Recognizing the symptoms and types of infection and their appropriate treatments.

Sinus infections are a common reason for health care visits in the United States. About 10-15 percent of Americans see a doctor each year with symptoms of sinusitis.

When infected, sinuses become blocked and cause symptoms such as discolored nasal drainage, facial pain or pressure, tooth pain, bad breath, fever, fatigue, decreased sense of smell, headache and cough. Severe symptoms such as fever (>102.5F), vision changes, facial swelling and neck stiffness require immediate medical attention. They may indicate a more serious problem.

Viral sinusitis is sinus inflammation caused by an infection by one of many kinds of viruses. It commonly occurs as an extension of an upper respiratory infection (URI) and is the cause of most infectious sinus complaints. Most occurrences will improve within 7–10 days. Antibiotics are unnecessary and ineffective in treating infections caused by viruses. 

Bacterial sinusitis develops after an infection by harmful bacteria. It may be the culprit if symptoms last greater than 10 days or worsen after a period of initial improvement (“double- worsening”). Antibiotics are frequently prescribed for bacterial infections. Bacterial infections are categorized by the duration of infection: acute (less than one month), recurrent (four separate infections within one year) or chronic (lasting greater than three months). Individuals experiencing recurrent or chronic infections should receive a medical evaluation.                                                                   

Fungal sinusitis, the result of an infectious fungus, is a condition less common than viral and bacterial sinusitis, though it may be a cause of chronic infections. Management typically emphasizes alleviating acute symptoms before referral to an otolaryngology specialist. 

While most people will experience an occasional sinus infection, those with infectious symptoms recurring throughout the year or with specific seasonal changes should consider a contributing allergy component. Allergic rhinitis, or hay fever, is a rather common diagnosis.                                                             

Initial sinusitis management

Early management may limit the duration of the infection and avoid worsening symptoms. The majority of sinus infections can be initially managed with conservative therapy. You should consult your physician for any underlying medical conditions or conflicts with recommended therapy, and let him or her know immediately about worsening or severe symptoms.

     1. Nasal irrigations

There are numerous products available over the counter. Just ask your pharmacist. I recommend patients use saline rinses 2-3 times daily to cleanse the nose and sinuses during active infection. Consult your physician.

     2. Pain relief

Non-prescription anti-inflammatories provide adequate pain relief in most cases. For patients who are candidates for these medications, I recommend alternating ibuprofen and acetaminophen every 3–4 hours as needed per bottle dosing instructions. Consult your physician.

     3. Nasal and systemic decongestants

Nasal decongestants can be used for a brief duration to reduce nasal congestion. It is not recommended to use them for more than three days. Systemic decongestants and mucus-thinning agents are available over the counter. Consult your physician.

Brandon W. Pierson, M.D., is a practicing otolaryngologist in Oklahoma City, OK, and member of Oklahoma Otolaryngology Associates. He treats both adult and pediatric patients for a variety of ear, nose and throat disorders.