It’s spring in Oregon, which means probably your nose is running. Maybe the discharge is yellowish. You also have pain behind your eyes, and facial pressure that increases when you bend forward. Are you thinking: “Uh oh, I must have a sinus infection, I better get some antibiotics?” Think again.

Here is a primer on sinusitis, the vast majority of which (>98%) DON’T require antibiotics to get better.

The sinuses are hollow air spaces within the facial bones surrounding the nose. They are covered with a thin lining that produces mucous, which normally drains through the nose and back of the throat. When the sinus linings are irritated, they respond by producing more mucous, and this can cause pressure, swelling (inflammation), pain and further irritation.

What causes sinusitis?

Anything that irritates the sinuses can cause sinusitis, such as:

  • Viruses (such as the common cold are by far the most common cause of sinusitis)
  • Allergies
  • Irritants (such as dust)
  • Bacteria (<2% of sinusitis cases, usually develop after > 10 days of a preceding virus) It can be difficult (or even impossible) to determine the cause of a sinusitis even after carefully examining you in the office.

The common symptoms of sinusitis are:

  • Stuffy or blocked nose
  • Facial pain (often worse when bending forward)
  • Tooth pain
  • Yellow or green discharge (mucous) from the nose
  • Post nasal drip

Possible additional symptoms include cough, trouble smelling, ear pressure or fullness, headache, sore throat, bad breath, feeling tired.

Reasons to contact your GreenField Health team right away (if you have these along with sinusitis):

  • Fever higher than 102
  • Sudden and severe head or facial pain
  • Trouble seeing or seeing double
  • Swelling or redness around one or both eyes
  • Trouble breathing
  • Stiff neck

What helps with sinusitis?

  • Rest, rest and rest – listen to your body so it can fight the virus.
  • Drink lots of fluids to keep mucous thin; hot fluids are especially helpful.
  • Boost humidity by inhaling steam (from hot showers, hot tea,soup, vaporizer, humidifier).
  • Rinse your nose with nasal irrigation.
  • Decrease pain with over-the-counter pain relievers such as ibuprofen or acetaminophen, also placing a heating pad on the face can help reduce pain.

Other things that might help:

  • Steroid nasal sprays like prescription “Flonase” and now over the counter “Nasacort” – these decrease inflammation. They probably help more for people who also have allergies.
  • Decongestant nasal sprays – such as over the counter “Afrin” (oxymetazoline). These can help with severe congestion – but it is very important NOT to USE THEM FOR MORE THAN THREE DAYS in a row or worsening congestion can occur.
  • Oral decongestants – such as pseudoephedrine (“Sudafed”) – which is prescription only in Oregon, and “behind the counter” in Washington – can dry mucous and relieve sinus pressure and pain.
  • Mucolytics – such as guaifenesin “Mucinex”– thin mucous so it can drain out.

Things that don’t help (NOT recommended):

  • Antihistamines - especially older ones like diphenhydramine (“Benadryl”) which can thicken mucous and worsen the symptoms of sinusitis

Don’t I need an antibiotic to treat a sinus infection?

Very few “sinus infections” (sinusitis) are actually caused by bacteria (<2%). When this occurs, it is usually more than 10 days after the symptoms of sinusitis begin. Even when a sinusitis is bacterial, in non-smoking people with healthy immune systems, the bacterial infection will go away on its own without antibiotics about half the time.

But my nasal discharge is yellowish or green, doesn’t that mean bacteria are growing?

The yellowish green color of nasal discharge that occurs with sinusitis does NOT indicate bacteria are present, rather that white blood cells are present. Our immune system sends white blood cells to the scene of inflammation even if bacteria are not present.

What’s the harm in using antibiotics for sinusitis?

Large studies that involve taking a culture from the sinuses show that clinicians nationwide are prescribing antibiotics too often for non-bacterial sinusitis. The bacteria that commonly infect the sinuses are becoming resistant to the antibiotics we used to use.

Antibiotic resistance is a serious problem worldwide because if we continue to use antibiotics when they are not necessary, they won’t work when they are needed for life-threatening conditions. 

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