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.
Symptoms > 1 Week Are Not A Reason To Prescribe
One very important new finding in this meta-analysis that should change practice is that the duration of illness did not predict a positive response to antibiotics.
Current national recommendations are to use an antibiotic for patients with a duration of illness longer than 1 week, as these patients are presumably more likely to have a bacterial infection.- However, that recommendation had been based on expert opinion, not on data from clinical trials. A longer duration of symptoms should not be a reason to prescribe an antibiotic for sinusitis symptoms.
Which Individuals Are At Greater Risk Of Developing Sinusitis
- Any factor that predisposes to obstruction of the sinus ostia, ciliary dysfunction, or thickening of secretions will predispose the patient to bacterial sinusitis. These factors can be divided into systemic and local factors and are listed inTable II. The most common factors are viral infection and nasal allergy.
Table II.
URI, urinary respiratory tract infection.
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Cant Get Rid Of A Sinus Infection After Tooth Extraction
My dentist extracted an old root canal tooth because after two root canals from an endodontist, three years apart, the tooth was still painful. After my dentist removed the tooth, he said that an infection in the roots spread into my sinus. He cleaned the sockets, bone grafted the holes, and stitched it. After taking 150mg of clindamyacin for ten days, I still have the infection. Its been a week since I finished the medication, but my sinus is draining, and I feel pressure in my face and gum. Decongestant doesnt work. I have been thinking about scheduling an emergency appointment with another dentist just to get a second opinion, but I decided to find a dentist online to ask. Thats why I am writing your office.
Do I need more clindamyacin or a different antibiotic? Or is what I am experiencing part of the healing process?
Thanks for your help. Leidi
Leidi,
Thank you for your clear explanation. Although Dr. Finley would need to examine your tooth and x-rays for an accurate diagnosis, we can provide some insight on what might be happening. An urgent visit with a dentist that you dont know may do more harm than good. A conscientious dentist will review your dental history and exams and even consider referring you to a specialist.
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Related Resources For Sinus Infections
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
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Caveats: Refer Seriously Ill Patients And Complicated Cases
A very important caveat to our recommendation is that seriously ill patients must be managed differently. Very infrequently a patient develops a serious complication of acute sinusitis such as brain abscess, periorbital cellulitis, or meningitis. Therefore, seriously ill patients with signs and symptoms of acute bacterial sinusitis, such as high fever, periorbital erythema or edema, severe headache, or intense facial pain must be carefully evaluated and treated with great caution and close follow-up. These patients should be referred immediately for consultation with an otolaryngologist.
Upper Tooth Extraction And Sinus Infections
Upper molar tooth roots are close to the sinus. Sometimes only a thin membrane separates them. And that membrane can easily rupture during tooth extraction and result in sinus perforation.
If youre leaky filling hurts or is irritated, dont delay getting it replaced
Treatment Surgically close the perforation using sponge-like surgical gelatin or bone grafting material. Stitch over the opening. As a patient, you must be gentle with the surgical site and allow it to heal. Clindamycin or another antibiotic is appropriate.
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What Tests Diagnose The Cause Of Sinus Infections And Sinusitis
Sinus infection is most often diagnosed based on the history and examination of a doctor. Because plain X-ray studies of the sinuses may be misleading and procedures such as CT and MRI scans, which are much more sensitive in their ability to diagnose a sinus infection, are so expensive and not available in most doctors’ offices, most sinus infections are initially diagnosed and treated based on clinical findings on examination. These physical findings may include:
- redness and swelling of the nasal passages,
- purulent drainage from the nasal passages ,
- tenderness to percussion over the cheeks or forehead region of the sinuses, and
- swelling about the eyes and cheeks.
Occasionally, nasal secretions are examined for secreted cells that may help differentiate between infectious and allergic sinusitis. Infectious sinusitis may show specialized cells of infection while allergic sinusitis may show specialized white blood cells of allergy . Physicians prescribe antibiotics if the bacterial infection is suspected. Antibiotics are not effective against viral infections many physicians then treat the symptoms.
In addition, both rigid and flexible endoscopy has been used to obtain diagnostic material from sinuses. These procedures are usually done by an otolaryngologist under topical and local anesthesia. Occasionally, there may be a need to sedate the patient. Some investigators suggest that endoscopy specimens are comparable to those obtained by needle puncture.
