Almost all cases of acute sinusitis begin with an upper respiratory infection also referred to simply as a common cold. Since the mucosa lining the nose and the sinuses appears continuous, acute rhinosinusitis is a more proper term for the condition.
Symptoms suggestive of a simple viral infection begin with nasal congestion or a runny nose often associated with sneezing, cough, sore throat and perhaps low grade fever. Illness usually peaks in 2-3 days and resolves within a week or so.
But some individuals ultimately note discoloration of the nasal discharge as it transforms from clear mucus to thick, opaque often white, yellow or green discharge. This change in mucus appearance identifies the condition as rhinosinusitis but fails to differentiate between an underlying viral or bacterial culprit. Actually physicians also find extreme difficultly in distinguishing the underlying cause.
With more than 30 million yearly office visits for “sinusitis” only an estimated 0.5% with develop acute bacterial rhinosinusitis. Of course a visit to a doctor with these symptoms often results in a prescription for an antibiotic. Since the culprit tends to be viral, the likelihood of benefit with an anti-bacterial drug seems remote at best. Estimates suggest for every 8 antibiotic prescriptions, at least 1 individual will suffer an adverse reaction. And antibiotics neither shorten the course of infection nor do they improve associated pain and discomfort.
Many complain of a sinus headache, however this is not a recognized condition. Actually the headache associated with rhinosinusitis represents a migraine both in children and adults. This concept continues to elude many general practitioners, neurologists and even ENT specialists.
Treatment aimed at the sinus headache routinely fails to provide relief while those designed to treat migraine succeed. Symptoms demonstrate an uncanny similarity between the migraine and acute rhinosinusitis. People with rhinosinusitis regularly experience facial fullness and pressure but not headache.
Routine x-rays rarely provide any benefit. CT scans may offer assistance but rarely beyond that associated with a complete physical examination except in cases where surgery is contemplated.
Treatment relies on symptom control which often equates to placebo therapy until the condition spontaneously resolves. Even acute bacterial rhinosinusitis generally improves without antibiotics as the nasal swelling subsides and the bacteria are swept from the sinuses. Nasal irrigation with salt water, intranasal steroid sprays and compounds such as guaifenesin to loosen secretions may hasten recovery or at least temporarily minimize symptoms.
Antibiotics only rarely improve the situation. Amoxicillin or possibly Augmentin remain favorites. Doxycycline or a sulfa such as Bactrim substitute for penicillin in allergic individuals. Cipro and Levaquin produce too many side effects and are no longer preferred agents.
16 сен 2024
