What are sinuses?
Sinuses are hollow air spaces in the located in the bone cavities. They make mucus, a fluid that cleans bacteria and other particles out of the air you breathe. These hollow spaces, located within the skull or bones of the head surrounding the nose, include
Frontal sinuses over the eyes in the brow area
Maxillary sinuses inside each cheekbon
Ethmoid sinuses just behind the bridge of the nose and between the eyes
Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes.
Normal human anatomy tells us that each sinus has an opening into the nose for the free exchange of air and mucus. There is also a continuous mucous membrane lining that coats all the sinuses. Therefore, it isn't hard to assume that, anything that causes a swelling or infection in the nose also can affect the sinuses.
What is sinusitis?
Sinusitis is an inflammation of the lining of one or more of the sinus cavities in the facial bones around your nose. Most cases of sinusitis are acute infectious sinusitis, which generally lasts less than four weeks. If the signs and symptoms of sinusitis last more than 12 weeks, or if a person has frequent attacks of sinusitis, it may have chronic sinusitis. Incidence of this condition is very high!
Chronic sinusitis is one of the most common chronic diseases in the United States, affecting an estimated 33 million people each year.
Signs and symptoms of sinusitis
Although, theoretically the condition affects only sinus lining, it literally affects the complete body functioning and can make your life miserable.
Some of the most common symptoms are:
Congestion that makes it difficult for breathing through nose
Sore throat
Pain, tenderness and swelling around eyes, cheeks, nose or forehead
Headache when you wake up in the morning is typical of a sinus problem.
Bad breath or loss of smell
Fever
Pain in eyes- The ethmoid sinuses are near the tear ducts in the corner of your eyes. Therefore, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes.
Reduced sense of smell or taste
Cough
Tooth pain
Bad breath
Fatigue
Possible causes of sinusitis
The most common causes of sinusitis are viral, bacterial or fungal infection of the upper respiratory tract including viruses that cause the common cold.
Mechanism of the infection is simple! When an infection such as a cold inflames and swells mucous membranes in your nose, the swollen membranes literally obstruct the sinus openings and keep mucus from draining. This is the critical point! As drainage becomes blocked, it creates an environment in which bacteria and viruses trapped in the sinuses can grow.
There are several other, less possible, causes of sinusitis and they include:
Allergies
Inflammation that occurs with allergies may easily block sinuses because it is very same mechanism.
Deviated nasal septum
In this condition, the wall between the nostrils, usually called- the nasal septum is crooked or unsymmetrical. This may restrict or block sinus passages, creating a perfect environment for infections.
Nasal polyps
Growths of tissue may restrict the nasal passages, slowing drainage and allowing infections to grow.
Other medical conditions
Several other conditions can affect sinuses also. For example, people with cystic fibrosis or HIV and other immune deficiency diseases are more likely to develop sinusitis then the healthy ones!
Chronic sinusitis - It can be difficult to determine the cause of chronic sinusitis. Some experts think it is an infectious disease, but others are not certain. It is an inflammatory disease that often occurs in people with asthma.
Risk factors for developing sinusitis:
Having asthma
Overuse of nasal decongestants
Chronic drug misuse (snorting substances)
Having a foreign body in your nose
Frequent swimming or diving
Dental work
Pregnancy
Changes in altitude (flying or diving)
Air pollution and smoking
Gastro-esophageal reflux disease (GERD)
Hospitalization that involves installed nasogastric tube
Complications of sinusitis
The most common complication of sinusitis is possible aggravation of asthma attack. Serious complications from sinusitis are rare, but the fact is that they can be life-threatening. Most common complications are:
Meningitis
The infection may spread to the bones of your eyes or to the membranes that protect your brain called meninges, causing severe brain damage. It can be lethal condition!
Vision problems
Although it happened rarely, some patients experienced reduced vision or even blindness if the infection spread to their eye socket.
Blood vessel complications
Infection that spreads to the veins around sinuses can cause aneurysms and blood clots that interfere with the blood supply to your brain. This can lead to infarctions!
Diagnosis of sinusitis
Because patient’s nose can get stuffy during some other conditions such as common cold, patient may confuse simple nasal congestion associated with cold with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.
