Do I have a Sinus Infection?

"Doc, I think I have a sinus infection and need an antibiotic," is a common patient complaint that I hear at this time of year. 

With the ups and downs of the weather around Spring time and with the allergy season in full force it is common for me to see patients who have significant sinus and allergy problems. Many patients associate sinus symptoms with sinus infection. 

Sinus pressure or inflammation of the sinuses (Sinusitis) can actually be caused by many things. These include viruses, allergies, and bacteria. The most common cause is a viral infection associated with the common cold. Bacterial sinusitis, which is treated with antibiotics, complicates viral sinusitis in only about 0.5 to 2 percent of cases. (1) In theory, this means that the vast majority of patients that present with a "sinus infection" should not be treated with antibiotics. 

However, it is not always so clear when someone has a bacterial sinus infection. So what are some criteria that are more suggestive of bacterial sinusitis. The Infectious Disease Society of America suggests the following three criteria (2):

• Persistent signs or symptoms that don't show clinical improvement in 10 days
• Onset of severe symptoms or signs of high fever (>39°C or 102°F) and purulent nasal discharge or facial pain for 3-4 consecutive days
• Worsening symptoms after initial improvement after 5-6 days 

Fortunately, if you do have a sinus infection or sinus symptoms there are some traditional treatments that may help. These include anti-inflammatories, saline irrigation, intranasal steroids like Flonase, antihistamines, mucolytics (guaifenesin), and decongestants. If these treatments are not helping or symptoms are worsening than antibiotics are often necessary. Antibiotics that are commonly used in adults include Augmentin, Doxycycline, Clindamycin, or a Levofloxacin. 

Steroids may also help and have been shown to shorten the time to resolution. 

Some natural treatments that may help include colloidal silver, essential oils, and natural antihistamines. 

If you are experiencing significant sinus or allergy symptoms please feel free to give me a call or see your doctor. 

References:

1. Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007; 45:97.

​2. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.