Nasal drip is as much a part of winter as freezing temperatures. There is little we can change about the latter, and, as it turns out, less we should do about the former in most cases. It is estimated 40 percent to 50 percent of people with sinusitis, or sinus inflammation, will recover in 10 days with or without antibiotic drugs.
“Antibiotics are overprescribed for sinus problems,” said Dr. Itzhak Brook, an infectious-diseases specialist at Georgetown University School of Medicine in Washington, D.C. “We have to educate both doctors and patients to not jump to antibiotics right away.”
Brook is doing his part. He is the lead author of a revised set of guidelines for sinusitis treatment published last May in Annals of Otology, Rhinology and Laryngology. Brook and colleagues recommended that physicians prescribe an antibiotic only when a patient has experienced symptoms for at least seven days.
Here’s why: Sinusitis typically begins as inflammation and infection of the sinus lining caused by a common cold virus. About 98 percent of those cases will clear on their own, albeit with more drainage than most of us want to observe in, say, an office setting. If you take antibiotics for a viral sinusitis, you are only putting yourself at risk for developing antibiotic resistance.
The other 2 percent, Brook explained, will develop into bacterial sinusitis because bacteria get trapped in the clogged sinuses. A sign of bacterial infection is if your cold gets worse instead of better starting about the fifth day and especially after a week to 10 days, according to Brook. Indicators of a sinus infection, called acute sinusitis, include color in the mucus, sinus pain and general fatigue. People with chronic sinus infections might never heal completely; they tend to develop symptoms in a few days. High fever and intense pain are symptoms that demand earlier attention from your physician.
Robert S. Ivker, a Colorado-based osteopathic physician and author of “Sinus Survival: The Holistic Medical Treatment for Allergies, Colds and Sinusitis” (Tarcher/Putnam, $13.95), is a pioneer on the subject of not overusing antibiotics for sinus troubles. His book, in a fourth edition, first was published in 1988. Within the last year, he has been asked to make first-ever presentations about alternative medical therapies at annual meetings of such mainstream medical organizations as the American Academy of Otolaryngology and the American College of Allergy, Asthma and Immunology. His talks were standing-room only.
“The program focuses on healing the mucus membranes,” Ivker said. “I ask patients to try `Sinus Survival’ for two months. The other objective is to strengthen the immune system.”
Ivker explained that people with sinus problems need to examine the air they breathe. The biggest culprit is the quality of indoor air. He suggests using negative ion generators and HEPA (high efficiency particulate arrestor) air cleaners in homes and offices. He also favors warm-mist humidifiers. (His www.sinussurvival.com Internet site provides product details.)
Ivker champions the link between diet and sinus problems, suggesting that patients avoid milk and other dairy products for two months. For more severe cases, he might add sugar, bread and alcohol to the off-limits list. Most people can reintroduce forbidden foods, he added, once they are healed.
These subtractions are based on making the sinus lining a more difficult breeding ground for bacteria and fungi, Ivker said. In fact, researchers at the Mayo Clinic have speculated that fungus might be a primary agitator for sinus sufferers.
Ivker highly recommends “water irrigation,” or rinsing the sinuses with water. Techniques include a narrow-spouted Neti Pot filled with saline solution that can be tipped to wash out the nostrils and a device that attaches to Water Pik appliances. Portable steam inhalers are another good option and safer than creating your own steam tent over a boiling pot of water.
Interestingly, a group of physicians at Rush-Presbyterian-St. Luke’s Medical Center are using a form of nasal irrigation to help chronic sinusitis patients avoid surgery, an alternative that still seems too widely recommended. Sinus surgery is typically performed to drain the sinuses of accumulated secretions or, in some cases, to enlarge the sinus cavities. The irrigation technique, called chemical cautery, is loosely based on nasal rinsing used during the early 1900s.
“The treatment has prevented a large number of my patients from having surgery,” said Dr. Neal Lofchy, a physician at the Rush-affiliated Midwest Sinus Center, with offices in Chicago, Tinley Park and Oak Brook.
The chemical cautery process begins with a topical numbing of the nostrils. Next the physician uses a fiber optic instrument to view the inside of the nose and sinus cavities for swollen tissue and potential polyps. Then the physician uses a series of mist sprays to treat the sinuses, allowing the patient to drain the sinuses after each spraying. The spray doing the main work is a diluted phenol solution, much weaker but nonetheless the same one used in chemical skin peels. The idea is to strip off the “mast cells” on the sinus lining surface that cause the inflammation.
The treatment can be repeated in later incidences.
On the longer view, Ivker said, good health habits are key to avoiding sinus problems.