Physical examination including a detailed patient’s history is sometimes enough to set the appropriate diagnosis. If your symptoms are vague or persist, your health care provider may order a CT (computed tomography) or X-ray scan to confirm that you have sinusitis.
If the doctor can't set the right diagnosis just from physical examination, it can do several other tests! Laboratory tests to diagnose chronic sinusitis may include:
Blood tests
These tests are done to rule out other conditions associated with sinusitis like an immune deficiency disorder or cystic fibrosis.
Cultures
These are special blood tests which are done in order to detect bacterial or fungal infection.
Biopsy
Biopsy is done to determine the health state of the cells lining the nasal cavity.
Treatment of sinusitis
Acute sinusitis
If a person is diagnosed with acute sinusitis, several treatment options could be beneficial. The most common may include use of:
Decongestants to reduce congestion
Antibiotics to control a bacterial infection, if present
Pain relievers to reduce any pain
Problem is that sometimes patients are using these over-the-counter or prescription decongestant nose drops and sprays for to long! They should be used for only few days because they can lead to even more congestion and swelling of nasal passages. If the sinusitis is caused by a virus, then the antibiotics will not help but, the condition usually resolves spontaneously in few days!
Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis successfully, because the symptoms persist even after taking antibiotics for a long period. Many general practitioners are treating chronic sinusitis as though it is an infection, by using antibiotics and decongestants, but not with success. Others use both antibiotics along with steroid nasal sprays.
Treatment options that could relieve some symptoms are:
Inhaling steam from a vaporizer or a hot cup of water
Saline nasal spray can give relief.
Gentle heat applied over the inflamed area is comforting.
Surgery for sinusitis
The most common surgery done today is called Functional endoscopic sinus surgery. This operation the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare. Surgery should be considered only after failure of medical treatment. Other types of surgery can correct bent nasal cartilage. This operation is called septoplasty. Other operations can remove nasal polyps that may be the cause of sinusitis.
Tips for prevention of sinusitis
There are several things that every person could do to reduce risk of developing sinusitis. Some of these steps are:
Risk of upper respiratory infections must be minimized. This can be done by minimizing close contact with people who have colds and washing hands frequently with soap and water.
Quitting with smoking. Tobacco smoke can cause irritation and inflammation of the lining of the sinuses and nose. Inflammation can result in blocked nasal passages.
Avoiding polluted air. Contaminants in the air can irritate and inflame your lungs and nasal passages.
Usage of humidifiers
Self-care
Steam your sinuses often by inhaling steam several times a day. It will stimulate drainage from the sinuses.
Warm compresses should be applied daily.
Every person diagnosed with sinusitis should drink as much fluids as it can because diluting secretions and promoting drainage by consuming additional fluids is very beneficial.
Don't drink alcohol. Drinking alcohol can worsen the swelling of the lining of the sinuses and nose.
have a flu vaccinations
keep your allergy symptoms under control
Swimming in pools treated with chlorine, which irritates the lining of the nose and sinuses, should be avoided.
General Treatment Approaches
The primary objectives for treatment of sinusitis are reduction of swelling, eradication of infection, draining of the sinuses, and ensuring that the sinuses remain open. Fewer than half of patients reporting symptoms of sinusitis need aggressive treatment. Home remedies can be very useful.
Treatment of Acute Sinusitis.
Support treatment with only saline nasal irrigation, decongestants, antihistamines, and expectorants are appropriate for a minimum of 7 - 10 days for patients with mild-to-moderate symptoms, and may be used for longer.
Antibiotics are not helpful for patients with mild-to-moderate symptoms, so they should not be prescribed for at least the first 7 days.
Treatment of Chronic Sinusitis.
A broad-spectrum antibiotic (one that can eliminate a wide range of bacteria) may be helpful. Some patients benefit from prolonged therapy.
A corticosteroid nasal spray. Some doctors also recommend oral corticosteroids (such as prednisone) for patients who do not respond to nasal corticosteroids or for those patients who have nasal polyps. Prednisone is also used for patients who have allergic fungal sinusitis.
Saline nasal irrigation is often needed on an ongoing basis.
If the condition dramatically improves after 1 - 2 months, antibiotics are stopped. The patient should continue with both the steroid and saline nasal solutions. If there is no improvement after this time, surgery may be considered. For some people with chronic sinusitis, however, the condition is not curable, and the goal of treatment is to improve the quality of life.
