What Takes Place During Surgery
Functional endoscopic sinus surgery is the standard surgical treatment for chronic sinusitis. It is performed with a nasal endoscope that enters the sinuses through the nostrils. This avoids any visible incisions or scars.
The endoscope is a surgical tool that looks like a thin metal rod with a camera at the tip. The camera acts as a telescope and shows enlarged images of the sinuses on a monitor. It allows the surgeon to take a deeper look at the sinuses to see exactly where the block is.
The goal of sinus surgery is to remove any bone or inflamed tissue that is crowding the sinus openings. This opens up your sinus passages and helps them to drain. FESS is usually performed under general anesthesia on an outpatient basis, meaning you can go home the same day. The procedure takes about 2 hours.
When To Take Antibioticsand When Other Treatments May Work Better
If youve been knocked out by sinus infection symptomsstuffiness, face pain or pressure, nasal dischargeyour doctor might recommend that you wait it out for a week or so before resorting to an antibiotic. And she or he might be right: Antibiotics are often not necessary for clearing up a sinus infection, according to recent research.
As a result, many health experts, including Zara Patel, M.D., a sinus infection expert and assistant professor of otolaryngology at Stanford University in Stanford, Calif., are urging doctors to think twice before prescribing antibiotics for sinus and other respiratory infections.
A 2016 study, published in JAMA, found that people who went to the doctor with a sinus infection were more likely to leave with a prescription for antibiotics than people seeing the doctor for any other reason . But some doctors, pointing to newer evidence, are starting to take a more cautious approach.
For acute sinusitis, there are very well-done studies indicating that antibiotics are not necessary in the vast majority of patients, and most people will be able to clear an infection on their own, Patel says.
Research And Statistics: Who Gets Sinus Infections
Each year, acute sinusitis affects about 31 million Americans, who spend a whopping $1 billion on over-the-counter medications and $150 million on prescription medications to treat the illness, according to the American College of Allergy, Asthma, & Immunology.
Epidemiologic studies suggest 5 to 12 percent of people have chronic sinus infections. However, research published in December 2018 in The Journal of Allergy and Clinical Immunology suggests this may be an overestimation due to misdiagnosis. According to the study, which relied on imaging tests for diagnosis , about 3.0 to 6.4 percent of people may have chronic sinus infections. 32786-6/fulltext” rel=”nofollow”> 5)
Is Your Sinus Infection Caused By A Virus Or Bacteria
Physicians may not know if sinusitis is bacterial or viral, because the diagnosis is typically done by observing symptoms. Symptoms include:
- Nasal congestion
- Thick nasal or post-nasal drainage
Sometimes other tests such as computed tomography scan or cultures are used to help make the diagnosis.
Despite the recommendations that antibiotic use be judicious, they are still overused for sinusitis, according to many physicians who specialize in treating sinus problems.
Some physicians say they give patients with sinusitis a prescription for antibiotics, and recommend they wait three to five days before filling it, and only fill it if symptoms are not better by then. A can be used to help relieve your symptoms and promote drainage.
The longer symptoms last, the more likely a sinus problem is to be a bacterial infection, some experts say.
How Can I Prevent Sinusitis
Some of the home remedies used to treat sinus infections symptoms may help prevent sinusitis. These include rinsing your nose out with salt water and using medications that your provider might suggest, such as allergy medications or steroid nasal sprays.
You should avoid things you are allergic to, like dust, pollen or smoke, and try to avoid sick people. Wash your hands to reduce your chance of getting a cold or flu.
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Two Types Of Sinus Infections
Lets differentiate between acute and chronic sinus infections. Acute sinus infections can last up to 4 weeks. If you are experiencing sinus infection symptoms for longer than 2 weeks, it doesnt mean you have a bad case of sinusitis this is normal. If you experience symptoms for longer than 4 weeks, this can be considered subacute anything that lasts longer than 12 weeks is considered chronic.
