What Are The Sinuses How Many Do We Have
A sinus is a hollow, air-filled cavity. For the purposes of this article, a sinus will refer to those hollow cavities that are in the skull and connected to the nasal airway by a narrow hole in the bone . Normally all sinuses are open to the nasal airway through an ostium. Humans have four pair of these cavities each referred to as the:
The four pairs of sinuses are often described as a unit and termed the “paranasal sinuses.” The cells of the inner lining of each sinus are mucus-secreting cells, epithelial cells, and some cells that are part of the immune system .
Functions of the sinuses include humidifying and warming inspired air, insulation of surrounding structures , increasing voice resonance, and as buffers against facial trauma. The sinuses decrease the weight of the skull. If the inflammation hinders the clearance of mucous or blocks the natural ostium, the inflammation may progress into a bacterial infection.
What Is The Pathophysiology Of Pharyngitis
Pharyngitis can be caused by viral, bacterial, or fungal infections. Viral causes are often self-limiting, while bacterial and fungal infections typically require antimicrobial therapy. Rapid antigen detection tests and throat cultures can be used with clinical findings to identify the inciting organism.
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When To Consider Antibiotics For Sinus Infections
AAAAI advises that antibiotics for sinus infections should be considered only if you develop a fever of 102° F or higher, you have severe face pain and tenderness, your symptoms last longer than a week or so, or your symptoms improve and then worsen again.
Some patients with acute sinusitis do need antibiotics, and if they continue with a worsening infection without treatment, they can suffer dramatic complications such as loss of vision, meningitis, or brain abscess, Patel says.
If your doctor says you need an antibiotic, ask for generic amoxicillin/clavulanate, according to guidelines from UpToDate, which provides evidence-based treatment information to healthcare providers. Its usually the best choice and works as well as more expensive brand-name antibiotics.
Avoid taking fluoroquinolones, a group of antibiotics that includes ciprofloxacin and levofloxacin . Although widely used, the antibiotics are inappropriate for treating sinus infections and they pose serious risks.
In 2016, after a safety review, the Food and Drug Administration linked fluoroquinolones to disabling and potentially permanent side effects. The agency advised against using the drugs to treat common illnessesbronchitis, sinus infections, and urinary tract infections.
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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.
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Help For Sinus When I Have High Blood Pressure
Many people suffer from sinus trouble, whether it is a temporary sinus problem or chronic sinusitis. Sinus congestion can cause breathing difficulties, and the extreme congestion leads to sinus headache. Prolonged sinus congestion can lead to sinus infections. There are treatments for congested sinuses, but if you have high blood pressure you must be careful about which treatments you use, as some may actually raise blood pressure.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
If You Think You Have A Sinus Infection
If you feel you are experiencing sinus infection symptoms, make an appointment with your PartnerMD physician, and do not attempt to treat symptoms on your own. While you may initially be recommended OTC treatments, only your doctor can accurately diagnose your symptoms, and prescribe the right treatment for relief.
Have a question about your sinus infection symptoms? Contact us today to see if a relationship with a concierge doctor could be beneficial.
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Treating Sinus Infections: Dont Rush To Antibiotics
Millions of people are prescribed antibiotics each year for sinus infections, a frequent complication of the common cold, hay fever, and other respiratory allergies. In fact, 15 to 21 percent of all antibiotic prescriptions for adults in outpatient care are for treating sinus infections. Unfortunately, most of those people dont need the drugs. Heres why:
The drugs usually dont help.
Sinus infections can be painful. People with the condition usually have a stuffy nose combined with yellow, green, or gray nasal discharge plus pain or pressure around the eyes, cheeks, forehead, or teeth that worsens when they bend over. But sinus infections almost always stem from a viral infection, not a bacterial oneand antibiotics dont work against viruses. Even when bacteria are the cause, the infections often clear up on their own in a week or so. And antibiotics dont help ease allergies, either.
They can pose risks.
About one in four people who take antibiotics have side effects, such as stomach problems, dizziness, or rashes. Those problems clear up soon after stopping the drugs, but in rare cases antibiotics can cause severe allergic reactions. Overuse of antibiotics also promotes the growth of bacteria that cant be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the good that antibiotics can do for others.
So when are antibiotics necessary?
How should you treat sinus infections?
Ways To Recognize Serious Signs Of Sinus Infections
#1: Duration
The length of the infection is an important determinant of the seriousness of the infection.