A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.
Hydration
Home remedies that open and hydrate sinuses may, indeed, be the only treatment necessary for mild sinusitis that is not accompanied by signs of acute infection.
Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Water is the best fluid and helps lubricate the mucus membranes. (There is NO evidence that drinking milk will increase or worsen mucus, although milk is a food and should not serve as fluid replacement.)
Chicken soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although laboratory studies have actually reported that ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
Spicy foods that contain hot peppers or horseradish may help clear sinuses.
Inhaling steam 2 - 4 times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water (no one should ever inhale steam from water as it boils) while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water. Long, steamy showers, vaporizers, and facial saunas are alternatives.
Nasal Wash
A nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased in a spray bottle at a drug store or made at home. (Mix 1 teaspoon of table, Kosher, or sea salt with 2 cups of warm water. Some people add a pinch of baking soda.) Perform the nasal wash several times a day. Researchers have reported that daily irrigation of the nasal passages with a hypertonic saline solution relieves sinusitis symptoms and also reduces antibiotic use and the occurrence of acute exacerbations.
A simple method for administering a nasal wash is:
Lean over the sink head down.
Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
Spit out the remaining solution.
Gently blow the nose.
Neti pots have also become popular in recent years for prevention and treatment of sinusitis. Nasal irrigation with a saline solution through a neti pot involves:
Lean over the sink with your head tilted to one side.
Insert the spout of the neti pot in the upper nostril.
Slowly pour the salt water into your nose while continuing to breathe through your mouth.
The water will flow through the upper nostril and out through the lower nostril.
When the water finishes dripping out, blow your nose.
Reverse the tilt of your head and repeat the process with the other nostril.
Antibiotic Use in the Treatment of Sinusitis
Overview on Antibiotics and Their Overuse. Sinusitis is the fifth most common diagnosis for antibiotic prescriptions. But there is much evidence that antibiotics are inappropriately prescribed for many patients:
Most acute sinusitis cases clear up on their own.
Antibiotics generally help only a very small number of children with persistent nasal discharge for at least 20 days. Even when antibiotics are helpful, benefits are modest in reducing duration of the infection.
The intense and widespread use of antibiotics (not only for sinusitis but also for ear infections and other upper respiratory tract infections) has led to a serious global problem, which is bacterial resistance to common antibiotics.
When to Use Antibiotics. Antibiotics should usually be reserved for select patients who are at higher risk for developing bacterial infections. Because up to 80% of sinusitis cases resolve on their own within 2 weeks, doctors generally wait 7 - 14 days before prescribing antibiotics. Some doctors feel that antibiotics still should not be prescribed if symptoms last longer than 10 days. However, antibiotics may be prescribed sooner if severe symptoms develop. These symptoms include:
Fever greater than 39° C (102.2° F)
Facial pain or headache
Severe swelling around the eyes
Chronic sinusitis is often the result of damage to the mucus membrane from a past, untreated acute sinus infection. The aerobic and anaerobic bacteria present in chronic sinusitis are often different from those that cause the acute form. The role of antibiotic treatment for chronic sinusitis is controversial. Special types of antibiotics may be used, and treatment may be needed for a longer time.
Some patients with chronic sinusitis may need intravenous antibiotic therapy, particularly those with underlying medical disorders that can worsen their condition. This therapy is typically given 2 weeks before surgery and continued for about a month afterwards.
Antibiotic Regimens.
The standard first-line antibiotic treatment for acute uncomplicated bacterial sinusitis is a 10 - 14 day course of amoxicillin. Trimethoprim-sulfamethoxazole is an alternative choice.
For more complicated illnesses (chronic illness, chronic sinusitis, symptoms lasting longer than 30 days, children in day care or younger than 2 years old, smokers, recent antibiotic use, or unresponsiveness to initial antibiotic course), the doctor may prescribe a different type of antibiotic, such as amoxicillin-clavulanate, cephalosporin, or a macrolide.
If the patient does not respond after 21 - 28 days, the doctor may switch to another broad-spectrum antibiotic, such as amoxicillin-clavulanate, cefuroxime, or cefpodoxime. Other choices include clarithromycin or azithromycin (macrolides) or levofloxacin (a fluoroquinolone).