Now, lets differentiate between bacteria and viruses. Either of the two can infect the body, and each warrants a different course of treatment. Bacterial infections require antibiotics, while viral infections do not they resolve themselves. All you can do in the latter case is to drink plenty of fluids, rest, and take decongestants. The majority of cases are viral, in which case your doctor cant prescribe you with anything other than decongestants.
Risk Of Unnecessary Antibiotics For Sinus Infections
Taking unnecessary antibiotics for a sinus infection is not only ineffectual, but can actually be harmful to the patient. Risks of taking unneeded antibiotics include:
- Increased chance of getting an antibiotic-resistant infection at a later time
- Destruction of healthy stomach bacteria, which can allow harmful bacteria to grow
- Possible side effects, such as upset stomach, rash, or dizziness
- Allergic reaction
According to studies conducted by the American Academy of Allergy, Asthma, and Immunology , 60-70% of patients with sinus infections fully recover without the use of antibiotics. Additional research shows that almost 90% of U.S. adults diagnosed with acute sinusitis are prescribed antibiotics.
This overuse of antibiotics for sinus infections, as well as other conditions, can lead to antibiotic resistance, a state in which bacteria change over time as a reaction to antibiotic treatment, in order to survive and multiply, thus making the antibiotics less effective.
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When Do I Really Need Antibiotics For A Sinus Infection
When do I really need antibiotics for a sinus infection? is a question many patients have when suffering from bothersome sinus and allergy problems. While sinus infections can be quite painful, antibiotics often do not help in treating the condition.
Sinus infections affect approximately 37 million people in the U.S. each year and can be caused by:
- Nasal polyps or deviated septum causing nasal obstruction
The majority of sinus infections are viral in nature, and antibiotics do not cure viral infections. Taking antibiotics for viral infections also will not:
- Keep you from being contagious to others
- Relieve symptoms or make you feel better
In order to distinguish a bacterial sinus infection from an infection caused by a virus or other contributing factor, your doctor will observe your symptoms and possibly conduct other tests, such as a CT scan or cultures.
Antibiotics are only effective on bacterial infections, and even in cases involving bacteria, the body can often cure itself of mild or moderate infections within a few days.
Favorite Resources For Finding A Specialist
Through research, education, and advocacy, the American Rhinologic Society is devoted to serving patients with nose, sinus, and skull base disorders. Their website provides a valuable search tool to find a doctor, as well as links to other medical societies and resources that are useful for patients.
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How To Treat Sinus Infections Without Antibiotics
While sinus infections caused by viruses, allergies, or other non-bacterial factors may not require antibiotics, they still cause the same symptoms which make you feel sick.
Symptoms of a sinus infection include:
- Nasal congestion
- Pain or tenderness around the eyes, cheeks, or forehead
- Thick nasal or post-nasal drainage
Taking steps to alleviate your sinusitis symptoms is often the best treatment to lessen your discomfort.
Sinus infection treatment options include:
- Drink plenty of fluids
- Rest, especially the first few days, to help your body fight the infection
- Moisturize the air with a cool-mist vaporizer
- Elevate your head while sleeping to decrease post-nasal drip
- Take warm showers or baths, as steam can soothe your sore throat and loosen mucus
- Gargle with warm salt water for a sore throat
- Use saline nasal spray or nasal irrigation kit to alleviate congestion
- Use over-the-counter treatments, such as nasal drops and sprays or pseudoephedrine pills, as your doctor recommends them
What Not to Do for a Sinus Infection
You should always follow your doctors instructions when you are diagnosed with a sinus infection.
- Ask for antibiotics if your doctor feels they are unnecessary
- Take antibiotics that are prescribed for someone else
- Skip doses of your antibiotics or stop taking your antibiotics early when your doctor prescribes them
- Save antibiotics for the next time you get sick
What Home Remedies Help Soothe Sinus Infection Or Sinusitis Symptoms
Sinus infections caused by viruses can use home treatments such as pain and fever medications , decongestants, and mucolytics. In addition, some health care professionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusitis symptoms. This irrigation is accomplished with a “Neti-Pot” or a sinus rinse kit . The last reference of this article shows a video of a sinus rinse procedure. In 2012, the FDA issued a warning about the use of Neti-Pots. The FDA cautions people not to use untreated tap water for rinsing, as contaminated tap water rinses lead to two deaths.
Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some authors suggest home treatments may reduce symptoms after medical therapy has begun some healthcare professionals recommend nasal irrigation after sinus surgery.
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Most Sinus Infections Dont Require Antibiotics
Ah, . The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.
It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, theres the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
What Can I Do To Help Myself Recover
Your recovery time after sinus surgery depends on your personal health and the type of procedure you have. Your surgeon will tell you what to expect. But you may need to stay home from work for at least a week after your surgery. This may feel overwhelming, but the good news is, there are things you can do to help your recovery after sinus surgery:
Attend follow-up visits with your surgical team. After surgery, its important to follow up with your provider as instructed. At these visits, your provider will clean out blood and fluid from your nose and sinuses. These visits are important to make sure you are recovering well and to help your sinuses heal.
Flush your sinuses. You will be instructed to flush out your sinuses after surgery at least twice a day. Nasal irrigation devices, such as neti pots and squeeze bottles, help to clear debris and mucus. Its best to follow these instructions in order to heal quickly.
Do not smoke. Smoking interferes with the healing process and can result in failure of the surgery.
Avoid straining. Try to avoid straining, such as blowing your nose too hard or lifting anything greater than 20 pounds for 1 to 2 weeks. Straining yourself can worsen bleeding.
Avoid aspirin and NSAIDs. Dont take aspirin or NSAIDs for 1 to 2 weeks after surgery because these can worsen bleeding.
If you have questions about your instructions, or if you have unexpected discomfort, please contact your surgical team.
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Should You Visit A Specialist
If your sinus infection just wont go away or keeps coming back, it may be time to see an ear, nose, and throat specialist. An ENT treats conditions of the ear, nose, throat, head, face, and neck. It may be time to see an ENT if:
- Youve completed several courses of antibiotics without success
- Your doctor suspects nasal polyps or another blockage of the nasal cavity
- You have chronic sinusitis that lasts longer than 12 weeks
Living with a sinus infection is miserable and living with a sinus infection for weeks on end is worse. Contact your doctor or an ENT to get the treatment you need.
How Do You Diagnose Chronic Sinusitis
Its not possible to diagnose chronic sinusitis based on symptoms alone. Your provider will likely perform additional testing to help confirm the diagnosis, such as:
Examination of your nasal passages with tools such as a rhinoscope or endoscope, which may reveal swelling
Imaging with a CT scan of your sinuses, which can help detect inflammation
Allergy testing, which can help distinguish chronic sinus infections from environmental allergies
In some cases, you may also be tested to ensure that your immune system is working properly. A low immune system can explain why someone keeps getting sinus infections.
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Check If You Have Sinusitis
Symptoms of sinusitis include:
- pain, swelling and tenderness around your cheeks, eyes or forehead
- a blocked nose
- a reduced sense of smell
- green or yellow mucus from your nose
- a sinus headache
- bad breath
Signs of sinusitis in young children may also include irritability, difficulty feeding, and breathing through their mouth.
The sinuses are small, empty spaces behind your cheekbones and forehead that connect to the inside of the nose.
Sinusitis causes the lining of the sinuses to swell up.
This stops mucus draining into your nose and throat properly, making you feel blocked up.
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
- Bad Breath
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.
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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.
Duration Of Sinus Infection
Acute sinusitis causes inflammation and symptoms that often develop quickly and last 7 to 10 days if caused by a viral infection. But the illness can last for up to 4 weeks if it’s caused by a bacterial infection.
Chronic sinusitis lasts for 12 weeks or more. This inflammation can continue for months or years more, and people often describe them as a never-ending cold.
Sinusitis may also be classified as:
- Subacute, in which symptoms last for more than 4 weeks but less than 12 weeks
- Recurrent acute, in which there are at least four acute sinus infection episodes within one year
- Acute exacerbation of chronic rhinosinusitis, in which symptoms worsen in a person with chronic sinusitis
But having symptoms of sinusitis doesnt always mean that you have a sinus infection.
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