Treating Acute Sinusitis and Rhinosinusitis


Unfortunately, there are no medicines today that fight viral sinus infections. The decongestants, cough suppressants, and fever/pain medications will only make you feel more comfortable through the healing phase. Antibiotics are never administered to treat either the common cold or viral acute sinusitis. Unfortunately, many patients expect their physician to prescribe an antibiotic whenever they feel sick. However, this line of thinking is not only wrong but potentially dangerous. First, antibiotics are not able to clear a viral infection. Second, unwarranted exposure to antibiotics can lead to resistance, so that they won’t work when you really need them. If your physician tells you that your sinuses have flared because of a viral infection, then you should be happy that he or she is not giving you an antibiotic unnecessarily.

However, it is possible that the day after you see your doctor you may develop a change in the color of your nasal discharge from clear to yellow or green, which would indicate a bacterial superinfection. This occurs when there is a bacterial infection on top of a viral infection. It does not mean that your cold “turned into” a bacterial infection. An
acute bacterial infection might be present if your symptoms last for more than 24 - 72 hours or worsen over 5 - 7 days. If this is the case, your doctor will then need to see you again and prescribe an antibiotic. Usually, a course of 7 - 14 days of antibiotics will clear up any acute bacterial infection.

Acute sinusitis responds well to the same treatment regimen that you would follow if you had a cold. If your physician feels that you have a viral infection, it is best to do the following:

■ Drink plenty of fluids to keep mucus thin and flowing.

■ Get plenty of rest, as much as 12 hours or more a night.

■ Take OTC oral decongestants to get relief.

OTC decongestants, such as pseudoephedrine, work well on a short-term basis over a few days. I caution you not to take them long term because they have stimulant-like properties and have potentially serious side effects on the heart and prostate. If you have diabetes, heart disease, high blood pressure, and/or prostate or thyroid problems or are taking any medicines like monoamine oxidase (MAO) inhibitors (drugs taken for depression, psychiatric or emotional conditions, or Parkinson’s disease) consult your doctor before taking a decongestant because it can lead to serious complications.

■ Seek medical attention after 24 hours if a nasal decongestant spray does not provide significant improvement.

Topical (spray) decongestants provide temporary relief for a stuffy nose but should not be used for more than 24 hours, after which the body will fight back by rebounding. This means your nose will swell and produce even more thick mucus. If you continue to use a nasal decongestant, your condition will slowly worsen and your nose will likely become more congested than it was originally. Nasal decongestant sprays can also damage the blood supply to the nose and sinuses and interfere with cilia function after repetitive use. I do not
recommend use of a topical decongestant for more than 24 hours unless under a physician’s care. These can be very dangerous products if used incorrectly.

■ Take an OTC anti-inflammatory, antipyretic, or analgesic agent (such as aspirin, ibuprofen or acetaminophen) for relief from fever and muscle aches.

Note, however, that common OTC pain relievers may also prevent your body from generating the heat it needs to fight a cold or flu virus. Make sure your doctor is aware if your fever lasts for more than

3 days or is greater than 103°F. More important, before giving these products to a child, you should always consult with your pediatrician or pharmacist because of potential harmful side effects. Adults who are taking these OTC products for more than a few days should also speak with their physician to avoid any significant potential adverse side effects. Although these drugs are standard products that we all have in our medicine cabinet, they can be dangerous. Tylenol can cause liver toxicity. Aspirin can cause Reye’s syndrome in children, which is characterized by fever, vomiting, and disturbances of consciousness progressing to coma and convulsions. Nonsteroidal antiinflammatory drugs (ibuprofen) can cause gastrointestinal (GI) side effects.

■ Skip the cough suppressants (e. g., dextromethorphan, codeine, hydrocodone), unless your cough is preventing you from sleeping or is so violent that you feel as if you could break a rib.

OTC cough suppressants dull your cough reflex so that you will lose the defense mechanism that is protecting your lungs from infection. Remember, coughing clears your breathing passages and prevents infection from reaching your lungs and the rest of your body. You may find it helpful to sleep with your head elevated 6 - 8 inches above your feet to reduce nighttime coughing.

■ Drink plenty of fluids to soothe a sore throat, including hot water with lemon and honey (the honey coats your throat). Warm water gargles made with chamomile tea, fresh lemon juice, or apple cider may also offer relief.

Gargle with a warm salt water mixture made of lA teaspoon of salt in 8 ounces of warm water. Cough drops, hard candy, and sugarless gum can also be soothing to the throat because they stimulate the secretion of saliva, which bathes and cleanses the throat.

■ Anesthetize your throat with Chloroseptic or another OTC liquid anesthetic.

However, if your throat is so sore that it is difficult to swallow, see your physician immediately to check for a bacterial infection such as strep throat. If your sore throat causes hoarseness, I recommend complete voice rest: Talking when you have an inflamed larynx may lead to more irritation and temporary loss of your voice. If you can’t swallow and start drooling because you can’t swallow your saliva, it is important for you to go to the nearest emergency room immediately.

■ Humidifying the air around you with a vaporizer or humidifier, especially where you sleep, can help during the dry fall and winter months.

Adding moisture to the air prevents irritation caused by dry mucous membranes. I recommend a humidifier with a ultraviolet (UV) light, (i. e., Slant/Fin), which will kill bacteria and fungi. Warm compresses or a heating pad or lamp may be useful to relieve pain and swelling in the sinus areas. For a more direct form of adding moisture, try saline nasal sprays or saline irrigation.

■ Avoid air pollutants, especially smoke-filled rooms, and fumes from household cleaners or paint.

Sinus Tips:
In the past, physicians recommended that their patients with chronic sinusitis and/or allergies move to another part of the country, where the climate was different, thinking that
A balanced diet high in protein, fruits, and vegetables is very important tor patients suffering from CAID. For patients who get frequent infections, I recommend supplementing thei
In the 12th century, the physician Moses Maimonides first prescribed chicken soup as a cold and asthma remedy. People have experienced the same tried-and-true results over the cent
Fungus and mold are always present in the air, so it is reasonable to expect that they are also found in our nasal passages. Recent research at the Mayo Clinic has confirmed this t
Throat sprays are appropriate when you are experiencing a sore throat caused by postnasal drip or during an acute flare-up of a chronic infection. Some products may contain an anti
Nasal emollients and gels allow mucus to glide over dry ciliated hair cells so that it can move through the sinuses with ease. These are useful for soothing your dry nasal membrane
This initial hit of inflammation would probably lead you to believe that you had come down with a simple cold.