Side Effects of Antibiotics. Most antibiotics have the following side effects (although specific antibiotics may have other side effects or fewer of the standard ones):
The most common side effect for nearly all antibiotics is gastrointestinal distress.
Antibiotics double the risk for vaginal infections in women. Taking supplements of acidophilus or eating yogurt with active cultures may help restore healthy bacteria that offset the risk for such infections.
Allergic reactions can also occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
Certain drugs, including some over-the-counter medications, interact with antibiotics; patients should inform the doctor of all medications they are taking and of any drug allergies.
Managing Sinusitis in Patients with Allergies
Patients often have various combinations of allergies, sinusitis, and asthma. Treating each condition is important for improving them all. In addition to decongestants, pain relievers, and expectorants, other remedies are available for people who suffer from nonbacterial sinusitis during allergy season.
Anti-Inflammatory Drugs. Nasal spray corticosteroids (commonly called steroids) are important for reducing the inflammatory response in the nasal passages and airways. They are important in the treatment of asthma and are now considered to be the most effective measure for preventing allergy attacks. Leukotriene-antagonists are also useful for sinusitis symptoms.
Antihistamines. Antihistamine tablets relieve sneezing and itching and can prevent nasal congestion before an allergy attack. Many brands are available by prescription and over the counter. Because they thicken mucus and make it harder to drain out from the sinuses, they should not be used for sinusitis.
Immunotherapy. Immunotherapy, commonly referred to as allergy shots, may be considered for patients with severe seasonal allergies that do not respond to treatment. Immunotherapy is the only treatment that affects the cause of allergies.
All drug treatments have side effects, some very unpleasant and, rarely, serious. Patients may need to try different drugs until they find one that relieves symptoms without producing excessively distressing side effects.
Emergency Treatment:
Patients who show signs that infection has spread beyond the nasal sinuses into the bone, brain, or other parts of the skull need emergency care. High dose antibiotics are administered intravenously, and emergency surgery is almost always necessary in such cases.
Severe Fungal Sinusitis. Sinusitis caused by severe fungal infections is a medical emergency. Treatment is aggressive surgery, and high-dose antifungal chemotherapy with a drug such as amphotericin B can be life saving.
Sinuses are hollow air spaces in the located in the bone cavities. They make mucus, a fluid that cleans bacteria and other particles out of the air you breathe. These hollow spaces, located within the skull or bones of the head surrounding the nose, include
Frontal sinuses over the eyes in the brow area
Maxillary sinuses inside each cheekbon
Ethmoid sinuses just behind the bridge of the nose and between the eyes
Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes.
Normal human anatomy tells us that each sinus has an opening into the nose for the free exchange of air and mucus. There is also a continuous mucous membrane lining that coats all the sinuses. Therefore, it isn't hard to assume that, anything that causes a swelling or infection in the nose also can affect the sinuses.
What is sinusitis?
Sinusitis is an inflammation of the lining of one or more of the sinus cavities in the facial bones around your nose. Most cases of sinusitis are acute infectious sinusitis, which generally lasts less than four weeks. If the signs and symptoms of sinusitis last more than 12 weeks, or if a person has frequent attacks of sinusitis, it may have chronic sinusitis. Incidence of this condition is very high!
Chronic sinusitis is one of the most common chronic diseases in the United States, affecting an estimated 33 million people each year.
Signs and symptoms of sinusitis
Although, theoretically the condition affects only sinus lining, it literally affects the complete body functioning and can make your life miserable.
Some of the most common symptoms are:
Congestion that makes it difficult for breathing through nose
Sore throat
Pain, tenderness and swelling around eyes, cheeks, nose or forehead
Headache when you wake up in the morning is typical of a sinus problem.
Bad breath or loss of smell
Fever
Pain in eyes- The ethmoid sinuses are near the tear ducts in the corner of your eyes. Therefore, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes.
Reduced sense of smell or taste
Cough
Tooth pain
Bad breath
Fatigue
Possible causes of sinusitis
The most common causes of sinusitis are viral, bacterial or fungal infection of the upper respiratory tract including viruses that cause the common cold.
Mechanism of the infection is simple! When an infection such as a cold inflames and swells mucous membranes in your nose, the swollen membranes literally obstruct the sinus openings and keep mucus from draining. This is the critical point! As drainage becomes blocked, it creates an environment in which bacteria and viruses trapped in the sinuses can grow.
