Medical Treatment of Sinusitis
Medical treatment is directed towards the microorganisms causing sinusitis and restoration of the normal drainage and ventilation of the sinuses. Specific treatments will be prescribed by a physician depending on each individual case.
Viral sinusitis is common and usually the individual recovers spontaneously. Treatment consists of treating symptoms, including low grade fever, malaise, nasal congestion and other supportive measures. Over-the-counter decongestants or cold tablets are useful, providing the patient does not have hypertension. Some individuals benefit from antihistamines, but most find the drying of the respiratory tract unpleasant. Analgesics are helpful with the treatment of the malaise and the low grade fever. Nasal steroid sprays and oral steroids may also be helpful.
Bacterial sinusitis follows viral sinusitis because the viruses injure the lining of the sinuses and respiratory tract, leading to thickening of this mucous membrane. The swollen membranes impair the ability of the sinuses to drain. Initial treatment of bacterial sinusitis includes all of the above recommendations for viral sinusitis. Treatment will include first-line antibiotics and second-line antibiotics when necessary.
Surgery for sinusitis is reserved for disorders resistant to medical treatment and/or impending complications of sinus disease. Endoscopic intranasal sinus approaches are utilized in the majority of patients.
In considering a patient for surgery, our physicians confirm that the following criteria are met:
- Persistent symptoms and/or physical findings after treatment with antibiotics for three to four weeks. Treatment should consist of continual administration of one broad spectrum antibiotic, rather than a total of several antibiotics over four weeks. In addition to antibiotics, oral and nasal steroids may be helpful. Increasing frequency, duration and severity of infections are also important factors in considering surgery.
- CT scan evidence of sinusitis after completing antibiotics.
Historically, there are numerous surgical approaches to the sinuses. The most common utilized today are: