By Peter Shepard, MD
Dr. Shepard is a board-certified otolaryngologist practicing at Southwestern Ear Nose and Throat in Santa Fe, NM.
February 4, 2015
Despite being one of the most common medical problems, there is a great deal of confusion about sinusitis. From its diagnosis to its treatment, even doctors have difficulty with it. To shed some light on the subject I wanted to share five of the most common myths about sinusitis:
Myth #1: My sinus headaches are caused by a sinus infection.
Sinus headache refers to pain that occurs in the area of the sinuses: above, below, between or behind the eyes. While a bacterial sinus infection can certainly cause pain in these locations, sinus headache is much more likely to be caused by something else. More common causes include the common cold, allergies, migraine headache and chronic sinusitis:
- The common cold can cause sinus pain, but it is a viral infection and only 2% of the time does this lead to a true bacterial sinusitis.
- Allergies are also another major cause of sinus headache, causing swelling, obstructing the sinuses, and resulting in pain without an infection.
- A fairly common but lesser known cause of sinus headache is migraine. Studies show that in at least 50% of people chronic sinus headaches are from migraine or other neurological causes.
- Chronic sinusitis refers to inflammation and or infection in the sinuses that persists for greater than three months. Chronic sinusitis is more often a problem of inflammation and drainage than infection.
It can sometimes be difficult to tell the difference between all of these causes. The timeline and the accompanying symptoms are all helpful in determining the correct diagnosis. Chronic sinus headache and sinusitis not starting to improve after 10 days are reasons to see your doctor.
Myth #2: I need an antibiotic for my sinus infection.
Whether or not you need an antibiotic, of course, depends on the cause. The symptoms of sinus pain, congestion, and discolored drainage suggest sinusitis, but in most cases, an antibiotic is not needed. A new sinus infection is caused by a virus 98% of the time, and an antibiotic won’t help. Current guidelines indicate use of an antibiotic only after 10 days of sinusitis; use of antibiotics before this 10 day cutoff is more likely to harm than help. Antibiotics can cause allergic reactions, antibiotic resistance, secondary infections and other complications. Treatment of sinusitis from the common cold includes decongestants, acetaminophen for pain and fever, mucous-thinning agents, and saline rinsing. If allergies are contributing to the sinus symptoms, then treatment with antihistamines or a nasal steroid may be helpful.
Chronic sinusitis, as mentioned above, is more a problem of inflammation and drainage, so reducing inflammation and improving drainage are usually more effective. This is often when sinus surgery or balloon dilation can be helpful.
Myth #3: I have the flu.
The flu is a respiratory infection caused by the influenza virus. It is usually more severe than the common cold and it affects more areas of the body. In addition to sinus, nose, and throat symptoms, cough, muscle aches, fatigue, and fever over 101 F are common. It is often so debilitating that people cannot function. While there are over a hundred common cold viruses, the flu refers to one specific virus that circles the globe once a year with gradually shifting subtypes.
Myth #4: I need a procedure for my sinus problems.
While a procedure can sometimes be helpful, one should be wary of the physician who immediately recommends a procedure when other potential causes of sinus symptoms haven’t been explored or considered. Chronic sinusitis is the most common accepted indication for a sinus procedure and will always have changes visible on a CT scan. When sinus symptoms have been lasting more than 3 months or are not responding to medical treatment, then a CT may be helpful.
Myth #5: Only decongestants make me breathe better.
Decongestants work very well for short-term relief of a stuffy nose, particularly when associated with the common cold or allergies. However, decongestant nasal sprays, when used for longer than three days, will actually lead to more swelling and stuffiness. This is a form of a physical addiction and is actually quite hard to stop once this pattern has started. Decongestants can also raise blood pressure and be hard on the heart. For long-term obstruction the best medication is a nasal steroid spray; if symptoms don’t improve with a steroid spray, an examination by an ear, nose, and throat doctor is necessary in order to look for anatomic causes of the blockage.