What Are The Six Types Of Sinusitis And Sinus Infections
Sinusitis may be classified in several ways, based on its duration and the type of inflammation . The term rhinosinusitis is used to imply that both the nose and sinuses are involved and is becoming the preferred term over sinusitis.
- Acute sinus infection usually lasts less than 3-5 days.
- Subacute sinus infection lasts one to three months.
- Chronic sinus infection is greater than three months. Chronic sinusitis may be further sub-classified into chronic sinusitis with or without nasal polyps, or allergic fungal sinusitis.
- Recurrent sinusitis has several sinusitis attacks every year.
There is no medical consensus on the above time periods.
- Infected sinusitis usually is caused by an uncomplicated virus infection. Less frequently, bacterial growth causes sinus infection and fungal sinus infection is very infrequent. Subacute and chronic forms of a sinus infection usually are the result of incomplete treatment of an acute sinus infection.
- Noninfectious sinusitis is caused by irritants and allergic conditions and follows the same general timeline for acute, subacute, and chronic as infectious sinusitis.
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Throat Irritation And Cough
As discharge from your sinuses drains down the back of your throat, it can cause irritation, especially over a long period of time. This can lead to a persistent and annoying cough, which can be worse when lying down to sleep or first thing in the morning after getting up from bed.
It can also make sleeping difficult. Sleeping upright or with your head elevated can help reduce the frequency and intensity of your coughing.
Untreated Sinus Infection Risks
Sinus infections often start to improve on their own after about 10 days. If your symptoms last longer without improving or if they worsen, a doctor may need to treat the underlying cause of the infection.
If a sinus infection affects a sinus cavity close to the brain, it can spread to the brain if left untreated. Though rare, an infection can also pass into the eye socket and cause vision changes or blindness. These types of infections are more common in kids.
While uncommon, a serious fungal sinus infection left untreated may pass into the bones.
Make an appointment with a doctor if you have severe symptoms, or if the following symptoms last longer than 10 days or keep coming back:
- fever
- congestion
- facial pain
Because the cause of your sinus infection can affect your treatment options, its important to see a doctor for a diagnosis. The Healthline FindCare tool can provide options in your area if youre looking for a doctor.
If you believe you have chronic or recurring sinusitis, consider asking for a referral to an otolaryngologist, also known as an ear, nose, and throat specialist. You may need imaging and other tests to determine the cause of your symptoms.
An ENT specialist can take a culture of nose drainage to better understand the cause of an infection. The ENT specialist can also examine the sinuses more closely and look for any problem in the structure of the nasal passages that could lead to chronic sinus problems.
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When Do You Really Need Antibiotics For That Sinus Infection
- By Monique Tello, MD, MPH, Contributor
It was February, and clinic was teeming with respiratory infections of all kinds: mostly the common cold, but also bronchitis, pneumonia, and sinus infections. The patients were coming in usually thinking that they needed antibiotics for their sinus infection, or another respiratory infection.The first patient on my schedule was a healthcare provider with sinus infection written down as her main issue.* Shed had about two weeks of nasal and sinus congestion which she blamed on a viral upper respiratory infection . Her two young kids had been sick with colds all winter, so she wasnt surprised to have these symptoms, along with endless postnasal drip and a cough.
Her congestion had improved a bit at one point, and she thought that she was finally getting better. But then, the day before her appointment, she awoke with throbbing pain between her eyes, completely blocked nasal passages, and, more concerning to her, green pus oozing from her left tear duct. She had body aches, chills, and extreme fatigue.
Upper Respiratory Infection Symptoms
- Fatigue
- Headache
Fever is a rare symptom of the common cold in adults but may be more likely in children.
Symptoms of an upper respiratory infection can last up to two weeks but usually peak at around three days and are gone within seven. Upper respiratory infections should clear up on their own without needing interventions from your healthcare provider.
But complications of colds can occur, including:
- Sinusitis: An infection in your sinuses causing pain and congestion
- Otitis media: An ear infection causing pain
- Pharyngitis: A sore throat, which might be strep throat
- Epiglottitis: An infection and resulting swelling of the epiglottis, a flap of tissue that covers your windpipe, which can interfere with breathing
- Laryngotracheitis: Infection of the larynx , trachea, or bronchi
Some of these complications may require treatment with antibiotics.