I usually consider most infections less than 3 weeks to be viral or inflammation related to congestion. At this point, the best treatment is usually medications that decrease the congestion and inflammation. This in turn will alleviate the symptoms and ultimately cure the illness.
When the illness continues beyond 3 weeks, bacterial infection can begin to develop. Though antibiotics can be considered at this point, other treatments may still be the best answer if they have not yet been given a try.
#2: Mucous Color
I will dispel a myth right here and now. Yellowish/greenish mucous does not necessarily mean the infection is bacterial.
Viruses can cause the same color mucous. The reason for the mucous is generally not the actual bacteria or virus, but the bodys immune response to the intruder.
So dont worry just because you see a colored mucous when you blow your nose. This will also improve as the infection abates.
#3: Sinus Pain
Sinus pain can occur anytime throughout a sinus infection. This is normal and means there is inflammation in the sinuses, as we discussed previously.
However, severe pain, redness over the skin, hardened skin over the sinuses, or even a severe headache are not generally normal and can indicate a bacterial infection.
#4: Fever
A fever can be caused by both viruses and bacteria. So how do you differentiate between the two?
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What Causes Sore Throat And Pharyngitis
Sore throat caused by pharyngitis is commonly seen in family medicine clinics and is caused by inflammation of the pharynx and surrounding tissues. Pharyngitis can be caused by viral, bacterial, or fungal infections. Viral causes are often self-limiting, while bacterial and fungal infections typically require antimicrobial therapy.
Viral Vs Bacterial Sinus Infections
Most sinus infections are caused by viruses that create inflammation in the sinuses, leading to blockage that can make it hard to breathe, nasal secretions, postnasal drip, and other discomfort like facial pain around your eyes, cheeks, nose, or forehead.
Knowing thisand that antibiotics dont work on viral infectionsmost healthcare providers first recommend treatments to relieve the symptoms of a sinus infection while you wait for it to resolve.
These may include:
- Over-the-counter such as pseudoephedrine
- Antihistamines
- Pain relievers like acetaminophen or ibuprofen to ease discomfort from swelling, fever, or sore throat
In rare cases, viral sinus infections can lead to bacterial growth in the nasal passages.
Theres no way to know for sure if you have a bacterial sinus infection without testing a mucus sample.
But even without a sample, two signs typically indicate a bacterial infection and may prompt your provider to prescribe antibiotics:
- A sinus infection that lasts for more than 10 days
- Symptoms of the infection resolve, then back worse a couple days later
Some people think yellow or green mucus may be a sign of a bacterial sinus infection, but colored mucus can occur with viral infections and does not necessarily mean you have a bacterial infection.
If you do have bacterial sinusitis , it should respond to antibiotics within a few days.
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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.
How An Ent Treats A Sinus Infection
If you have a lingering sinus infection after antibiotics, an ENT doctor often elects to be more aggressive in treatment than a primary care physician. They may prescribe longer courses of antibiotics, stronger medications, or recommend a procedure to open the sinuses.
If you have persistent sinus problems, the sinuses must first be unblocked. Sometimes, thats done through a simple balloon sinuplasty and irrigation. Other times, unblocking the sinuses requires a more aggressive procedure like endoscopic sinus surgery. We opt for this procedure when the sinuses become so blocked, tissue and bone need to be removed to create a wider opening.
If youre dealing with a lingering sinus infection, dont let it progress to a more serious issue. Call your ENT so they can discover whats at the root of your problem and find a treatment to bring you relief.
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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.
Using Antibiotics May Worksome Of The Time
Colds are caused by viruses, so medicines like antibiotics wont help. Consult a doctor if you have any questions, but generally speaking, the best approach is to treat symptoms. If a headache is bothering you, an over-the-counter pain reliever might help, while a nasal decongestant could help relieve a stuffy nose.
For sinusitis, sinus doctors sometimes prescribe antibiotics ONLY if a bacterial infection is suspected as the root cause. In other cases, oral or nasal steroids are recommended, along with mucus thinners or pain relievers.
Overmedicating or masking symptoms with the wrong medications can lead to more problems, so get personalized help from the start. Our NYC sinus doctors are here to discuss your symptoms and help you come up with a treatment plan thats right for you.
