective. However, occasionally, surgery may be needed to open up the sinuses and restore free drainage. Only a skilled ears nose and throat surgeon (ENT) can do this. But opening the “plumbing” does not cure this condition; it still requires treatment of the underlying causes of allergy, inflammation, and infection.
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Recurring Sinus Infections: Diagnosis and Treatment
When to Contact a Doctor
If you exhibit any symptoms of sinus infection for several weeks, make an appointment with your doctor as soon as possible. You should also contact your doctor if you experience any pressure or pain in your upper face, accompanied with postnasal drip, nasal discharge, bad breath that isn’t related to dental issues, or a high fever that lasts several days.
If left untreated, your sinus infection can pose more serious health issues, including:
- Changes to vision and potential blindness
- Changes to the personality
- Osteomyelitis, or Pott’s puffy tumor, a condition indicating an infection of the frontal bone in the forehead (this is mainly limited to children)
Sinus infections, particularly those caused by viruses, will generally clear up on their own. Treatments for other sinus infections are available and mainly center around a course of antibiotics. However, even if you have a simple acute sinus infection, you should consider consulting your doctor or visit an urgent care center for relief from any uncomfortable symptoms.