What You Need To Know About Sinus Infections
As the fall months approach, the potential for seasonal allergies, runny noses and sinus infections increases.
Sinus infections happen when fluid builds up in the air-filled pockets in the face. This allows germs to grow. Viruses cause most sinus infections, but bacteria can also be the culprit.
However, Jessica Grayson, M.D., an assistant professor with the University of Alabama at BirminghamDepartment of Otolaryngology, says many people confuse sinus infections for sinus pressure.
When people say they have sinus pressure, they may mean nasal congestion, Grayson said. Bilateral congestion could mean a person has a viral infection or an allergic reaction. Viral infections dont pick and choose a side.
Grayson adds that people who live in more humid climates like the South tend to suffer more from seasonal allergies because the humidity allows more fungus to grow, and long growing seasons allow for other trees, grasses and weeds. Living in cities can also affect people with allergies due to dust mites.
If your sinus pressure is isolated, you might have a bacterial infection, she said. Thats when you really should go see a doctor. With a virus, you just have to let it run its course.
Some people do get repetitive events, and people who work with small children, such as teachers or day care workers, are more likely to get recurrent viral infections.
Treatment
Jessica Grayson, M.D.That pesky flu
Aftermath
You Probably Dont Need Antibiotics For Sinus Infections Or Sinusitis
If you were wondering whether you needed antibiotics for a sinus infection, heres why antibiotics are rarely the right treatment for chronic sinusitis. According to the CDC, 9 out of 10 sinus infections are caused by viruses, while only 1 out of 10 cases of sinusitis are caused by bacterial infections. Antibiotics can only treat bacterial infections, and therefore an antibiotic treatment will not be effective for most sinus infections caused by chronic sinusitis.
For people with chronic sinusitis, taking antibiotics to clear up as many as four sinus infections a year can have some unintended long term consequences. The more often you take antibiotics for basic illnesses, the worse your body becomes at actually fighting them off. Not only will your sinus infections keep coming back, the effectiveness of antibiotics against other, more serious infections could become compromised.
What Takes Place During Surgery
Functional endoscopic sinus surgery is the standard surgical treatment for chronic sinusitis. It is performed with a nasal endoscope that enters the sinuses through the nostrils. This avoids any visible incisions or scars.
The endoscope is a surgical tool that looks like a thin metal rod with a camera at the tip. The camera acts as a telescope and shows enlarged images of the sinuses on a monitor. It allows the surgeon to take a deeper look at the sinuses to see exactly where the block is.
The goal of sinus surgery is to remove any bone or inflamed tissue that is crowding the sinus openings. This opens up your sinus passages and helps them to drain. FESS is usually performed under general anesthesia on an outpatient basis, meaning you can go home the same day. The procedure takes about 2 hours.
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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.
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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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How To Get Rid Of Sinusitis
If you want to get rid of your sinusitis, you and your ENT will need to work together to discover the source of your sinus infections. For example, your sinusitis might always be precipitated by a cold, or you could have a deviated septum and sinusitis or sinusitis and sleep apnea. Regardless, finding the root cause behind your recurrent or prolonged sinusitis will help determine treatment.
Once the source of your sinus infections is found, you and your ENT will need to discuss treatment options. For those with recurrent sinus issues, one treatment, in particular, has proven itself effective again and again. That treatment option is balloon sinuplasty.
Balloon sinuplasty is a minimally invasive, in-office procedure that takes less than 20 minutes to perform and requires little to no recovery time.
Risk Of Unnecessary Antibiotics For Sinus Infections
Taking unnecessary antibiotics for a sinus infection is not only ineffectual, but can actually be harmful to the patient. Risks of taking unneeded antibiotics include:
- Increased chance of getting an antibiotic-resistant infection at a later time
- Destruction of healthy stomach bacteria, which can allow harmful bacteria to grow
- Possible side effects, such as upset stomach, rash, or dizziness
- Allergic reaction
According to studies conducted by the American Academy of Allergy, Asthma, and Immunology , 60-70% of patients with sinus infections fully recover without the use of antibiotics. Additional research shows that almost 90% of U.S. adults diagnosed with acute sinusitis are prescribed antibiotics.
This overuse of antibiotics for sinus infections, as well as other conditions, can lead to antibiotic resistance, a state in which bacteria change over time as a reaction to antibiotic treatment, in order to survive and multiply, thus making the antibiotics less effective.
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Rare Cases Can Turn Serious
Antibiotics also can help ward off rare but potentially dangerous complications that arise when a sinus infection spreads to the eyes or brain, Dr. Sindwani says.
Complications around the eyes are the more common of the two. These complications can cause redness, swelling around the eyes and reduced vision, and even lead to blindness in a severe form known as cavernous sinus thrombosis. Serious cases are immediately treated with IV antibiotics. Patients are usually admitted to the hospital for a CT scan to see if fluid needs to be drained, Dr. Sindwani says.
Also in rare cases, sinus infections in the rear center of ones head can spread into the brain. This can lead to life-threatening conditions like meningitis or brain abscess, Dr. Sindwani says.
Before antibiotics, people would die from sinusitis, he says. But he emphasizes that such complications are unlikely. In most cases, the bacterial infection goes away, especially if you dont have underlying medical problems.
Its important to monitor your symptoms if you suspect a sinus infection. If the condition lingers or worsens, call your doctor.
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.
