How Is Sinus Infection Diagnosed
Diagnosis depends on symptoms and requires an examination of the throat, nose and sinuses. Your allergist will look for:
- Discolored nasal discharge
If your sinus infection lasts longer than eight weeks, or if standard antibiotic treatment is not working, a sinus CT scan may help your allergist diagnose the problem. Your allergist may examine your nose or sinus openings. The exam uses a long, thin, flexible tube with a tiny camera and a light at one end that is inserted through the nose. It is not painful. Your allergist may give you a light anesthetic nasal spray to make you more comfortable.
Mucus cultures: If your sinus infection is chronic or has not improved after several rounds of antibiotics, a mucus culture may help to determine what is causing the infection. Most mucus samples are taken from the nose. However, it is sometimes necessary to get mucus directly from the sinuses.
Knowing what kind of bacteria is causing the infection can lead to more effective antibiotic therapy. A fungus could also cause your sinus infection. Confirming the presence of fungus is important. Fungal sinus infection needs to be treated with antifungal agents, rather than antibiotics. In addition, some forms of fungal sinus infection allergic fungal sinus infection, for example do not respond to antifungal agents and often require the use of oral steroids.
When Does Antibiotic Resistance Occur
Antibiotic resistance occurs in a persons own body and within the community when certain drugs no longer work for a specific type of germ. This can occur when bacteria change in response to exposure to antibiotics so that the antibiotics no longer work efficiently against the bacteria.
Unfortunately, it’s hard to know if a sinus infection is bacterial, viral, or has other causes based on symptoms alone. Because viral sinus infections tend to improve in 5 to 7 days, healthcare providers will usually only prescribe antibiotics if your symptoms go on for longer than this. A sinus infection that persists for longer than a week or continues to get worse during this time period is more likely to be bacterial.
Therefore, allergists and other specialists recommend limiting the use of antibiotics unless:
- Symptoms last over seven to 10 days
- A fever is present
Pain Or Pressure In Your Sinuses
Facial pain is a common symptom of sinusitis. You have several different sinuses above and below your eyes, as well as behind your nose. Any of these air-filled cavities can hurt when you have a sinus infection.
Inflammation and swelling can cause your sinuses to ache with dull pressure. This is because inflammation may alter the typical path of mucus from the nose to the back of the throat.
You may feel pain in:
- on either side of your nose
- in your upper jaws and teeth
- between your eyes
This may lead to a headache. Headaches caused by sinus infections can occur where the sinuses are or in other places.
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Do I Need Antibiotics For A Sinus Infection
Sinus infections can be extremely frustrating, especially when you have a headache and facial pain that doesnt go away, coupled with the inability to breathe through your nose. You want immediate relief, but unfortunately, it takes at least a few days to start feeling better. You may think you need to go to the doctor and get antibiotics for a sinus infection, but this isnt always the case.
In the winter months, sinus infections, colds, bronchitis, pneumonia, the flu, and other respiratory infections are common. Patients think that if they come down with an illness, they will require antibiotics. However, most sinus infections dont require antibiotics.
Sore Throat And Hoarse Voice
Postnasal drip can leave you with a raw and aching throat. Although it may start as an annoying tickle, it can get worse.
If your infection lasts for a few weeks or more, mucus can irritate and inflame your throat as it drips, resulting in a painful sore throat and hoarse voice. Frequent coughing and throat clearing can make a hoarse voice worse.
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How Can I Tell If I Have A Sinus Infection Cold Or Nasal Allergy
It can be difficult to tell the difference between a cold, allergies, and a sinus infection. The common cold typically builds, peaks, and slowly disappears. It lasts a few days to a week. A cold can transform into a sinus infection. Nasal allergy is inflammation of the nose due to irritating particles . Symptoms of a nasal allergy can include sneezing, itchy nose and eyes, congestion, runny nose, and post nasal drip . Sinusitis and allergy symptoms can happen at the same time as a common cold.
If you are fighting off a cold and develop symptoms of a sinus infection or nasal allergy, see your healthcare provider. You will be asked to describe your symptoms and medical history.
How To Treat A Sinus Infection At Home
In the first two weeks of a sinus infection, patients may use saline sprays, over-the-counter steroid sprays like Flonase, and over-the-counter decongestants.
After 10 days, if the drainage is still colored, an antibiotic is likely necessary. Theres no homeopathic alternative to antibiotics. However, saline spray, topical steroid sprays, and decongestants work well with antibiotics to clear most infections.
