Sinusitis In The Real World
How effective are antibiotics for patients diagnosed not by sinus x-rays or CTs, but by signs and symptomsas we typically do in daily practice?
A meta-analysis of 13 randomized controlled trials found that sinusitis improved without antibiotics, but it included trials in which patients were recruited based on results of imaging studies and cultures, which are not normally used in primary care clinical practice. That study compared antibiotic treatment to placebo for acute uncomplicated sinusitis 35% of placebo-treated patients were clinically cured by 7 to 12 days and 73% were improved after 7 days. Antibiotic therapy increased cure rates by 15% and improvement rates by 14%, yielding a number needed to treat of 7 to achieve 1 additional positive outcome at 7 days.
When Should You Talk To An Ent About A Sinus Infection
You should schedule a consultation with an ear, nose, and throat doctor if you are experiencing these sinus infection symptoms:
- An infection that lasts longer than 10 days
- Chronic, recurring sinus infections
- Sinus pain and pressure that is disrupting your daily activities
- At-home remedies dont work to relieve your symptoms
- Increase in pain
Family doctors or primary care physicians can help with basic sinus infection treatment by prescribing antibiotics and prescription-strength decongestants. But recurring sinus infections or chronic issues should be addressed by an ear, nose, and throat specialist also known as an otolaryngologist. Depending on your insurance coverage, you might need a referral from your primary care physician before visiting an ENT.
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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.
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Can You Catch A Sinus Infection From Someone Else
If you are experiencing a viral sinus infection, you cant spread the infection to others, but you can pass along the virus. Someone who catches the virus from you is then at a higher risk of also developing a sinus infection. You may be contagious for up to two weeks. Sinus infections can also be caused by bacteria.
When Antibiotics Dont Work
Some patients suffer from recurring sinus infections. If your sinus infection does not improve within five to seven days after you finish the whole course of antibiotics, or if you experience another sinus infection within a few weeks, you may be referred to an Ear, Nose and Throat specialist for treatment.
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Sinus Infection Treatment Timeline With Antibiotics
Our sinuses are hard to reach, so it can be two to three days before antibiotic treatment begins to take effect.
It is critical to continue the whole course of antibiotics, even if you start to feel better. If you dont finish the whole course, your body could begin to build a resistance to those antibiotics. This makes future treatment more difficult.
Sometimes, patients experience negative side effects while taking antibiotics. If you experience rash, hives or have difficulty breathing while taking antibiotics, call your doctor immediately. You may be experiencing an allergic reaction. In older adults, some types of antibiotics may cause inflammation in tendons.
In addition to clearing your sinuses of infection, antibiotics also work in other parts of your body, particularly the gut. This could cause diarrhea, so you may want to take a probiotic as well.
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Treatment For Sinusitis From A Gp
If you have sinusitis, a GP may be able to recommend other medicines to help with your symptoms, such as:
- steroid nasal sprays or drops â to reduce the swelling in your sinuses
- antihistamines â if an allergy is causing your symptoms
- antibiotics â if a bacterial infection is causing your symptoms and youâre very unwell or at risk of complications
You might need to take steroid nasal sprays or drops for a few months. They sometimes cause irritation, sore throats or nosebleeds.
A GP may refer you to an ear, nose and throat specialist if, for example, you:
- still have sinusitis after 3 months of treatment
- keep getting sinusitis
- only have symptoms on 1 side of your face
They may also recommend surgery in some cases.
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When Antibiotics Are In Order
The main reason to prescribe antibiotics is for patient comfort, Dr. Sindwani says. The medical field used to be more convinced than it is today than untreated sinusitis would inevitably become a chronic issue, he says.
We dont think that way as much, he says. We dont know that an untreated acute sinusitis, if left untreated, will grumble along and cause people to have a chronic sinus infection.
Some people think thats two separate things, with chronic sinusitis more likely due to underlying issues like allergies or immune problems.
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.
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Some Steps You Can Take
Whether your sinus infection turns out to be viral or bacterial, you can help to ease your symptoms early on with supportive sinus care:
If your symptoms arent improving after one week, its important to see your doctor. If a bacterial infection is suspected, youll probably need to take an antibiotic to clear up the infection and prevent further complications.
If your infections occur more frequently, and your doctor really wants to establish if they are bacterial or viral, your Otolaryngologist or ear, nose and throat doctor can sample the snot from your nose when youre infected and send it to a laboratory to know for sure.
Note: Antibiotics wont help a viral infection, and taking an antibiotic unnecessarily can do more harm than good. You risk possible side effects and increase your chances of developing antibiotic resistance, which can make future infections harder to treat, says Dr. Sindwani. So its important to wait and see how long your symptoms last.
How Is Sinusitis Diagnosed
Symptoms of sinusitis mimic a cold in the early stages and diagnosis can be difficult. However, sinusitis tends to persist long after cold symptoms have resolved and symptoms can last for three weeks or more. Sinus infections are also more likely to cause symptoms such as facial or tooth pain, green nasal discharge, and fever.
Your doctor will ask you about your symptoms and any history of illness leading up to this episode of sinusitis. The doctor will also perform a simple office examination and look into your ears, nose and throat, and take your temperature.
Other examinations or procedures may be undertaken to rule out other conditions or if the diagnosis is uncertain.
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Antibiotics Are Not A Good First Choice For Sinus Infections
People often are quick to ask their doctor for an antibiotic prescription when they suffer from a bad flu or sinus infection. These infections can be annoying, with congested noses, headaches, pain all across the face and never-ending mucus. People just want to make the pain and discomfort go away and get on with their lives. Thats understandable, but antibiotics most likely wont better their situation, as has been shown in countless studies. This is because sinusitis, like most infections of the upper respiratory tract, are caused by viruses, not bacteria. And antibiotics only go after bacteria.