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How Can You Help Your Patient
What to do, then, for patients with acute sinusitis? Treat the symptoms, which means recommending pain medication for facial pain or headache and saline nasal spray for the nasal discharge, not antibiotics or nasal corticosteroids. Side effects will be fewer and costs will be lower.
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Saline irrigation. A 2007 Cochrane review of 8 chronic and recurrent sinusitis trials showed that nasal saline irrigation is effective for reducing symptoms of chronic and recurrent sinusitis. Although we do not have high-quality RCT data on saline nasal irrigation for treatment of acute sinusitis, nasal saline irrigation is harmless and inexpensive.
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What about nasal steroids? The evidence is equivocal, and the most recent high-quality RCT of nasal steroids showed no effect.
How Long Should It Take For A Bad Sinus Infection To Go Away
Before we delve into what to do when your sinusitis wont go away, lets figure out whether you have a sinus infection in the first place. The symptoms shared between the common cold, chronic sinusitis, and chronic allergies, are similar making it rather difficult to deduce which culprit is causing your sinus issues.
One major differentiator, however, is time. A cold should go away within a week. If your cold lasts longer than 7-10 days, its likely that your cold has either turned into a bacterial sinus infection, or you actually had a sinus infection from the very beginning. Whatever the case, if your symptoms persist for more than a week, its best to see a doctor.
Once your doctor determines treatment, your sinus infection symptoms should begin to subside within a few days.
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Symptoms Of Bacterial Sinusitis In Children
In children, the symptoms of sinusitis may differ from those in adults. Children may experience:
- Irritability
- Scar tissue in sinus areas, for example from nasogastric tubes or mechanical ventilation
- Facial fractures
- Tooth or mouth infections such as a dental abscess
In general, women are slightly more likely than men to get bacterial sinusitis.
If youâve had a cold or any of the disorders listed above, and youâre concerned that you may have bacterial sinusitis, check out the Ada app for a free symptom assessment.
What Home Remedies Help Soothe Sinus Infection Or Sinusitis Symptoms
Sinus infections caused by viruses can use home treatments such as pain and fever medications , decongestants, and mucolytics. In addition, some health care professionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusitis symptoms. This irrigation is accomplished with a Neti-Pot or a sinus rinse kit . The last reference of this article shows a video of a sinus rinse procedure. In 2012, the FDA issued a warning about the use of Neti-Pots. The FDA cautions people not to use untreated tap water for rinsing, as contaminated tap water rinses lead to two deaths.
Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some authors suggest home treatments may reduce symptoms after medical therapy has begun some healthcare professionals recommend nasal irrigation after sinus surgery.
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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.
Answer: Not Very Often
The CDC has published guidelines as to when antibiotics are needed for a sinus infection . Here are the bullet points:
- Most episodes of sinusitis are due to viral infections. Symptoms may include nasal congestion, discolored mucus, teeth pain, facial pain, fever and ear pain. The symptoms may last 1-33 days.
- Occasionally bacteria cause sinusitis . This usually occurs after a viral sinus infection but only occurs in 2% of cases.
- X-rays cannot tell if the infection is due to a virus or bacteria, so are not particularly helpful.
- Antibiotics should be reserved for patients whose symptoms persist for over 10 days, are severe, or deteriorate after initial improvement. Severe symptoms include fever over 102, discolored nasal drainage, facial pain for over 3 days.
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When Antibiotics Are Appropriate Treatment
Antibiotics may be given to people who are less able to fight off infection, such as those with diabetes, or serious heart or lung disease.
In addition, antibiotics can be given to those whose symptoms have gotten worse or those who show no improvement after seven days.
If antibiotics are given, a 10- to 14-day course is recommended, according to the practice guidelines. Amoxicillin or amoxicillin clavulanate are typically the first choice for people who are not allergic to penicillin.
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What Is Bacterial Sinusitis
Bacterial sinusitis is a bacterial infection of the paranasal sinuses, the hollow spaces in the bones of the face around the nose. Sinusitis is a very common problem, affecting approximately one in every eight American adults annually. Almost 30 million people seek medical help for sinusitis in the USA every year.
Bacterial sinusitis involves inflammation of the mucous membrane lining of the sinuses, and is caused by a bacterial infection. There are four pairs of paranasal sinuses which are located below, above, between and behind the eye sockets â the maxillary sinuses, frontal sinuses, ethmoid sinuses and sphenoidal sinuses. The maxillary sinuses are the largest of these, and are most often affected by sinusitis. However, sinusitis can affect any or all of the paranasal sinuses. Because sinusitis often occurs along with rhinitis, inflammation of the mucous membrane in the nose, it is sometimes known as rhinosinusitis.
Bacterial sinusitis often follows a viral infection, such as a cold or the flu. Viral infections can cause the mucosal lining of the sinuses to swell. In healthy sinuses, mucus drains into the nasal cavity via small holes, known as ostia. Swelling of the mucus membranes in the nose or sinus cavities can block these holes, preventing mucus from draining out of the sinuses. Bacteria colonize the undrained mucus, which can lead to bacterial sinusitis.
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What Is A Sinus Infection
The sinuses are cavities in the head that are filled with air. These air-filled pockets are lined with a very thin layer of mucus that functions to collect particles from the air that are breathed in, such as dust, germs, or other particles.
Very small hair-like projections function to sweep the mucus, along with any particles trapped inside of the mucus. The germ- or dirt-filled mucus then slides down the back of the throat and into the stomach where stomach acid works to kill any germs.
When a sinus infection occurs, this natural process involving mucus flow is blocked.
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?
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