Sinus Infection: Prevention & Treatment

By Dr. Franklyn M. Millman

This time of year, when the seasons are changing, many of us get a stuffy nose, a dry cough or worse – a sinus infection. But I like to think that all the sneezing and wheezing make us appreciate an organ we tend to take for granted.

[Wake Forest Baptist Health Urgent Care is open seven days a week and evenings to treat sinus infections and other unexpected health needs and minor medical emergencies.]

Let me start with a quick anatomy lesson. The nose serves as the body’s primary defense against germs. The tiny hairs and overlying mucus that line the nasal passages filter out dust, germs and other particles that would otherwise irritate the lungs and make us sick. The nasal passages also warm and moisten the air we breathe so that by the time it reaches our lungs, the air is the right temperature. During the winter, the outdoor air is dry and indoor air is even dryer. The nasal passages dry out and the nose doesn’t do as good a job as it could at protecting itself from germs. Several viruses cause the common cold and with it a runny nose, congestion and scratchy throat. When the virus moves to the sinuses, the hollow areas within the frontal bones that connect to the nasal passages, a sinus infection develops.

The symptoms of acute sinusitis include: 

  • Nasal congestion 
  • Thick discolored secretions 
  • Pain in the teeth or along the side of the nose that is worse when bending forward

The initial treatment of uncomplicated acute sinusitis can be obtained without a prescription at most drug stores and supermarkets: 

  • Saline solution in a nasal spray helps keep the nasal passages moist and washes away the mucus build-up. Some drug stores sell Neti pots, with a saline solution. These devices provide a larger volume of saline solution than a spray to clear out nasal passages and keep them moist. 
  • Pain and fever reducers such as Tylenol® 
  • Antihistamines can help control a runny nose, especially in patients with allergies, but may cause side effects such as over-drying.
  • Decongestants can help relieve clogged nasal passages. Decongestants taken orally can lead to such side effects as trouble urinating, jitters and sleeplessness. Nasal decongestant sprays may help open the clogged nose and adjacent tissues. The sprays also have fewer side effects than oral decongestants. I would avoid using the spray for more than two to three days to prevent rebound. 
  • Many of my patients ask me about vitamin C, Echinacea and other herbal remedies. I have not seen any evidence that persuades me that these remedies work at preventing colds or reducing symptoms. And I warn patients against zinc because there is the risk of a permanent loss of smell. 
  • Mucus thinners such as guaifenesin may help thin the secretions. 
  • Antibiotics are not usually prescribed at this point because most cases of sinusitis are caused by cold viruses, which don’t respond to antibiotics.

These remedies treat the symptoms, making patients more comfortable while their immune system fights off the virus that causes the infection. But sometimes the symptoms linger for more than ten days. Patients feel swelling in their face, headache and pain around their nasal passages. They may develop a low grade fever or their mucus may change to green or they may get worse after initial improvement. It’s time to see a doctor.

This is an appropriate time to consider adding a topical corticosteroid nasal spray and antibiotic therapy. Here’s my dilemma over antibiotics. It turns out that fewer than 2 percent of sinusitis cases are caused by bacteria. I don’t want my patients to develop a resistance to an antibiotic they may need some day for a serious infection. I also want to avoid side effects such as diarrhea or a rash. And I don’t want to contribute to the growing public health crisis over bacteria that have become resistant to antibiotics. But I want my patients to recover and prevent any serious complications from sinusitis. So generally I prescribe an antibiotic if a patient isn’t improving as expected.

Complications from sinusitis are rare, but potentially serious. You should call your doctor immediately if you develop fever greater than 102 degrees, difficulty with eyesight, swelling or redness around the eyes, severe pain or headache.
Cold and sinusitis symptoms may linger for several weeks, but when they last longer than 12 weeks there’s likely some other cause. These patients need to see a specialist. There may be an obstruction in the nasal passages, an allergic disorder or an inherited condition.

Patients with chronic conditions know how much a healthy nose means to a happy, healthy life. So take care of your nose. Wash your hands. Use a saline spray when needed. And remember this complex organ that allows you to smell the ocean breeze also warms the air you breathe and protects you from infection.

Learn more from a Wake Forest Baptist primary care physician.

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Last Updated: 02-18-2014
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