3. What is the most common treatment for sinusitis?
faq03-drhwang
Peter Hwang, M.D.
Associate Professor and Director
Stanford Sinus Center Stanford, CA
Sinusitis should be primarily treated with medication to cover both sinus inflammation and sinus infection. Sinus inflammation can be treated with decongestants, topical nasal steroids, and/or oral steroids. The sinus infection is treated with antibiotics. Sinus cultures taken in the doctor's office can aid in selecting the most appropriate antibiotic. Saline sinus washings may also be helpful. Surgery is reserved for those patients who continue to have problems despite extended courses of broad medical therapy.
faq03-ferguson
Berrylin J. Ferguson, M.D. Pittsburgh, PA The common cold - There is still no cure for the common cold. The symptoms of a cold can be lessened by using a topical decongestant spray such as oxymetazoline (i.e. Afrin). This will quickly relieve nasal congestion and is available over-the-counter. Patients should not use this product for more than 3 days in a row because of the possibility of causing a rebound congestion. High doses of guaifenesin (Robitussin; 1200 mg two times a day) can help loosen thick mucus. Drinking lots of fluids can also be helpful. There is one study that suggests that zinc gel applied to the nose within the first day or two of cold onset may diminish the severity and duration of the cold. One pharmaceutical company is hoping to have a drug available within the next year that will decrease the frequency and duration of the common cold if initiated within the first 48 hours of the cold.
Bacterial sinusitis - almost half of all cases of bacterial rhinosinusitis will resolve without antibiotic therapy. The most common causes of bacterial sinus infections are Streptococcus pneumoniae, Haemophilus influenza and Moraxella cattaralis. These organisms are increasingly resistant to antibiotics that we have used to treat them in the past. The patient should start to feel better within 48 hours of starting an antibiotic if it is effective in treating the bacteria. The patient who only starts to feel better at the end of a ten-day course of antibiotic therapy probably would have felt better at this point in time even if they had not been on an antibiotic. Some clinicians obtain a culture of the drainage from the sinuses using a small telescope. Analysis of the specimens will allow the doctor to know what antibiotic is most likely to be effective in treating a bacterial sinus infection. The same treatments used for patients who have a cold will also make patients with a bacterial sinus infection feel better.
Allergic rhinitis - is best treated by avoiding the allergen which triggered the response in the first place. This, however, is often impractical. There are a number of medications that are helpful in treating the symptoms, allergic rhinitis. For patients whose primary symptom is congestion than a nasal steroid spray or a topical antihistamine spray are usually the most helpful. Antihistamines alone are most effective for symptoms of sneezing and itching. Examples of oral antihistamines include loratadine (Claritin), fexofenadine (Allegra) and ceterizine (Zyrtec). These medications are not very effective for nasal congestion. Allergy shots are the only therapeutic intervention which has the possibility of a long-term cure for allergic rhinitis.
