I've been having trouble with cronic sinus infections recently. I've had the current infection for close to three months now. Like most people, it's allergy related. I've been on a couple of antibiotics that certainly helped, but it just won't seem to go away, or at least I don't think it's gone. The only current symptoms are aching upper teeth, and occasionally coughing up, or blowing thick yellow mucous from my nose. My antibiotics have run out, and I hesitate to go back to the doctor, primarily because nothing seems to be helping.
I'm currently been having only minor allergy problems, but I fear that since the bad allergy season is upon us, the infection will get out of hand again. I take antihistamines and use flonase regularly to help keep the allergy symptoms under control. I use a variety of antihistamines, including Claritin D, over the counter Actifed and other over the counter medications.
One thing I do when the infections are bad to help bring temporary relief, especially from that "glob" of mucous that just "hangs" in your throat in the mornings is to flush my nasal passages with warm salt water. Is this creating any other problems that I may not be aware of? One thing I have noticed is that when I do this two or three times a day, the mucous starts to take on a reddish color after two or three days.
Could there be any long term effects associated with letting a mild infection go on untreated?
Thanks
Answer -----------
Chronic sinusitis is generally defined by characteristic symptoms (congestion, nasal obstruction, facial pressure, pain referred to teeth, purulent drainage, smell or taste disturbance, etc.); characteristic findings on physical examination (congested nasal lining, exudate on the membrane surface, tenderness with percussion of the cheek bones, redness or edema of the lining in the back of the throat, etc.); and duration greater than 8-12 weeks. Allergy is not felt to be the most common cause of chronic sinusitis. Anatomic factors in fact are felt to be a more common cause of this problem such as deviations of the nasal septum, polyps, unusually narrow ostia or openings of the sinus, etc. Allergies however may be a potential factor.
Contemporary management of chronic sinusitis typically involves: 1) Long-term antibiotics. The bacteriology of chronic sinusitis is different than garden variety acute sinusitis. Current antibiotic recommendations for chronic sinusitis include these examples: Bactrim, cephalosporins such as Lorabid or Ceftin, Augmentin, Doxycycline, Cipro, clindamycin. Usually 3-6 weeks of antibiotic therapy are recommended for this condition. 2) Medication to thin or reduce the viscosity of secretions. Currently only one such drug known as a mucolytic is available called guaifenesin and brand names include: Fenesin, Humibid, etc It may be prescribed in combination with a decongestant - Entex, Deconsal, etc. 3) Topical nasal steroid sprays are recommended to reduce the mucosal swelling and inflammation particularly around the sinus openings to allow proper ventilation and ultimately proper drainage of the sinuses. Common brands include Nasacort, Beconase, Flonase, Rhinocort, Vancenase. These are best used on a daily basis and often require several weeks to months to be effective. 4) Other adjunctive measures such as nasal irrigations with saline - a common recipe is 1/4 teaspoon salt in 8 ounces warm water and performed several times daily; proper humidification, adequate hydration, rest, proper nutrition, avoidance of nasal irritants such as cigarette smoke, etc. If symptoms are particularly severe systemic steroids such as prednisone may also be used on a short term basis.
In the case of chronic sinusitis, otolaryngologists typically do not recommend X-rays until several weeks of therapy as described above have been completed, unless there is some question of the diagnosis in which case x-rays may be ordered earlier. The type of x-rays ordered are typically limited Cat Scans which provide detailed views of the intricate anatomy of the sinuses and their drainage pathways. The rationale for doing the x-rays after prolonged treatment is that if significant disease is still noted radiographically at this point, the likelihood of resolution without surgical drainage of the sinuses is low.
When medical therapy fails to resolve chronic sinusitis, surgical intervention is typically recommended since if untreated, complications including extension of infection to the bone of the skull, brain,eye etc can occur. Contemporary surgery for chronic sinusitis involves the use of endoscopes and is designed to remove infected tissue surrounding the drainage pathways of the sinuses, generally as outpatient surgery.
In the case of co-existent allergy, while it may be necessary because of significant allergy symptoms (itching, sneezing, watery drainage) to use antihistamines such as Seldane, Hismanal, Claritin, Dimetapp, etc, these medications are best avoided if possible in the presence of chronic sinusitis until the infection is resolved. This is because antihistamines tend to increase the viscosity of secretions thereby impairing drainage of secretions that have accumulated in sinusitis.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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