Sinusitis

Description

Alternative Names

Treatment for Chronic Sinusitis

Determining and Treating any Underlying Conditions. A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.

Initial Treatment of Sinusitis. For treatment of chronic sinusitis itself, some physicians recommend the staging the treatment in the following way.

• Initial Treatment:
• A wide spectrum antibiotic (one that can eliminate a wide range of bacteria) taken for at least 30 days.
• A corticosteroid nasal spray. (Some experts also suggest a short trial of oral corticosteroids.)
• Saline nasal washes.
• Possibly the expectorant guaifenesin with an oral (not spray or droplet) decongestant.

If the condition dramatically improves between one and two months, then the antibiotics are stopped. The patient should continue with both the steroid and saline nasal solutions. If there is no improvement after this time, the surgery may be considered. For some people with chronic sinusitis, however, the condition is not curable, and the goal of treatment is to improve the quality of life.

Antibiotics for Chronic Sinusitis

Chronic sinusitis is often the result of damage to the mucous membrane from a past, untreated acute sinus infection. The aerobic and anaerobic bacteria present in chronic sinusitis are often different from those that cause the acute form. More potent and expensive antibiotics are usually needed to oppose these organisms. Antibiotic treatment in such cases may continue for several weeks.

Intravenous antibiotic therapy may be required for some patients with chronic sinusitis, particularly those with underlying medical disorders that can worsen the condition. They are typically administered two weeks before surgery and continued for about month afterward.

Interesting studies are reporting good to excellent results in these patients using antibiotics that are sprayed into the nasal passages using a nebulizer. In one study, patients preferred this method to either oral or intravenous treatments.

Corticosteroids for Chronic Sinusitis

Benefits of Corticosteroid Nasal Sprays. Nasal-spray corticosteroids, most commonly called steroids, are effective agents currently available for treating allergic rhinitis. They also are proving to be very important in the treatment of chronic sinusitis. Some studies have reported that, when combined with antibiotics, they speed recovery and improve healing rates of sinusitis compared to antibiotics alone. Nasal spray steroids are proving to be safe and have the following benefits:

• They reduce inflammation and mucus production.
• They improve night sleep and daytime alertness in patients with perennial allergic rhinitis.
• They appear to be beneficial in treating polyps in the nasal passages.

Nasal-Spray Brands. Corticosteroids available in nasal spray form include the following:

• Triamcinolone (Nasacort). Approved for children over six.
• Mometasone furoate (Nasonex). Approved for use in patients as young as three.
• Fluticasone (Flonase, Flounce). Approved for children over four.
• Beclomethasone (Beconase, Vancenase), flunisolide (Nasalide), and budesonide (Rhinocort). Approved for children over six.

These agents have some differences in their effects. For example in one 2002 study, patients preferred triamcinolone over either fluticasone or mometasone. Furthermore, in another study fluticasone reduced stress hormone levels significantly compared to triamcinolone, which might over time produce more adverse side effects. Some experts then suggest that triamcinolone may be a better first choice than others for many patients.

One caution, triamcinolone (Nasacort) and Nasonex--among others--contain a preservative-- benzalkonium chloride (BKC)--which may impair one of the defense systems in the nose that wards off infections. Studies are mixed, however, on whether this effect is significant. Not all preparations use BKC. For example, Rhinocort does not contain it.

Side Effects. Corticosteroids are powerful anti-inflammatory drugs. Although oral steroids can have many side effects, the nasal-spray form affects only local areas, and the risk for wide spread side effects is very low unless the drug is used excessively.

• Dryness, burning, stinging in the nasal passage.
• Sneezing.
• Headaches and nosebleed. These side effects are uncommon but should be reported to your doctor immediately.

Possible Long-Term Complications. Corticosteroids suppress stress hormones, which are known to produce some serious long-term complications in people who take oral steroids. Researchers have found far fewer concerns with nasal administration or inhaled forms, but there may be certain problems.

• Effect on growth. The major concern for children is whether nasal steroids, like other forms of steroids, will adversely affect growth. Studies report either only a temporary and slight (about half an inch) early effect on growth or no effect at all.
• Effect on eyes. Of some concern is the possible risk for adverse effects in the eyes, particularly glaucoma, which is a known side effect with oral steroids. Some ophthalmologists have observed higher pressure in the eye (a sign of glaucoma) in some patients taking nasal steroid sprays. (Studies have found no increased risk for cataracts in young people who have taken intranasal steroids.) All the conditions resolve after stopping the steroid, although periodic eye examinations are advised.
• Use during pregnancy. These agents are most likely safe during pregnancy, but pregnant women should discuss all options carefully before taking them.
• Nasal passage injury. Steroid sprays may injure the nasal septum (the bony area that separates the nasal passage) if the spray is directed onto it. This complication is very rare.
• Lower resistance to infection. People with any infectious disease or injury in the nose should not take these drugs until the disease or wound has been treated and cured. People should avoid steroids who have not been vaccinated or had chicken pox or measles.
• In some cases, people become insensitive to the effects of corticosteroids and they stop working.

Leukotriene-Antagonists

Leukotriene-antagonists are oral drugs that block leukotrienes, powerful immune system factors that are important in causing airway constriction and mucus production in allergy-related asthma. The leukotriene-antagonists include zafirlukast (Accolate), montelukast (Singulair), (Ziflo), and pranlukast (Ultair, Onon). They may also prove to be important in certain cases of chronic sinusitis, including sinusitis due to polyps, when allergies are the cause, or in some cases when the cause is unknown.