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Chronic Sinus Problems Require Treatment

JAMA study got it wrong and patients could be the losers

By Henry J. Fishman, M.D.
ConsumerAffairs.com

December 18, 2007    Spanish

• Chronic Sinus Problems Require Treatment • Some Common Sinus Treatments May Not Be Effective • Study: Antibiotics Overprescribed for Sinus Infections --- • More Health News ...

Antibiotics and steroid nose sprays don’t work for sinusitis. That’s the take-home message of an article published in JAMA on Dec 5.

Well, don’t believe everything you read or hear.

In the study published in JAMA, researchers studied 240 people with acute sinusitis, a bacterial infection in the air-filled holes in your head called the sinuses. They treated some with an antibiotic called Amoxicillin, some with a nasal steroid spray, some with both and some with placebo.

According to the authors, it is tough to tell a sinus infection from a cold -- which can be true -- and antibiotics and sprays don’t help much, which is only occasionally true.

Where did they go wrong?

Well, for starters, they used amoxicillin. Somewhere between 20 and 60 per cent of bacteria are resistant to it, so of course it did not work. Perhaps they should have tried a more effective antibiotic, and treated people longer.

They only gave antibiotics for 7 days. Some sinus infections take ten days to four weeks to get better. Chronic sinus problems can last for weeks or months. The study did not include anyone with chronic sinus problems at all.

Truth be told, the authors' conclusions, that antibiotics and nose spray don’t work, simply do not apply to anyone with chronic problems. In fact, antibiotics and sprays help most folks with chronic sinus problems.

What to do

So what to do about sinus problems?

Well sinuses are air-filled spaces in your skull. You have eight of them behind the forehead, cheeks and eyes. No one knows what good they do. They may help make your skull lighter or they may warm and humidify the air you breathe.

One thing we do know is that the sinuses get blocked up easily with mucus, which germs love.

Each year 30 million Americans develop sinus infections from viruses, bacteria and fungi. The infections can be acute, lasting 2-4 weeks, or chronic. Sinus infections can lead to abcesses, meningitis, orbital cellulitis (an infection around the eye), pneumonia and bone infections.

Sinus infections cause nasal congestion and discharge, sore throat and postnasal drip, headaches in the face or behind the eyes, tooth pain, and cough. They can also cause a fever, bad breath, and tiredness. If you have any of these symptoms call your doctor.

Risk factors for sinus problems include air pollution, environmental allergies, cigarette smoke, dental work, nose problems like a deviated septum or polyp, frequent swimming or diving, and gastroesophageal reflux disease.

Changing altitudes, like flying or scuba diving, pregnancy, cystic fibrosis and over-using over-the-counter nose spays can lead to sinus problems, as can immune deficiencies like AIDS.

If you have sinus problems, call your doctor, and ask to see a specialist like an allergist or ENT doctor. As the authors of the JAMA article point out, diagnosing sinusitis can be tough.

Your doctor will take a history and do a physical exam. Sometimes they tap a sinus to see if it is tender, try to shine a light through a sinus, or culture your nose. These are all pretty inaccurate techniques.

He or she may also take an x-ray or view your sinus through a fiber-optic scope. The best and most accurate way to diagnose any kind of sinus problem is with a CT scan or, occasionally, an MRI.

If you have sinus problems, you and your doctor should try to figure out why. You may need allergy tests, an immune evaluation in the blood, or a test for diseases like cystic fibrosis.

Prevention

Clearing up sinus problems can be a real pain, so it's best to prevent them if you can. Here are a few things you can do to help keep your sinuses happy, healthy and, most important, unclogged.

• Keep your nasal passages moist with nasal saline or a humidifier. Don’t overdo humidity. Measure it with a humidistat. Too much humidity can lead to mold which makes things worse.

• Drink plenty of fluids.

• If you have allergies, allergy-proof your bedroom and ask about allergy shots. Avoid OTC nose sprays.

• Two vaccines can help: the influenza vaccine and the pneumonia vaccine or pneumococcal vaccine, which help prevent bacterial sinus problems.

Diagnosis

It can be hard to tell a cold from a sinus infection. If you develop trouble a week or so after a cold starts, have severe symptoms like a headache or fever, or have an infection on a CT scan or X-ray you usually need antibiotics for at least ten days.

We don’t have an easy way to culture the sinuses, other than using an endoscope in the nose. Ask your doctor which antibiotics in your area have the least drug resistance.

Treating chronic sinus problems may require weeks of antibiotics, antifungal medicines, and surgery to drain the sinuses. Despite the JAMA study, most experts recommend steroidal nose sprays topically and oral decongestants to treat most kinds of sinus problems. Use them carefully and ask about side effects.

Sinus problems can cause a lot of trouble. But if you get proper medical care, you can usually deal with them pretty well and lead a long and active life. Just don’t believe everything you read, or hear.

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