There are several other, less possible, causes of sinusitis and they include:
Allergies
Inflammation that occurs with allergies may easily block sinuses because it is very same mechanism.
Deviated nasal septum
In this condition, the wall between the nostrils, usually called- the nasal septum is crooked or unsymmetrical. This may restrict or block sinus passages, creating a perfect environment for infections.
Nasal polyps
Growths of tissue may restrict the nasal passages, slowing drainage and allowing infections to grow.
Other medical conditions
Several other conditions can affect sinuses also. For example, people with cystic fibrosis or HIV and other immune deficiency diseases are more likely to develop sinusitis then the healthy ones!
Chronic sinusitis - It can be difficult to determine the cause of chronic sinusitis. Some experts think it is an infectious disease, but others are not certain. It is an inflammatory disease that often occurs in people with asthma.
Risk factors for developing sinusitis:
Having asthma
Overuse of nasal decongestants
Chronic drug misuse (snorting substances)
Having a foreign body in your nose
Frequent swimming or diving
Dental work
Pregnancy
Changes in altitude (flying or diving)
Air pollution and smoking
Gastro-esophageal reflux disease (GERD)
Hospitalization that involves installed nasogastric tube
Complications of sinusitis
The most common complication of sinusitis is possible aggravation of asthma attack. Serious complications from sinusitis are rare, but the fact is that they can be life-threatening. Most common complications are:
Meningitis
The infection may spread to the bones of your eyes or to the membranes that protect your brain called meninges, causing severe brain damage. It can be lethal condition!
Vision problems
Although it happened rarely, some patients experienced reduced vision or even blindness if the infection spread to their eye socket.
Blood vessel complications
Infection that spreads to the veins around sinuses can cause aneurysms and blood clots that interfere with the blood supply to your brain. This can lead to infarctions!
Diagnosis of sinusitis
Because patient’s nose can get stuffy during some other conditions such as common cold, patient may confuse simple nasal congestion associated with cold with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.
Physical examination including a detailed patient’s history is sometimes enough to set the appropriate diagnosis. If your symptoms are vague or persist, your health care provider may order a CT (computed tomography) or X-ray scan to confirm that you have sinusitis.
If the doctor can't set the right diagnosis just from physical examination, it can do several other tests! Laboratory tests to diagnose chronic sinusitis may include:
Blood tests
These tests are done to rule out other conditions associated with sinusitis like an immune deficiency disorder or cystic fibrosis.
Cultures
These are special blood tests which are done in order to detect bacterial or fungal infection.
Biopsy
Biopsy is done to determine the health state of the cells lining the nasal cavity.
Treatment of sinusitis
Acute sinusitis
If a person is diagnosed with acute sinusitis, several treatment options could be beneficial. The most common may include use of:
Decongestants to reduce congestion
Antibiotics to control a bacterial infection, if present
Pain relievers to reduce any pain
Problem is that sometimes patients are using these over-the-counter or prescription decongestant nose drops and sprays for to long! They should be used for only few days because they can lead to even more congestion and swelling of nasal passages. If the sinusitis is caused by a virus, then the antibiotics will not help but, the condition usually resolves spontaneously in few days!
Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis successfully, because the symptoms persist even after taking antibiotics for a long period. Many general practitioners are treating chronic sinusitis as though it is an infection, by using antibiotics and decongestants, but not with success. Others use both antibiotics along with steroid nasal sprays.
Treatment options that could relieve some symptoms are:
Inhaling steam from a vaporizer or a hot cup of water
Saline nasal spray can give relief.
Gentle heat applied over the inflamed area is comforting.
Surgery for sinusitis
The most common surgery done today is called Functional endoscopic sinus surgery. This operation the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare. Surgery should be considered only after failure of medical treatment. Other types of surgery can correct bent nasal cartilage. This operation is called septoplasty. Other operations can remove nasal polyps that may be the cause of sinusitis.
Tips for prevention of sinusitis
There are several things that every person could do to reduce risk of developing sinusitis. Some of these steps are:
Risk of upper respiratory infections must be minimized. This can be done by minimizing close contact with people who have colds and washing hands frequently with soap and water.