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Is There A Best Antibiotic For A Sinus Infection
In most cases, a sinus infection doesnt need antibiotics it will go away on its own. Viruses are usually the cause of sinusitis. However, if yours is due to a bacterial infection, your doctor may prescribe antibiotic treatment to shorten your recovery time and relieve your symptoms. Amoxicillin, with or without clavulanate,is a first-line antibiotic prescribed for sinus infections, but your doctor will prescribe the antibiotic thats best for your condition.
Only take antibiotics if your doctor prescribes them. Dont try to self-treat your sinus infection by taking leftover antibiotics you may have on hand. Taking antibiotics when you dont need them wont help your condition and could cause serious health problems.
The Science Behind Pseudoephedrine
When you have a cold or an allergy attack, your white blood cells gather in your nasal passages and sinuses. This causes nasal membranes to swell and increases mucus production. Pseudoephedrine constricts these blood vessels, which decreases drainage.
But those same constricted vessels might also increase your blood pressure and heart rate.
Pharmacist Kayla Ryan explains the mechanism of pseudoephedrine. Pseudoephedrine is chemically similar to adrenaline, so the body recognizes it as adrenaline, causing the blood pressure and heart rate to increase.
She refers to one of the last major studies of the effects of pseudoephedrine on blood pressure, which took place in 2005. This study found that pseudoephedrine increased systolic blood pressure by one point on average, while heart rate increased by an average of three beats per minute.
Ryan adds that the immediate-release products had a greater impact on heart rate and blood pressure than their 12 hour or 24 hour extended-release counterparts, which showed a smaller increase in blood pressure.
In 2005, the FDA passed the Combat Methamphetamine Act, which requires pharmacies to sell all medications containing pseudoephedrine behind the counter. At your local drugstore, youll find cards in the cold and flu aisle with information for these medications. You can take the card to the pharmacist, who is required to scan your drivers license before purchase.
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Antibiotics No Help For Sinus Infections
Roughly 20% of the antibiotic prescriptions written in the United States for adults each year are for sinus infections. That’s an impressive statistic, given that doctors and public health officials have long doubted that antibiotics can successfully treat the condition.
A new study, published this week in the Journal of the American Medical Association, appears to confirm those doubts: The antibiotic amoxicillin was no better than placebo at improving the congestion, cough, runny nose, pain, and other symptoms that accompany sinus infections , researchers found.
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“Compared to placebo, amoxicillin doesn’t seem to provide any benefits,” says lead author Jane Garbutt, an associate professor at the Washington University School of Medicine, in St. Louis. “In terms of patient satisfaction, side effects, symptom relief, days missed from work, et cetera, we did not see any difference.”
Most sinus infections are caused by viruses, which don’t respond to antibiotics. But even bacterial sinus infections rarely require antibiotic treatment, according to the Centers for Disease Control and Prevention. In most cases, both types of infection go away on their own in less than two weeks.
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“Most patients get better despite antibiotics, not because of them,” says Garbutt. “There is a high rate of spontaneous resolution.”
When To See The Doctor
If you try the home remedies and they do not work, then you should consider visiting a doctor. A sinus infection that is diagnosed early can be treated faster. Do not wait for too long once you begin to notice symptoms of sinusitis. Use the medicines prescribed by the doctor so that you can manage the symptoms better.
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What Decongestants And Nasal Sprays Soothe Or Cure Sinus Infections Or Sinusitis
Taking decongestants and mucolytics orally may be helpful in assisting drainage of sinus infection.
The treatment of chronic forms of sinus infection requires longer courses of medications, such as Augmentin, and may require a sinus drainage procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia. In general, antihistamines should be avoided unless it is felt that the sinusitis sinus infection is due to allergies, such as from pollens, dander, or other environmental causes.
It is likely that the use of a topical nasal steroid spray will help reduce swelling in the allergic individual without the drying that is caused by using antihistamines although both are occasionally used. Oral steroids may be prescribed to reduce acute inflammation and to help with chronic inflammation in cases with or without polyps and in allergic fungal sinusitis.
In many people, allergic sinusitis develops first, and later, bacterial infection occurs. For these individuals, early treatment of allergic sinusitis may prevent the development of secondary bacterial sinusitis.
In rare instances or in natural disasters, fungal infections may develop in debilitated people. Death rates of 50%-85% have been reported for patients with these sinus infections. Treatment relies on early diagnosis followed by immediate surgical debridement, antifungal drugs, , and stabilizing any underlying health problem such as diabetes.