What can I do for my chronic sinusitis?

Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Sinusitis is a very common problem worldwide. We know it affects more than 30 million Americans annually and many more around the world.

Sinusitis is inflammation of the nasal cavity and the sinuses, which are air-filled spaces located primarily in the jaw above the upper teeth and in the forehead around the eyes. Symptoms of acute sinusitis include nasal congestion and obstruction, nasal discharge, tooth discomfort and facial pain or pressure that is worse when bending forward. People can also get fever, fatigue, cough, changes in ability to taste and smell, ear pressure, headache and bad breath.

Sinusitis can be classified as acute, meaning symptoms last less than four weeks; subacute, meaning symptoms last for four to 12 weeks; chronic, in which symptoms persist longer than 12 weeks; and recurrent acute sinusitis, in which there are four or more episodes per year.

The acute conditions are usually caused by viruses such as the "common cold" virus or by common bacteria. Treatment of both viral and bacterial acute sinusitis is primarily supportive care. Reasonable things that a health care provider might suggest for a patient with an acute sinusitis include:

• Analgesics such as nonsteroidal anti-inflammatories or acetaminophen for pain and fever relief.

• Irrigation of the nasal passages and sinuses with buffered hypertonic saline (0.9 percent salt water). This can clear debris and provide some relief.

• Steroid nasal sprays, which can reduce inflammation, but overuse can worsen infection.

• Decongestants, such as oxymetazoline, help relieve symptoms, but should be used sparingly as they can cause rebound congestion if used for more than three days. Nasal spray decongestants are more effective than oral decongestants.

• Antihistamines are frequently prescribed for symptom relief because of their drying effects, but there are no studies to show their efficacy and they can overdry nasal passages.

• Guaifenesin is a drug that thins mucous secretion and can promote drainage. It, too, has not been extensively studied.

Only bacterial sinusitis should be treated with antibiotics and even those cases usually resolve without antibiotic treatment. Distinguishing bacterial versus viral can be difficult. I generally give antibiotics only when there is fever, sinus pain and a yellow or green nasal discharge. Unnecessary antibiotic use can lead to significant long-term problems.

The chronic version of this condition is very difficult to treat. We start by looking at causes, some of which are treatable or avoidable. Things that can predispose to chronic bacterial infection include allergies, oral infections, an anatomic blockage such as a deviated nasal septum, nasal polyps or enlarged tonsils, frequent swimming, intranasal cocaine use, immunodeficiency syndromes and diseases such as cystic fibrosis and diabetes. Allergies and oral infections often can be treated medically. Anatomic blockages may require surgery for effective treatment. Prolonged or recurrent bacterial sinus infections can merit evaluation for diabetes and some rare immunodeficiency conditions that involve the inability to mount an antibody defense. There is increasing interest in fungal allergy or even fungal infection as a cause of some chronic sinusitis. Treatment of chronic sinusitis with anti-fungal medicines has not shown benefit. This is an area of active investigation.

One can have skin reactions and rashes due to a reaction to bacterial, viral or fungal infection or an allergic reaction to medicines used to treat it. Seek a second opinion and keep lines of communication with your doctors open.