As the long days of summer come to a close cooler and drier weather prevails. A common affliction that can develop is acute sinusitis (sinus infection). There are roughly two kinds of sinusitis: viral and bacterial. Both types cause inflammation of the lining of the nasal passages and connected sinuses but sometimes treatment can vary.
Acute sinusitis is one of the most common diagnoses in the adult population. It affects approximately 16 percent of the adult population. Common symptoms include congestion, headache, facial pain or pressure, tooth pain, nasal discharge, and occasionally fever. More serious symptoms can include double vision and require immediate medical attention.
Approximately 0.5 to 13 percent of viral upper respiratory tract infections (common cold) can progress to acute bacterial sinusitis. Only 0.5 to 2 percent of viral sinusitis can progress to acute bacterial sinusitis.
Viral sinusitis generally lasts 10 days or less. The treatment is targeted to the symptoms and includes rest and hydration. For pain, analgesics such as acetaminophen (Tylenol) and ibuprofen (Advil) can be used. Saline nasal spray can be very effective at soothing the irritated nasal passages/sinuses as well as diluting the thickened congestion. Careful use of decongestants can help relieve pressure but should not be used for more than 3-5 days, as rebound congestion has been known to occur. Also, topical decongestants like nasal sprays are often preferred over pills because the nasal spray has increased potency and decreased risk of toxicity. Some forms of decongestant should be avoided if the patient has other medical issues such as hypertension.
Another option for treatment includes intranasal steroids, which help relieve congestion regardless of the cause (allergies, infection). Intranasal steroids are generally low risk but should be used for at least one month depending on the course of the illness. Lastly, warm facial packs and steam inhalation may help ease the discomfort.
Bacterial sinusitis is generally diagnosed by a physician and could be considered if symptoms persist for more than 10 days or if symptoms initially improve then abruptly worsen. Often it is associated with one-sided facial pain. Nasal discharge is often present but the color or consistency does not help distinguish viral from bacterial infection. The color or consistency of nasal discharge is often directly related to hydration status of the patient. Diagnosis of bacterial sinusitis does not necessarily require imaging studies. If bacterial sinusitis is considered, antibiotic therapy may be initiated.
The physician will decide which antibiotic would be most appropriate depending on the patient’s other medical conditions, allergies, and medication interactions. Also, regional variances in resistance to antibiotics need to be considered. The risks of treatment with antibiotics have to be weighed against the severity of symptoms. Once an antibiotic is initiated, symptoms should improve in 3-5 days and if they do not, a different antibiotic can be considered. All the treatments mentioned for viral sinusitis should be considered for treatment in bacterial sinusitis.
If symptoms fail to improve with treatment, consideration can be given to specialist referral. Sometimes anatomic variances (nasal polyps or deviated septum) can predispose a patient to more frequent or severe infections. In these cases Otolaryngologist can evaluate and consider alternative treatments up to and including surgery.
One last note should be made about the distinction between a sinus infection and seasonal allergies. Symptoms can be very similar and it can be difficult to distinguish between the two. Some helpful considerations include how sick the patient feels. Generally, allergies can mimic infection but the patient does not feel ill or abruptly fatigued. Acute bacterial infection can develop; however, after prolonged congestion regardless of what caused the prolonged congestion (allergies or viral infection).