Jason Hamilton (Facial Plastic & Reconstructive Surgeon) gives expert video advice on: Can I treat acute sinusitis myself or should I consult a doctor?; Should I use decongestants to treat sinusitis?; What treatments are available for acute sinusitis? and more...
What are "sinuses"?
Sinuses are air-filled spaces in the face. They are lined with mucosa that secretes mucus to help moisturize the nose. Sinuses also serve to lighten the weight of the face, because if the face didn't have sinuses it'd be solid bone, and the face would be probably three or four times as heavy as it is. The sinuses provide a cushion for the jawbones when you eat; they're almost like shock absorbers. They also serve to help fight infection when you have like a nasal rhinitis or flu. The sinuses help with infections because they provide mucus that helps to flush the nose out and remove irritants and viral infections. Sinuses are like a reservoir for the nose.
What is "sinusitis"?
Sinusitis is inflammation of the sinus cavities that are in the face. Sinuses are made up of the frontal sinus, which is in the forehead, the maxillary sinus, which is above the cheeks, the ethmoid sinus, between the eyes, and the sphenoid sinus, which is in the middle of our head. They can either all be affected, or one or more can be affected at the same time. Typically sinusitis is treated with antibiotics. Patients who have chronic sinus infections - sinusitis - may need surgery to open the drainage path of the sinuses, so they don't have the chronic infections.
How common is sinusitis?
Most sinusitis is very common. Most people experience one to two infections of acute sinusitis in their lifetime, which will need to be treated by antibiotics. Chronic sinusitis is less common but does afflict patients, particularly those who have allergic rhinitis or nasal polyps. Chronic sinusitis is a surgical disease and needs to be treated, typically with an endoscopic sinus surgery after the treatment of long-term antibiotics.
What is "acute sinusitis"?
Acute sinusitis is usually caused by a bacterial infection that afflicts one of the sinus cavities. It's usually signaled by fever, pain and swelling over the sinus area. Typically, patients with acute sinusitis complain of tenderness when they touch that area on their face. It usually lasts for five to ten days and can be treated with antibiotics.
Can I treat acute sinusitis myself or should I consult a doctor?
Acute sinusitis can be treated at home. Typically it would require that you make the diagnosis early. You can use either decongestants or nasal sprays to help kind of wash the nose and decongest it. Typically that will allow the sinus to drain. If these home measures don't work, then you should probably see the physician to be treated with antibiotics.
Should I use decongestants to treat sinusitis?
Well, decongestants work by constricting vessels in the nose. Over time, they lose the ability to affect those vessels and keep the blood out. Eventually, the vessels become tired and they relax, and they actually let more blood in so the nose becomes more swollen and the cheek tissues swell more. Then it makes the symptoms even worse.
What treatments are available for acute sinusitis?
Typically for an acute sinusitis your physician will prescribe an antibiotic, a nasal decongestant, and likely, some saline spray. The antibiotic is used to treat the bacteria, the decongestant is to relieve the obstruction and allow the sinuses to drain, and the saline is simply used to wash away the thick mucus that's infected with bacteria.
What is "chronic sinusitis"?
Chronic sinusitis is typically a bacterial infection that persists for more than three months. It's usually caused by the same bacterias that cause otitis media. They're very resistant to antibiotics. Patients who have problems with obstruction, either from allergic rhinitis or nasal polyps, will have a mechanical obstruction which won't allow the sinuses to drain, which will allow the bacteria to become more resistant to the antibiotics. Typically, either a long course of antibiotics, up to six weeks, can help relieve the symptoms of chronic sinusitis, or a surgical procedure to increase the drainage of those sinuses will help as well.
What are the symptoms of chronic sinusitis?
The symptoms of chronic sinusitis are little, vague, in comparison to acute sinusitis. Typically patients do not have fevers. They may complain of chronic nasal congestion, chronic thick mucus that comes from the front of the nose or that they swallow. They may feel like they have chronic headaches or migraines or tenderness over a particular area of the face.
Can I treat chronic sinusitis myself or should I consult a doctor?
You can not treat chronic sinusitis by yourself. Patients who have chronic sinus infections definitely should be seen by specialist. Typically, the specialist has the ability to either culture the sinus so that culture directed antibiotics can be given for a prolonged period of time. They'll also typically order a CT scan which is a x-ray of the sinuses is in two dimensions which can give them more information about which particular sinus is blocked, and they also have the ability to treat you surgically if the antibiotic fail.
What treatments are available for chronic sinusitis?
Treatments for chronic sinusitis are typically prolonged antibiotics for up to six weeks. Usually your physician will get a baseline Cat scan, and then after your six weeks course of antibiotics, they'll repeat it. If it looks like the sinuses are clear, then you don't need any more antibiotics. If you continue to have sinus infection after the six week course of antibiotics, your physician will typically culture your sinuses to find out exactly what bacteria may be resistant, and then change the antibiotic to target that bacteria itself. If all this fails, sometimes your physician will treat you with a steroid, like Prednisone, to help decrease the inflammation in the sinuses, and then that's typically followed with a surgery. The surgery removes bone and strips the mucosa from the sinuses to allow them to drain, and also removes the infection at the same time.
How will an otolaryngologist diagnose my sinusitis?
Usually an otolaryngogogist would diagnose your sinusitis by geting a CAT scan. And the CAT scan is, basically, a two dimensional X-ray that will show him or her the sinus cavities and be able to assess whether there is fluid or thickened mucus in there or bacteria that is causing an infection. Sinusitis can be diagnosed clinically but it's difficult often to tell whether the patient is just suffering from a rhinitis, meaning their nose is blocked and they just feel pressure in the face or if there's actually a problem with the sinus. The definitive examination for sinusitis is a CAT scan.
What is a "nasal endoscopy"?
Nasal endoscopy is a fiber-optic exam, via a small rod that's placed into the nasal cavity. It's magnified, so that you can visualize the turbinates, which are the humidifiers of the nose, and you can see the drainage pathways for the sinuses, as well as the back of the nose as well. Typically, just looking at the front of the nose with an otoscope doesn't show you the entire nasal cavity, so the nasal endoscopy diagnoses either sinus or nasal disease in its entirety.
What can I do to minimize sinusitis pain and symptoms?
If you suffer from chronic sinus disease, you probably need to see your physician, and they can help you best with decreasing the pain and symptoms. Typically, chronic sinusitis is very insidious and it kind of lingers for years and years before patients come in for treatment. They are trying to treat themselves at home with over-the-counter remedies that typically have no effect on the bacteria or increasing the ability for the sinuses to drain. So probably your best source of treatment for chronic sinus problems is your physician. If you have chronic sinusitis, and you have an acute exacerbation, meaning all of a sudden, you have one of your sinuses inflamed, swollen, and painful, something you can do before you get into the physician is take a decongestant like Sudafed or a nasal spray like Afrin to allow the sinus to drain. A pain medication such as Tylenol or Advil will also help with the symptoms until you get to your physician.