When allergies or a cold or strike, sinus pressure, pain and that “stopped-up” feeling can make you miserable. Sinusitis—swelling of the sinus cavities that affects one in eight adults—is a top cause of missed work and doctor visits. For some people, sinus infections return frequently or linger for weeks or months.
Dr. Kevin Gersten, M.D., an otolaryngologist with the Palo Alto Medical Foundation, explains how to treat sinusitis and offers tips for keeping it at bay.
Sinusitis is inflammation of the sinuses, a connected system of cavities in the bones behind your nose, cheeks, eyes and forehead. Environmental allergens or irritants, viruses or bacteria can trigger your sinuses to swell shut and trap mucus, which backs up and can cause pain in your face or teeth.
If your sinusitis starts with a cold, it should clear up within seven to 10 days. Since most colds are caused by viruses, antibiotics won’t help, and using them unnecessarily could contribute to antibiotic resistance.
“When you have nasal blockage, pain along the sinuses and colored drainage, it’s important to determine if the cause is noninfectious, viral or bacterial,” Dr. Gersten says. “While we all want to get well as fast as possible, antibiotics are often not the best answer.”
If you still feel lousy after 10 days, or if your symptoms improve and then worsen, your sinusitis may have turned into a bacterial sinus infection. That’s when your doctor might consider antibiotics, Dr. Gersten says.
Does mucous color indicate whether you have a bacterial sinus infection? “Green snot does not necessarily mean you have a bacterial infection,” Dr. Gersten says. Forehead and cheek pain may stem from muscle tension or migraines instead of sinusitis, he adds.
See a doctor if your symptoms last more than 10 days or are getting worse, or if you have persistent facial pain or headaches. Chronic post-nasal drainage or multiple sinus infections in the past year also warrant a doctor’s visit.
To reduce your chance of catching colds that can trigger a sinus infection, start by washing your hands frequently and avoiding close contact with people who are ill. Also try not to touch your face. “If you touch a doorknob after someone who was sick touched that doorknob—and then you touch your face—you’ve now transferred that infectious organism to yourself,” Dr. Gersten says.
If you’re prone to nasal irritation or sinusitis, try a daily saline rinse. “The vast majority of ENTs [ear, nose and throat doctors] truly believe in the benefits of that,” Dr. Gersten says. “It cleans the sinuses also helps add moisture to the nose to prevent dryness and congestion.”
For saline rinses, use a neti pot (which looks like a small teapot) or a specially designed squeeze bottle or bulb syringe, available at many drugstores. You can also buy saline solution packets, or make your own using instructions from The American Academy of Allergy, Asthma and Immunology.
If you have allergies, consider a nasal steroid spray, such as Flonase, to fight inflammation, Dr. Gersten says. The medication usually takes two weeks to improve symptoms. In dry environments, use a humidifier for added relief. “If you really have a lot of thick secretions, you can use something called Mucinex to thin it,” he adds.
When antibiotics, saline sprays and steroids fail, you might want to consider surgery to make the natural sinus openings larger.
“I think of the sinuses as a room with a door; if that door swells shut, then you can’t get out of the room,” Dr. Gersten says. “Surgery is designed to make that door bigger, so that the sinuses drain more easily. If you do get a cold, the goal is for that door to be big enough that it never swells shut.”
The vast majority of people who get surgery see significant improvements, he says. “It doesn’t prevent all infections, but it makes them less frequent and easier to manage.”