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Types Of Sinus Infections: Chronic Vs Acute
There are four types of sinus infections. These classifications depend on the length and frequency of the infection:
- Acute sinusitis.This type of sinus infection lasts only for a short time, defined by the American Academy of Otolaryngology as less than 4 weeks. This short-term infection is usually part of a cold or other respiratory illness. It may also be caused by a bacterial infection .
- Subacute sinusitis. A subacute sinus infection lasts between 4 and 12 weeks .
- Recurrent acute sinusitis. An acute sinus infection is considered recurrent if the infection returns four or more times within a year, with each infection lasting 7 days or more.
- Chronic sinusitis.Chronic sinus infections last for more than 12 weeks or continue to recur.
Many sinus infection symptoms are common in both acute and chronic forms. Seeing a doctor is the best way to learn if you have an infection, find the cause, and get treatment.
For cases of acute bacterial sinus infections, these symptoms last at least 10 days without improving, or they worsen within 10 days after seeming to improve. In this case, its important to talk with a doctor, such as a general practitioner or an ear, nose, and throat doctor , to get a diagnosis and treatment plan.
Learn more about the symptoms of a sinus infection below.
When To Contact A Doctor
Reach out to your physician or a doctor if you have severe symptoms or if the following symptoms persist for longer than ten days or keep returning:
- Nasal discharge
- Facial and sinus pain
Because the cause of your sinus infection will determine the appropriate treatment options, its crucial to see a doctor for a diagnosis sooner rather than later. Several online tools can help you find a local provider covered by your insurance.
If you think you have a chronic or recurring sinus infection, think about getting a referral to an otolaryngologist, also called an ear, nose, and throat doctor. A CT scan and other diagnostic tests might be necessary to determine the cause of your condition.
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But Sometimes Antibiotics For Sinus Infections Are Needed
So how does one judge when it is appropriate to prescribe antibiotics for a sinus infection? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if its been less than 10 days, they meet criteria for antibiotic treatment.
The authors, however, also suggest that doctors discuss watchful waiting with patients and explain that most sinus infections clear up on their own in one to two weeks, and its a safe option to hold off on antibiotics. The symptoms can then be treated with a cocktail of over-the-counter medications and supportive care, like nasal saline irrigation, nasal steroid sprays, decongestants, and pain medications.
Of course, many patients expect and demand antibiotics for sinus infections, and even those who are open to watchful waiting may hear about the rare but possible complications of things like, oh, brain abscess, and opt to treat.
In the case of my patient above, she met criteria for treatment. She weighed the watchful waiting option against the potential risks of antibiotics for her sinus infection, and chose the prescription. I can tell you from very close follow-up that she improved quickly, though in truth, we will never really know if she would have gotten better anyway.
What Happens When Unnecessary Antibiotics Are Prescribed
Research shows that even bacterial infections can clear up on their own without antibiotics within one to two weeks. This means that the majority of the time, antibiotics are unnecessarily prescribed. Of all sinus infections, 85% clear up on their own, while only 15% do not. This 15% is the population that needs antibiotics.
Consuming antibiotics, even when you need them, increases side effects and bacterial resistance rates. This means that the more antibiotics prescribed, the more the bacteria will adapt to become resistant to that specific antibiotic. And there are only so many antibiotics to go around, so resistance should not be taken lightly. Thats why the overprescription of antibiotics is a public health emergency.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antibiotics for sinusitis
Reasons not to take antibiotics
I know I have a bacterial infection that is causing my sinusitis.
A virus is causing my sinusitis.
What You Need To Know About Sinus Infections
As the fall months approach, the potential for seasonal allergies, runny noses and sinus infections increases.
Sinus infections happen when fluid builds up in the air-filled pockets in the face. This allows germs to grow. Viruses cause most sinus infections, but bacteria can also be the culprit.
When people say they have sinus pressure, they may mean nasal congestion, Grayson said. Bilateral congestion could mean a person has a viral infection or an allergic reaction. Viral infections dont pick and choose a side.
Grayson adds that people who live in more humid climates like the South tend to suffer more from seasonal allergies because the humidity allows more fungus to grow, and long growing seasons allow for other trees, grasses and weeds. Living in cities can also affect people with allergies due to dust mites.
If your sinus pressure is isolated, you might have a bacterial infection, she said. Thats when you really should go see a doctor. With a virus, you just have to let it run its course.
Some people do get repetitive events, and people who work with small children, such as teachers or day care workers, are more likely to get recurrent viral infections.
Jessica Grayson, M.D.That pesky flu
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How Can You Help Your Patient
What to do, then, for patients with acute sinusitis? Treat the symptoms, which means recommending pain medication for facial pain or headache and saline nasal spray for the nasal discharge, not antibiotics or nasal corticosteroids. Side effects will be fewer and costs will be lower.