Quitting with smoking. Tobacco smoke can cause irritation and inflammation of the lining of the sinuses and nose. Inflammation can result in blocked nasal passages.
Avoiding polluted air. Contaminants in the air can irritate and inflame your lungs and nasal passages.
Usage of humidifiers
Self-care
Steam your sinuses often by inhaling steam several times a day. It will stimulate drainage from the sinuses.
Warm compresses should be applied daily.
Every person diagnosed with sinusitis should drink as much fluids as it can because diluting secretions and promoting drainage by consuming additional fluids is very beneficial.
Don't drink alcohol. Drinking alcohol can worsen the swelling of the lining of the sinuses and nose.
have a flu vaccinations
keep your allergy symptoms under control
Swimming in pools treated with chlorine, which irritates the lining of the nose and sinuses, should be avoided.
General Treatment Approaches
The primary objectives for treatment of sinusitis are reduction of swelling, eradication of infection, draining of the sinuses, and ensuring that the sinuses remain open. Fewer than half of patients reporting symptoms of sinusitis need aggressive treatment. Home remedies can be very useful.
Treatment of Acute Sinusitis.
Support treatment with only saline nasal irrigation, decongestants, antihistamines, and expectorants are appropriate for a minimum of 7 - 10 days for patients with mild-to-moderate symptoms, and may be used for longer.
Antibiotics are not helpful for patients with mild-to-moderate symptoms, so they should not be prescribed for at least the first 7 days.
Treatment of Chronic Sinusitis.
A broad-spectrum antibiotic (one that can eliminate a wide range of bacteria) may be helpful. Some patients benefit from prolonged therapy.
A corticosteroid nasal spray. Some doctors also recommend oral corticosteroids (such as prednisone) for patients who do not respond to nasal corticosteroids or for those patients who have nasal polyps. Prednisone is also used for patients who have allergic fungal sinusitis.
Saline nasal irrigation is often needed on an ongoing basis.
If the condition dramatically improves after 1 - 2 months, antibiotics are stopped. The patient should continue with both the steroid and saline nasal solutions. If there is no improvement after this time, surgery may be considered. For some people with chronic sinusitis, however, the condition is not curable, and the goal of treatment is to improve the quality of life.
A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.
Hydration
Home remedies that open and hydrate sinuses may, indeed, be the only treatment necessary for mild sinusitis that is not accompanied by signs of acute infection.
Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Water is the best fluid and helps lubricate the mucus membranes. (There is NO evidence that drinking milk will increase or worsen mucus, although milk is a food and should not serve as fluid replacement.)
Chicken soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although laboratory studies have actually reported that ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
Spicy foods that contain hot peppers or horseradish may help clear sinuses.
Inhaling steam 2 - 4 times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water (no one should ever inhale steam from water as it boils) while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water. Long, steamy showers, vaporizers, and facial saunas are alternatives.
Nasal Wash
A nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased in a spray bottle at a drug store or made at home. (Mix 1 teaspoon of table, Kosher, or sea salt with 2 cups of warm water. Some people add a pinch of baking soda.) Perform the nasal wash several times a day. Researchers have reported that daily irrigation of the nasal passages with a hypertonic saline solution relieves sinusitis symptoms and also reduces antibiotic use and the occurrence of acute exacerbations.
A simple method for administering a nasal wash is:
Lean over the sink head down.
Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
Spit out the remaining solution.
Gently blow the nose.
Neti pots have also become popular in recent years for prevention and treatment of sinusitis. Nasal irrigation with a saline solution through a neti pot involves:
Lean over the sink with your head tilted to one side.
Insert the spout of the neti pot in the upper nostril.
Slowly pour the salt water into your nose while continuing to breathe through your mouth.
The water will flow through the upper nostril and out through the lower nostril.
When the water finishes dripping out, blow your nose.
Reverse the tilt of your head and repeat the process with the other nostril.
Antibiotic Use in the Treatment of Sinusitis
Overview on Antibiotics and Their Overuse. Sinusitis is the fifth most common diagnosis for antibiotic prescriptions. But there is much evidence that antibiotics are inappropriately prescribed for many patients:
Most acute sinusitis cases clear up on their own.
Antibiotics generally help only a very small number of children with persistent nasal discharge for at least 20 days. Even when antibiotics are helpful, benefits are modest in reducing duration of the infection.
The intense and widespread use of antibiotics (not only for sinusitis but also for ear infections and other upper respiratory tract infections) has led to a serious global problem, which is bacterial resistance to common antibiotics.
When to Use Antibiotics. Antibiotics should usually be reserved for select patients who are at higher risk for developing bacterial infections. Because up to 80% of sinusitis cases resolve on their own within 2 weeks, doctors generally wait 7 - 14 days before prescribing antibiotics. Some doctors feel that antibiotics still should not be prescribed if symptoms last longer than 10 days. However, antibiotics may be prescribed sooner if severe symptoms develop. These symptoms include:
Fever greater than 39° C (102.2° F)
Facial pain or headache
Severe swelling around the eyes
Chronic sinusitis is often the result of damage to the mucus membrane from a past, untreated acute sinus infection. The aerobic and anaerobic bacteria present in chronic sinusitis are often different from those that cause the acute form. The role of antibiotic treatment for chronic sinusitis is controversial. Special types of antibiotics may be used, and treatment may be needed for a longer time.
Some patients with chronic sinusitis may need intravenous antibiotic therapy, particularly those with underlying medical disorders that can worsen their condition. This therapy is typically given 2 weeks before surgery and continued for about a month afterwards.
Antibiotic Regimens.
The standard first-line antibiotic treatment for acute uncomplicated bacterial sinusitis is a 10 - 14 day course of amoxicillin. Trimethoprim-sulfamethoxazole is an alternative choice.
For more complicated illnesses (chronic illness, chronic sinusitis, symptoms lasting longer than 30 days, children in day care or younger than 2 years old, smokers, recent antibiotic use, or unresponsiveness to initial antibiotic course), the doctor may prescribe a different type of antibiotic, such as amoxicillin-clavulanate, cephalosporin, or a macrolide.
If the patient does not respond after 21 - 28 days, the doctor may switch to another broad-spectrum antibiotic, such as amoxicillin-clavulanate, cefuroxime, or cefpodoxime. Other choices include clarithromycin or azithromycin (macrolides) or levofloxacin (a fluoroquinolone).
Side Effects of Antibiotics. Most antibiotics have the following side effects (although specific antibiotics may have other side effects or fewer of the standard ones):
The most common side effect for nearly all antibiotics is gastrointestinal distress.
Antibiotics double the risk for vaginal infections in women. Taking supplements of acidophilus or eating yogurt with active cultures may help restore healthy bacteria that offset the risk for such infections.
Allergic reactions can also occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
Certain drugs, including some over-the-counter medications, interact with antibiotics; patients should inform the doctor of all medications they are taking and of any drug allergies.
Managing Sinusitis in Patients with Allergies
Patients often have various combinations of allergies, sinusitis, and asthma. Treating each condition is important for improving them all. In addition to decongestants, pain relievers, and expectorants, other remedies are available for people who suffer from nonbacterial sinusitis during allergy season.
Anti-Inflammatory Drugs. Nasal spray corticosteroids (commonly called steroids) are important for reducing the inflammatory response in the nasal passages and airways. They are important in the treatment of asthma and are now considered to be the most effective measure for preventing allergy attacks. Leukotriene-antagonists are also useful for sinusitis symptoms.
Antihistamines. Antihistamine tablets relieve sneezing and itching and can prevent nasal congestion before an allergy attack. Many brands are available by prescription and over the counter. Because they thicken mucus and make it harder to drain out from the sinuses, they should not be used for sinusitis.
Immunotherapy. Immunotherapy, commonly referred to as allergy shots, may be considered for patients with severe seasonal allergies that do not respond to treatment. Immunotherapy is the only treatment that affects the cause of allergies.
All drug treatments have side effects, some very unpleasant and, rarely, serious. Patients may need to try different drugs until they find one that relieves symptoms without producing excessively distressing side effects.
Emergency Treatment:
Patients who show signs that infection has spread beyond the nasal sinuses into the bone, brain, or other parts of the skull need emergency care. High dose antibiotics are administered intravenously, and emergency surgery is almost always necessary in such cases.
Severe Fungal Sinusitis. Sinusitis caused by severe fungal infections is a medical emergency. Treatment is aggressive surgery, and high-dose antifungal chemotherapy with a drug such as amphotericin B can be life saving.
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