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Chronic sinusitis

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After diagnosing sinusitis and identifying a possible cause, a doctor can prescribe a course of treatment that will reduce the inflammation and relieve the symptoms.

Acute sinusitis is treated by re-establishing drainage of the nasal passages, controlling or eliminating the source of the inflammation, and relieving the pain. Doctors generally recommend decongestants to reduce the congestion, antibiotics to control a bacterial infection, if present, and pain relievers to reduce the pain.

Over-the-counter and prescription decongestant nose drops and sprays, however, should not be used for more than a few days. When used for longer periods, these drugs can lead to even more congestion and swelling of the nasal passages.

Most patients with sinusitis that is caused by bacteria can be treated successfully with antibiotics used along with a nasal or oral decongestant. An antibiotic that fights the bacteria most commonly associated with sinusitis is the initial treatment recommended.

Many cases of acute sinusitis resolve without antibiotics. However, patients with underlying allergic disease, and infectious sinusitis, need to be treated to relieve their allergy symptoms. Patients with asthma and infectious sinusitis often have exacerbations of asthma which need to be treated. Many physicians feel that some patients with severe asthma have dramatic symptom improvement when their chronic sinusitis is treated with antibiotics.

Doctors often prescribe steroid nasal sprays, along with other treatments, to reduce the congestion, swelling, and inflammation of sinusitis.

Chronic sinusitis is often difficult to treat successfully, as symptoms persist even after prolonged courses of antibiotics. In general, the treatment of chronic sinusitis, such as with antibiotics and decongestants, is similar to treatment of acute sinusitis. However, the role of bacterial infections, and hence the usefulness of antibiotics in treating chronic sinusitis, is debated. Steroid nasal sprays are commonly used to reduce inflammation in chronic sinusitis. Although these nasal sprays are occasionally used for long-term treatment for patients with chronic sinusitis, the long-term safety of these medications, especially in children, is not fully understood, and the benefits and risks need to be balanced. For patients with severe chronic sinusitis, a doctor may prescribe oral steroids, such as prednisone. Because oral steroids can have significant side effects, they are prescribed only when other medications have not been effective.

Although sinus infection cannot be cured by home remedies, people can use them to lessen their discomfort. Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities. Another treatment is saline nasal spray, which can be purchased in a pharmacy. A hot water bottle; hot, wet compresses; or an electric heating pad applied over the inflamed area also can be comforting.

When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Studies suggest that the vast majority of patients who undergo surgery have fewer symptoms and better quality of life. In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages. Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms. The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery and serious complications are rare.

Treatments for chronic sinusitis include:

  • Antibiotics. Chronic sinusitis may require a long period of antibiotic treatment. You may need to take antibiotics for a minimum of 3 weeks, and up to 12 weeks, or until you've been symptom-free for 7 days.

  • Corticosteroids. If you have intense inflammation of your sinuses, your doctor may prescribe a corticosteroid. Doctors commonly prescribe nasal corticosteroid sprays, but severe inflammatory sinusitis may require oral corticosteroids. Your doctor may prescribe corticosteroid pills to try to shrink the inflamed sinus membranes, then recommend a corticosteroid nasal spray to prevent them from swelling again.

If your condition doesn't improve with medications, your doctor may recommend surgery. Surgically enlarging a narrow sinus passage or removing a bone or polyp that's blocking a passage will allow better drainage, making an infection less likely. Your doctor may perform surgery using a thin, flexible tube called an endoscope.

There are many treatments available to help fight sinusitis and sinus infections. Once you are diagnosed with a form of sinusitis, your doctor may recommend one of the following (and in some cases, a combination of the following):

Oral Antibiotics: There are over a dozen antibiotics that can be prescribed to help fight sinusitis, with the most popular being Amoxicillin (a form of Penicillin). Oral antibiotic treatments consist of taking a specific amount of antibiotic pills 2-3 times a day for up to two weeks. The problem with oral antibiotic treatments is that the distribution in the sinuses is very poor. In addition, some people can experience side effects like dizziness or nausea.

Nasal Sprays: Nasal steroid sprays and nasal saline irrigations may be recommended to help contain and reduce the inflammation of your sinuses.

IV: IV is the process of treating a sinus infection intravenously. Antibiotics are injected into a vein, which then enter the blood stream.

Surgery: If other treatments fail, the final attempt to resolve a serious sinus problem is usually surgery. The sinus surgery is usually conducted through the nose with the purpose of draining the sinuses, removing diseased tissue, resolving the conflict, and improving the drainage and health of the sinuses. There is a lot of preparation that goes into a surgery including a CT scan of the patient to find out which sinus areas need to be treated. Thanks to modern advances, micro-telescopes have made it possible to do most sinus surgeries without incisions. Still, the surgery can take 1-2 hours and may require a hospital stay for one night.


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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 03/15/08 02:09 AM