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If I Am Not Sure What Pathogen Is Causing The Infection What Anti
Because of the invasiveness of sinus puncture the specific pathogen causing sinusitis is rarely known. Thus nearly all therapy for sinusitis is empirical. The exception is when complications of sinusitis allow for the sampling of a fluid collection that can be sent for culture. Treatment options are summarized in Table IV.
Table IV.
-
antibiotic use within the past month
immunocompromised state
- Respiratory fluoroquinolones are not recommended for first-line therapy for ABS as there is no evidence that they are superior to -lactam agents. GRADE: weak, moderate
- For second-line therapy or in the penicillin allergic patient:
Macrolides are not recommended due to high rates of pneumococcal resistance. GRADE: strong, moderate
Trimethoprim/sulfamethoxazole is not recommended due to the high rate of pneumococcal and H. influenzae resistance. GRADE: strong, moderate
Doxycycline may be used in adults. GRADE: weak, low
In children with non-type I penicillin allergy the combination of an oral, third-generation cephalosporin plus clindamycin may be used. GRADE: weak, moderate
A respiratory fluoroquinolone may be used.
- It is not necessary to cover S. aureus during empiric therapy. GRADE: strong, moderate
- The recommended duration of therapy for ABS is:
5 to 7 days in adults. GRADE: weak, low to moderate
10 to 14 days in children. GRADE: weak, low to moderate
Managing Side Effects Of Antibiotics
While there are some cases in which you may be prescribed antibiotics for a common cold, these medications aren’t harmless. There are many side effects of antibiotics. Some are common, and others can be severe and potentially deadly.
- Allergic reactions
- Vaginal itching or yeast infections
- Nausea and vomiting
In a dataset from 2013 and 2014, adverse drug reactions caused 4 out of every 1,000 emergency room visits each year. The most common reason for the visit among children was an adverse reaction to antibiotics.
If you or your child is experiencing side effects from a prescribed antibiotic, make sure to tell your healthcare provider to be certain its nothing to worry about. Theyll also let you know if you should continue taking it or stop.
If youre taking antibiotics, here are a few things you can do to help ward off some side effects of antibiotics:
- Take a probiotic and eat fermented foods like yogurt and kefir.
- Limit sun exposure.
- Take your antibiotic as prescribed .
- Make sure to store it correctly .
- Ensure your healthcare provider knows about all other drugs and supplements youre taking.
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How To Take Azithromycin
Use Azithromycin exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Azithromycin oral is taken by mouth. Azithromycin injection is given as an infusion into a vein, usually for 2 days before you switch to azithromycin oral. A healthcare provider will give you this injection.
You may take azithromycin oral with or without food.
Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device .
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Azithromycin will not treat a viral infection such as the flu or a common cold.
Store at room temperature away from moisture and heat. Throw away any unused liquid medicine after 10 days.
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
Are There Any Potential Side Effects
Gastrointestinal upset in both dogs and cats has been reported, including vomiting, diarrhea, and occasionally bloody diarrhea in dogs.
Cats may experience drooling and lip smacking after giving the medication.
It is important to never dry pill a cat if using capsules or tablets as esophagitis can occur.
If your pet appears to have trouble swallowing or eating, or has bloody diarrhea, contact your veterinarian immediately.
This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.
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What Is The Treatment For Chronic Sinus Infection
When it comes to treating chronic sinusitis, theres no one-size-fits-all solution. While several treatment options are available, what works for one person may not be appropriate for the other. Hence, we tailor the treatment to each individuals needs, symptoms, and whether or not other conditions are also at play.
The goals of treating chronic sinusitis are to address the allergic causes, minimize inflammation, promote free sinus drainage, and eradicate the infection .
Here are a few potential treatment options for chronic sinusitis. We will likely try out a combination of two or more of these options to see what works best for you.
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Diagnosing A Sinus Infection
Since you cant tell if an infection is viral or bacterial just from looking at the symptoms, your surgeon will most likely run a few tests to diagnose the problem before recommending treatment. Diagnosing the infection can involve imaging to examine the sinuses and a mucus culture. Taking a sample of mucus from the nose or sinuses will help your surgeon determine if a bacteria is to blame and, if so, what type of bacteria is responsible. Knowing the type of bacteria thats causing your infection allows your surgeon to prescribe the type of antibiotic that would be most effective in treating it.
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How To Treat A Sinus Infection Without Antibiotics
Before you consider antibiotics, a sinus infection can be treated without leaving at home. Some of the home remedies to treat a sinus infection without antibiotics include: