Simply Sinus

Edema of the skin caused by inflammation

Image via Wikipedia

A have a nephew that’s fond of saying, “Oh, that blows!,” when hearing bad news; especially involving him. However, it makes me think of patients complaining of sinus pressure or pain, asking for antibiotics to help make them feel better. Since Fall is beginning and head colds will be around the corner, what helps in getting our collective snouts to generate less snot?

Believe it or not, bacterial infection is responsible for less than two percent of sinus infections. That leaves the remaining 98 percent of sinus infections caused by our little viral friends. The same viruses that defy our ability to develop an effective arsenal of drugs capable of loosening their grip on sinus tissue and killing them outright. They cause inflammation of our nose and sinus, which the body tries to protect by generating excessive mucous. When that fills the small, bony, sinus cavities, pressure results causing pain, ear pressure, headaches and sometimes, low-grade fever.

Most of us reach for Tylenol, or acetaminophen for the pain and fever. Oral antihistamines (Claritin, Tavist) would seem to make sense, as they work for seasonal allergies. But for viral infections their effectiveness is limited, since we’re not dealing with a typical allergen. Scanning the drugstore shelves, we next come across mucolytics (guaifenesin is the active ingredient), drugs to thin mucous secretions, promoting drainage—if they work—trouble is a large number of clinical trials clearly show they don’t.

Nasal decongestants, that we spray into our snouts, do work to reduce edema and inflammation. They help for three to five days at best, longer use oddly enough promotes increased or “rebound” congestion. Oral decongestants, containing pseudoephedrine, also help reduce nasal swelling. They also help reduce swelling in the eustachian tube, a drainage pipe in the back of the throat that leads to the inner ear. Helping this drain relieves the pressure we commonly attribute to our sinuses. For those with a spirit of adventure you can flush out the sinuses with a Neti pot; a vessel that uses sterile water, or salt water, to flush out the sinuses, reducing mucous and inflammation.

After we’ve done all this and our pain and discomfort persists, what’s next? We use antibiotics in severe cases and they’re certainly prescribed in great numbers. Many times they seem to help; we’ve already been through seven to ten days of using everything else and the virus infection is finally over. When physicians prescribe the ‘killercillin,’ after we’re already healing, it seems like a miracle. It’s times like that when I’m reminded of a quote by Voltaire when he said, “The art of medicine consists in amusing the patient while nature cures the disease.” Having a sinus infection may ‘blow’ as my nephew says, but given time we’ll be able to stop and smell the roses this Fall once again.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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