Actually, taking antibiotics can make you feel sicker, since your body is already weakened by the viral infection and now you expose it to the stress of antibiotics side effects. All antibiotics have side effects, so they should only be taken when it makes medical sense, such as when treating a bacterial infection.
More generally, you want to keep your antibiotics use at a minimum. Because the more you use antibiotics, the more likely you are to get ill in the upper respiratory tract in the future, as the antibiotics not just kill bad bacteria but also the good bacteria in your body that help protect your health.
It, therefore, is recommended not to immediately treat every sinus infections with antibiotics, but preserve them as heavy ammunition for the most severe cases.
Treatments For Sinus Infections Other Than Antibiotics
#1: Saline Nasal Wash
Saline nasal wash can be a great way to thin out the mucous in the sinuses enough to clear out the blockage. I recommend starting this early on in the course of the illness to prevent the infection from worsening.
You can even make this at home using 2 cups of water and a 1/2 teaspoon of salt. I would add a 1/2 to 1 teaspoon of baking soda to prevent burning that can occur with use. There are also plenty of over the counter saline nasal sprays that you can purchase. You can use this 4-6 times per day.
#2: Vaporizer
Vaporizers are great because they can also thin out the mucous and make you feel a lot better. An easy home remedy, steam is probably the best way to use this treatment. Beware if you are an asthmatic as the steam could cause worsening of the asthma symptoms.
#3: Steroid Nasal Spray
Steroid nasal sprays such as Flonase have been my go to remedy recently and the great news is that they are now over the counter. The general recommendation is to use 1-2 sprays per nostril daily.
But I have found great relief using 2 sprays in each nostril twice daily. At these higher doses it is important to remember that you should use this short term, no more than 5-7 days.
These medications can significantly reduce inflammation allowing the congestion blockage to clear and significantly alleviate symptoms.
#4: Decongestants
#5: Guaifenesin
Guaifenesin such as Mucinex can certainly break up the mucous, allowing the congestion to clear more quickly.
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How Long Does A Sinus Infection Last
Sinus infections can last several days. Viral sinus infections are usually most severe three to six days after they start, and then begin to improve by day 10. A viral sinus infection can develop into a bacterial infection, which typically lasts longer than 10 days. Patients will usually respond to antibiotics within two to three days after a bacterial sinus infection is diagnosed and treated. After that, sinus infections can resolve anywhere between seven and 14 days.
There are three types of sinusitis. All three are based on length of symptoms:
- Acute Sinusitis â symptoms last for less than four weeks
- Subacute Sinusitis â symptoms last for four to 12 weeks
- Chronic Sinusitis â symptoms last for more than 12 weeks
Do These Things Work For Kids
Sinus infections make everyone miserable, children as well as adults!
Most of the tips above also work for kids, but antihistamines arent recommended for young children.
Young children cant blow their noses well, so helping them thin and clear the mucus from their nose is beneficial.
A nasal aspirator or a product like the Nose Frida can be a lifesaver in helping young children breathe through their nose.
A warm bath can help clear the sinuses and take a childs mind off their illness.
Kids are often fascinated by the condensation that forms on surfaces in a steamy room. To occupy them while a hot shower runs in the bathroom, try tracing pictures with them on the mirror!
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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.
What Does A Sinus Headache Feel Like
Sinus headaches are headaches that may feel like an infection in the sinuses . You may feel pressure around your eyes, cheeks and forehead. Perhaps your head throbs. However, many people who assume they have headaches from sinusitis, including many who have received such a diagnosis, actually have migraines.
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Ear Infection Or Sinus Infection Treating Your Symptoms Quickly
By raphael, January 2, 2019
Sometimes its hard to know whether you are experiencing an ear infection or a sinus infection because of the similarities in symptoms. Both diagnoses involve significant pressure or pain in the head/neck area and both infections may trigger a fever response in your body.
So, why is it important to know whether youre suffering from a sinus infection or an ear infection? Because the treatment option selected will only be effective if you have the right diagnosis.
Heres how to decide whether youre experiencing a sinus infection or an ear infection and how your ear, nose, and throat doctor can help along the way.
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When To Seek Medical Care
See a doctor if you have:
- Severe symptoms, such as severe headache or facial pain.
- Symptoms that get worse after initially improving.
- Symptoms lasting more than 10 days without improvement.
- Fever longer than 3-4 days.
You should also seek medical care if you have had multiple sinus infections in the past year.
This list is not all-inclusive. Please see a doctor for any symptom that is severe or concerning.
Other conditions can cause symptoms similar to a sinus infection, including:
- Seasonal allergies
- Colds
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Common Antibiotics For Sinus Infections
Antibiotics may be prescribed when symptoms of a sinus infection warrant such treatment. Common antibiotics for sinus infection include:
- Zithromax
- Levaquin : Although this drug is often prescribed as a first line of therapy for sinusitis, it has serious side effects and should only be used as a last resort.
Inhale Menthol And Camphor
Another inhaled odor that can help open up sinus passages is menthol, which is an ingredient in popular ointments that are used specifically to treat a stuffy nose. These ointments also contain eucalyptus oil and camphor, which combine with menthol to create a powerful scent that immediately relieves sinus pressure. This ointment can be rubbed on your chest and under your nose to deliver its soothing benefits. Unlike eucalyptus oil, this ointment should not be placed in the mouth.
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