Prescription: Infection of the sinus cavities

Every fortnight Dr Sunita Agarwal highlights a common, but often ignored, medical problem


Do you have repeated attacks of cold or allergy that won't go away? If so, there's a good chance you actually have sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds or allergies, and many sufferers never see a doctor for proper diagnosis.

What is sinusitis?

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to cure the infection and prevent future complications. Normally, mucus collecting in the sinuses drains into the nasal passages. When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Diagnosis of acute sinusitis usually is based on a physical examination and a discussion of symptoms. Your doctor also may use X-rays of your sinuses or obtain sample of your nasal discharge to test for bacteria.

When acute becomes chronic sinusitis

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.

Treating sinusitis

Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis, be sure to see your doctor for diagnosis. In addition to an antibiotic, an oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid prolonged use of non-prescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help.

Relieving sinus discomfort

Antibiotic resistance: This means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. If the doctor prescribes an antibiotic, it is important that you take all of the medication just as your doctor instructs, even if your symptoms are gone before the medicine runs out.

Chronic sinusitis: If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.

Sinus surgery

Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease. Surgery can be performed under the upper lip, behind the eyebrow, next to the nose or scalp, or inside the nose itself.

Functional endoscopic sinus surgery is recommended for certain types of sinus. The decision whether to use local or general anaesthesia is made depending on individual circumstances. Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. It is equally important for patients to follow pre- and postoperative instructions.

Preventing sinusitis

To avoid developing sinusitis during a cold or allergy attack, keep your sinuses clear by using an oral decongestant or a short course of nasal spray decongestant, blocking one nostril while blowing through the other, drinking plenty of fluids to keep nasal discharge thin and avoiding air travel. If you must fly, use a nasal spray decongestant before take-off to prevent blockage of the sinuses allowing mucus to drain.

If you have allergies, try to avoid contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks. Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances.

— Dr Sunita Agarwal can be contacted on dr_Agarwal@vsnl.com or visit website www.agarwalhospitals.com