Management of sinusitis all depends on the cause of your recurrent infections. Basically there are four ways of treating recurrent sinus disease:
Antibiotics may be considered if you have an acute (short-term) infection. There are many types of antibiotics that are available. Sometimes you may require multiple antibiotics to resolve your infection. Antibiotics are not harmless and can lead to resistance and side effects from the medicine. If you are given antibiotics year-after-year then you need a formal evaluation of the cause of your recurrent sinusitis.
Corticosteroid Nasal Sprays such as Nasonex™, Flonase™, Fluticasone, Veramyst™, Omnaris™, Nasacort™, as well as others may be used daily to reduce the swelling in your nose. These type of nasal sprays only work if used everyday. Single use or “as needed” use will not be effective since the benefit from nasal corticosteroids takes 1-2 weeks. The side effects of nasal steroid sprays are minimal since the steroid has little penetration into the bloodstream. They are not addicting.
Salt water (Saline) Sprays are an excellent, safe way to rinse your sinuses of trapped mucous and keep your sinuses clean. These sprays are available over-the counter (Nedipot™, Ayr spray™, Ocean Spray™) and may be used safely throughout the day.
Nasal Decongestants such as Afrin™ or Neo-Synephrine™ are over the counter medications that reduce swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating temporary severe nasal congestion. Nasal decongestant sprays are safe to use for only 3-5 days. Prolonged use leads to rebound congestion or “nasal spray addiction.”
Oral Decongestants are primarily over-the counter such as pseudoephedrine (Sudafed™) and phenylpropanolamine. They may also be considered for temporary relief of nasal congestion. Oral decongestant may cause anxiety, urination difficulty (enlarged prostate), worsened high blood pressure, and an increased heart rate. Patients with high blood pressure, enlarged prostate, or heart problems should consult with Dr. Pasha before using decongestants. Please note that some decongestants are combined to reduce the number of pills and are often given the suffix “-D” such as Claritin-D™, Allegra-D™. Other combination decongestant products include Tylenol–Sinus™ or Advil Cold and Sinus™.
A major concern in the world today is antibiotic resistance. If one uses antibiotics for a long period of time or if one takes several antibiotics and continues to have infections, the bacteria may have developed resistance to the most commonly prescribed antibiotics. You do not become “immune” to antibiotics but rather the bacteria “learns” to tolerate the antibiotics (especially amoxicillin).
Additionally, all medications have the potential for side effects (especially when taken for the long-term). Some patients are poorly tolerant of antibiotics, with gastrointestinal side effects or rashes. Finally, antibiotics do not treat the underlying cause of sinusitis and therefore may result in repeated infections and discomfort for you.