Can’t Take the Pressure? Sinus Infection or Sinus Inflammation?

Statue with headache/sinus infection representing person about to be seen for urgent care telemedicine visit.

Springtime brings out the flowers, the pollinating trees, and the usually happy to see you pets being walked around our neighborhoods.  But for many of you this time of year, you feel like you are under water, or your eyes are going to pop out of your head, your upper teeth might explode, or your head if full of cement.  These are just a few of the sensations we get when our sinuses are causing us problems.  But is it just allergies or is it an infection?  We can help you determine that.

Sinus Infection vs. Inflammation

It is not too infrequently that we see patients on video basically begging that something gets done to help relieve the discomfort. Often asking for antibiotics to take care of my sinus infection.  However, did you know that less than 2% of all sinus issues in adults with symptoms of less than 4 weeks duration are believed to be caused by a bacteria?  So antibiotics will not help about 98 out of every 100 adults presenting to a health care provider with acute sinus problems.

So what is causing all that discomfort?  Most of the time it is viral or allergic, relatively unlikely bacterial, and very rarely fungal.

Multiple guidelines from various medical societies have been published over the years on recommendations regarding who might have a bacterial infection and who might not.  These guidelines occasionally differ a bit but the two most commonly referenced ones come from the Infectious Disease Society of American(IDSA) and the American Academy of Otolyaryngology – Head and Neck Surgery Foundation.

At Care on Location, we believe in practicing evidence based medicine and avoiding inappropriate use of antibiotics for reasons running from bacterial resistance, to side effects and allergic reactions, to unnecessary added costs of healthcare from any of the preceding.  Each of our providers has access to the guidelines, which in the case of sinus complaints, follows the guidelines of the societies mentioned above.

The guideline that we use to identify those most at risk of a bacterial sinus infection include:

  1. Persistent & not improving symptoms lasting 10 or more days
  2. Severe symptoms(Fever >102F, worsening thick yellow discharge, initial and persistent facial pain lasting more than 3-4 days)
  3. A “double worsening” when an initial apparently viral infection begins to improve but then worsens

Multiple other factors play into the decision to use antibiotics or not but for patients without significant risk factors for bacterial infection, the above three items can generally be used a good guide to whether or not they are needed.

Treatments

If antibiotics do not seem like they are going to be of much help, there are multiple other options to try and calm things down:

  1. Nasal saline irrigation – Using commercially available or home-made nasal irrigation, this saltwater solution helps flush that often stubborn to remove mucous from your nasal passages.  This helps provide pain and pressure relief, while also decreasing airflow obstruction from the mucous.
  2. Nasal steroids – A short course of nasal steroids has been shown in studies to have a positive effect on symptom improvement compared to placebo.  This effect is more likely to be beneficial in those that have a primarily inflammatory cause of sinus issues such as allergies compared to those with infections.  But the mechanism of decreased inflammation could be of some benefit to all causes and again help to clear out the nasal passages.
  3. Oral Decongestants – A short course of decongestant pills can help clear things up for some.  Be careful using these medications if you have heart disease, high blood pressure, certain types of glaucoma, or certain bladder emptying problems as they could make these medical issues worse.
  4. Nasal Decongestants – These over-the-counter sprays may provide some sense of relief.  Many of them work by narrowing the blood vessels leading to the lining of your sinuses and nasal passage.  In theory, this constriction of the small arteries will help decrease the amount of swelling on the lining.  Be warned, that these medications should not be used for more than three days, as the rebound congestion can lead to addictive use of the sprays.  Plus the long term use also could mean long term decrease in blood flow to the nasal passage lining which could cause damage.
  5. Pain relief/anti-inflammatories – Acetaminophen(Tylenol) and Non-steroidal anti-inflammatories(ibuprofen, naproxen) can help with and and fever relief.  In some circumstances, caution should be used for those with stomach problems like ulcers, kidney problems, or liver problems….depending on the medication chosen to take.  Please read the package insert.
  6. Antihistamines – While there are not great studies to show much benefit from anti-histamines, there could be a theoretical benefit, particularly for those with allergies as the trigger for their symptoms.  Others have suggested antihistamines could worsen symptoms by drying out the mucous and making it harder to clear.
  7. Mucolytics – These medications(guaifenesin is one example) are designed to thin the mucous secretions to make them easier to clear.

Get Recommendations for the Best Treatment Course

We feel your pain.  Hopefully some of the above information will help provide you some relief.  We are always happy to evaluate you for determination of the best treatment method for your individual situation and to determine if antibiotics are needed.  To be seen by one of emergency medicine, family medicine, or internal medicine trained clinicians, CLICK HERE to be taken to our “Request Care” Login Page.