- Saline irrigation. A 2007 Cochrane review of 8 chronic and recurrent sinusitis trials showed that nasal saline irrigation is effective for reducing symptoms of chronic and recurrent sinusitis.8 Although we do not have high-quality RCT data on saline nasal irrigation for treatment of acute sinusitis, nasal saline irrigation is harmless and inexpensive.
- What about nasal steroids? The evidence is equivocal, and the most recent high-quality RCT of nasal steroids showed no effect.9
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Do Antibiotics Treat Sinus Infections
Antibiotics are a type of medication that stops bacteria from growing and, as a result, improves symptoms of an infection.
Healthcare providers only prescribe antibiotics for sinus infections that they believe are bacterial.
Antibiotics dont work on viral or fungal infections, and taking antibiotics when you dont need them can cause unnecessary side effects such as diarrhea, nausea, and stomach pain.
Plus, taking antibiotics too often can create antibiotic resistance.
The most common antibiotics prescribed for sinus infections are penicillin-class antibiotics such as amoxicillin or amoxicillin-clavulanate .
If you have a penicillin allergy, a common alternative is doxycycline.
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How To Get Rid Of Sinusitis
If you want to get rid of your sinusitis, you and your ENT will need to work together to discover the source of your sinus infections. For example, your sinusitis might always be precipitated by a cold, or you could have a deviated septum and sinusitis or sinusitis and sleep apnea. Regardless, finding the root cause behind your recurrent or prolonged sinusitis will help determine treatment.
Once the source of your sinus infections is found, you and your ENT will need to discuss treatment options. For those with recurrent sinus issues, one treatment, in particular, has proven itself effective again and again. That treatment option is balloon sinuplasty.
Balloon sinuplasty is a minimally invasive, in-office procedure that takes less than 20 minutes to perform and requires little to no recovery time.
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What Are The Most Common Antibiotics Used For Sinusitis
Amoxicillin remains the drug of choice for acute, uncomplicated bacterial sinusitis. Amoxicillin is most effective when given frequently enough to sustain adequate levels in the infected tissue. While often prescribed twice daily, it is even more effective if taken in 3 or 4 divided doses. Amoxicillin is typically prescribed for 7-10 days at a time. While it is critical to finish the entire 10 day course of antibiotics when treating strep throat, there is evidence that shorter courses of treatment may be sufficient for most cases of sinusitis. Amoxicillin is closely related to the parent compound penicillin and should not be prescribed in patients who are penicillin allergic.
Cephalosporins and Augmentin are considered broad-spectrum antibiotics because they have enhanced effectiveness against a wider range of bacteria, including those that are resistant to ordinary penicillin or amoxicillin. If the patient does not improve within the first week on amoxicillin, a change to Augmentin or to a cephalosporin such as Ceftin, Cefzil, Omnicef, or Suprax is reasonable. Although these drugs have a similar mechanism of action to penicillin, they generally can be taken in adequate doses once or twice daily. These medications should be used with extreme caution in patients with a history of penicillin allergy, as cross-reaction may occur.
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Why Do I Need Antibiotics For Sinus Infection
You should use antibiotics for a sinus infection when it is clear that its been caused by bacteria.
Its probably a bacterial infection if you notice the following:
- Symptoms persist for seven days or more, especially if they seem to get better and then worsen.
- Your mucus is yellow or green and thick.
- Your facial or sinus tenderness is severe, mainly if one side of your face is worse.
- Pain in your upper teeth area is worse on one side.
Contact your physician if the infection becomes severe, comes back, or isnt getting better on its own.
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Why Antibiotics Wont Help And Might Hurt
Almost all URIs are caused by viruses, and at present we dont have medications that work against them.
As for the small percentage of upper respiratory infections caused by bacteria, most go away on their own and often just as quickly even if you dont take antibiotics. So if theres a chance antibiotics can help, whats the harm?
There are many reasons to be conscientious about taking antibiotics, including breeding resistant superbugs or making your health care cost more. However, theres another reason thats of immediate concern: diarrhea. Antibiotics can wreak havoc in your intestines and upset the normal balance of bacteria including the bacteria that help you digest food, which can lead to abdominal pain, bloating, gas, and alternating diarrhea and constipation. Taking multiple courses of antibiotics puts you at risk of potentially long-lasting effects on your gut.
Like everything health-related, the decision about whether to take antibiotics for a bacterial infection comes down to weighing the risks and benefits. Your provider will be happy to discuss the decision with you in detail.