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Sinusitis is caused by inflammation of the inner lining of the sinuses commonly caused by infections. Treatment is usually self care and home remedies as the causative agent is commonly cold or flu virus that has no specific medications.
Most patients recover in a week to 10 days from symptoms as the infection subsides. However, in some cases sinusitis the infection may last for over three months. These are chronic cases and may be resistant to therapy or may recur after remission of the symptoms. 1-7
Management of sinusitis includes home care, decongestants and so forth.
Home care involves inhaling moist warm air from a humidifier or a vaporizer. As an alternative, steam may be inhaled over a basin of hot water or shower. This helps open up the sinuses and allows the blocked mucus to flow out so that there is relief of pain. Warm compresses may be applied over the sinuses to ease the pain.
The patient is advised plenty of rest and plain drinking water.
Decongestants may help in some cases. These may be those that are prescribed by the physician or may be those available over-the-counter. These may be available as liquids, tablets or nose sprays. Generally nasal spray decongestants should not be used for more than 3 days. Long term use may cause more harm to the mucous membranes than good.
For pain over the sinuses as well as fever over the counter medications like Paracetamol or Ibuprofen may be used.
Vitamin C and zinc gluconate lozenges are recommended by some for easing symptoms. Echinacea extract has also shown benefits in some studies.
The nasal passages may be irrigated with normal saline. This is called nasal saline irrigation. This can be performed at the physician office by an ENT specialist or even performed at home using a ‘Neti pot’ (a tea pot like utensil with a spout). The saline is poured through one of the nostrils and it is used to irrigate the passages of the nose and sinuses. Use of the ‘Neti pot’ requires expertise and guidance.
For infants and young children who cannot blow the nose, a nasal aspirator may be used to suction each nostril gently before applying nose drops.
These are usually needed in patients who have a bacterial or fungal infection of the sinuses. Antibiotics may also be needed in patients with viral infections and inflammations in case there are secondary bacterial infections.
In case of bacterial sinusitis, 70% of patients improve within 2 weeks without antibiotics and around 85% improve with necessary antibiotics. Azithromycin is one of the antibiotics that are approved for use in acute bacterial sinusitis.
Other antibiotics include Levofloxacin that may be used if the first line antibiotic fails to show a response. Alternatives are Clarithromycin, Doxycycline, Amoxicillin etc.
If allergies are the cause of the recurrent sinusitis, anti-allergy medications like antihistamines may be prescribed. These include agents like Levocetirizine.
Patients with severe inflammation of the nasal and sinus mucosal membranes may need prescription nasal sprays with corticosteroids like Fluticasone, Betamethasone or Beclomethasone. These are available only with medical advice and care must be taken not to use them beyond prescription or stop them abruptly without medical advice as this may worsen the condition.
Some nasal sprays with Cromolyn sodium are also prescribed. These are useful in long term allergic conditions as they prevent onset of recurrent attacks of sinusitis.
Those who do not respond to medications or have long term sinusitis with anatomical problems like nasal polyps, deviated nasal septum, nasal bony spurs or large adenoids, may need surgical therapy. Surgery may be performed to correct each of the conditions and removal of polyps or adenoids are commonly undertaken to prevent recurrent sinusitis.
These surgeries, however, need to be performed after correction of the infection to avoid complications. Another surgical option is to create an extra or enlarged passageway in the wall of the sinus so that the sinuses drain more easily through the nasal passages.
Patients are advised to avoid smoking, air pollutants, avoid allergenic triggers like pet hair, dust mites etc. to prevent onset of sinusitis.
Complications of sinusitis include meningitis or brain abscess, infection of the bones and blood (sepsis). These are usually rare and occur in those with compromised immunity.
Hospital admission may be needed for those with severe infections, severe headache, symptoms of neurological disease, blurring of vision, spread to the eye ball and eye cavity, those with suppressed immunity etc.