Sinusitis Guidelines
Hilda Demetrios was visiting her doctor for sinus complaints, which she frequently experiences. “I have a drip in the back of my throat it’s constantly dripping, a lot of mucus is bothering me, I wanted to see if it’s an allergy or a sinus problem,” she complained.
And that is the 64 dollar question for Hilda Demetrios and for millions of Americans like her who think they might be coming down with a case of sinusitis.
Many are over treated with antibiotics, or treated with the wrong ones.
Now, new sinusitis guidelines clearly define what is and is not a sinusitis.
Sinusitis is an inflammation of one or more of the eight paranasal sinuses--essentially air pockets above, next to and below the nose and eyes.
Now, most cases of sinusitis will go away on their own, without antibiotics!
Dr. Steven Schaefer, Chairman of the Department of Otolaryngology at New York Eye and Ear, says, “So many of these people have viral illnesses they’re going to run their own course. What we want to be sure is that this antibiotic is necessary.”
Hilda says, “Normally I would take over the counter products, maybe advil. It goes away on its own, I try not to get the antibiotics.”
Those who develop a bacterial--and that’s the key--a bacterial sinusitis are the ones who need an antibiotic.
The guidelines say antibiotics should be withheld for ten to 14 days unless the person is experiencing severe symptoms: face or tooth pain, swelling around the eye, and fever.
Perhaps the tell tale sign is green or yellow mucus production.
For the first shot at treatment, the guidelines call for simple antibiotics like amoxicillin or bactrim for 10 to 14 days.
The guidelines say at the start of the problem, x-rays and cat scans are not necessary.
If there’s no improvement..then a switch to another antibiotic, like augmentin, is warranted.
Other treatments that can help including saline sprays which prevent crusting around the sinus opening, and decongestants like sudafed; both maximize sinus drainage.
If it’s believed allergies are involved, an antihistamine can also help.
If after 14 days there’s no improvement, then a different antibiotic course and perhaps referral to an ENT specialist, to have endoscopy performed to look in the sinuses, might be appropriate.
Sinusitis can be new: acute sinusitis involves symptoms for less than four weeks.
It can linger: subacute sinusitis lasts between four and eight weeks.
If it hangs on longer than eight weeks, .it’s then considered chronic sinusitis. If you have chronic sinusitis, then you need cat scans to define what’s going on, you do need to be scoped, and patients often get very, very long courses of antibiotics and close follow up with an ENT doctor.
But if you’re first having symptoms, bear in mind, that even bacterial sinusitis can go away on it’s own.
“There wouldn’t be a lot of humans around if we all would have died of bacterial sinusitis so the vast majority of people are going to do fine without a physician being involved. But they will do better faster with intelligent use of medical therapy,” says Dr. Schaefer.
The two most common predisposing conditions to developing sinusitis are viral upper respiratory tract infections and allergic rhinitis. So, controlling allergies is very important in preventing sinusitis in these individuals. That often calls for follow up with an allergist if the allergies are severe.
By the way, surgery is a consideration only after medical therapy has failed.
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