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SINUSITIS, RHINITIS: The sinuses are air-filled cavities lined with mucus membranes above and below the eyes. Sinusitis is a bacterial infection that causes the sinuses to be inflamed. The condition is characterized by persistent nasal congestion, cold or flu like symptoms that go beyond the usual 7 to 10 days, and pain and headache in the sinus area. A study of American veterans with sinusitis identified these symptoms: toothache, congested sinus cavities (as determined by transillumination), poor response to nasal decongestants or antihistamines, and nasal discharge containing pus. People who are particularly susceptible to sinusitis are those with allergies or deformities of the nose (deviated septum), those habitually exposed to bacteria (healthcare workers, school teachers), and smokers.
Sinusitis is often confused with allergic rhinitis, which has similar symptoms but is not caused by bacteria. Rhinitis may be caused by a virus, an environmental allergen, extreme temperature change, or overuse of nasal sprays.
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DRUGS AND SURGERY: Because it's caused by bacteria, sinusitis should respond to antibiotics. But an increasing number of cases are resistant to standard forms such as amoxicillin, causing doctors to resort to more powerful antibiotics, or to a 4 to 6 week course of amoxicillin combined with Flagyl (metronidazole), a drug with substantial side effects of its own. Sinusitis that doesn't respond after several weeks of antibiotic treatment is termed "chronic sinusitis" and is referred to a specialist, since if left untreated it can cause serious illness.
When antibiotics don't work, surgery may be resorted to. The development of endoscopic surgery, along with a substantial increase in antibiotic-resistant cases of sinusitis, has led to a dramatic increase in these surgeries. Endoscopic surgery uses a pencil-thin telescope and can be done without an incision. But while it's a relatively painless outpatient procedure, the pain after surgery is considerable; and its safety and effectiveness have not yet been established in controlled studies. There is some evidence that the incidence of disabling or life-threatening complications, including hemorrhage and toxic shock syndrome, may be as high as 5 to 18%.
For allergic rhinitis, which is not caused by bacteria, antibiotics are not effective. The condition is treated conventionally with antihistamines and decongestants. If those drugs don't work, corticosteroids are generally prescribed. CAUTION: If over-the-counter decongestant nose drops or sprays containing phenylephrine (Neo-Synephrine) are used, they should not be continued for more than 3 days, since they can cause addiction.
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