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Strike back against sinusitis and breathe more easily: new guidelines outline a strategy for battling this condition, and several treatments may help you cope with sinus infections.

Your forehead and cheeks ache, and you can't remember the last time you could breathe freely through your nose. It feels like a cold that you can't shake,


What might have started out as a cold now may be rhinosinusitis (RS, or sinusitis), an inflammation or infection of the sinuses that annually affects about 31 million Americans of all ages and genders.

Not all RS is alike, and pinpointing a cause and treating the condition can be difficult. In some people, an infection can linger for years.

"It can be challenging. For many patients, it can be a chronic problem," says Pete Batra, MD, assistant professor of surgery with Cleveland Clinic's Head and Neck Institute.

Fortunately, you can take steps to breathe more easily. For example, nasal irrigation--the flushing of the sinuses with a saline solution--can clear nasal discharges and provide relief, a study in the November 2007 Archives of Otolaryngology--Head and Neck Surgery found.

And, new guidelines, issued in September by the American Academy of Otolaryngology--Head and Neck Surgery (AAO-HNS) may aid your doctor in treating RS.


Viral infections resulting from colds are responsible for many acute RS cases and usually go away without treatment, but in some instances, the inflammation caused by the cold leads to a bacterial infection that may require medical help.

Both types of infection produce similar symptoms: nasal congestion, facial pressure and thick mucus secretions. Other symptoms may include fever, headache, altered sense of smell, dental pain and bad breath.

Doctors rely on the duration of symptoms to help differentiate between the types of acute RS (X-rays and other imaging scans usually are not recommended for acute cases). Viral infections tend to go away in about seven to 10 days, while acute bacterial RS usually lasts about 30 days. Experts also have identified subacute RS (lasting one to three months) and chronic RS (lasting three months or longer).

Chronic RS requires evaluation by an ear, nose and throat specialist. The doctor may perform an endoscopy--a visual inspection of your nasal passages and sinuses using a tiny scope inserted into your nose--and, if necessary, request a computed tomography (CT) scan of your sinuses. The specialist also can obtain cultures from the sinuses to identify the offending bacteria.


Many RS patients need only symptomatic treatment to manage pain or congestion, while those with bacterial RS may require antibiotics. However, experts are concerned about antibiotic overuse, which can produce resistant bacterial strains.

The new AAO-HNS guidelines stress the need to distinguish between viral and acute bacterial RS and not over-prescribe antibiotics. Bacterial RS may be suspected when symptoms continue 10 days or more after the onset of a cold or worsen within 10 days after an initial improvement, the guidelines state.

They also note that bacterial RS patients with moderate to severe pain and a fever of 101 degrees or higher need antibiotics, while those with mild pain and a lower fever may defer antibiotic use for seven days after diagnosis.

Dr. Batra says people with conditions that weaken the body's immune response to infections warrant prompt attention.

Antibiotics and topical steroid sprays are mainstays of RS treatment, as are analgesic pain medications, expectorants and drugs that thin mucus (mucolytics). Oral or nasal decongestants (Neo-Synephrine, Sudafed and Afrin are examples) can provide relief, but they should be used for no more than three days. And, there's nasal irrigation (see chart). "The nice thing about the irrigation is it's a benign treatment," Dr. Batra says.

For patients with chronic RS that persists after two or three rounds of medical therapy and testing, surgery may be in order.

A recipe for sinus relief

To relieve rhinosinusitis symptoms, Cleveland Clinic's Pete Batra, MD, recommends nasal irrigation, using a saline solution you can make at home:

* 1 tsp. salt

* 1/2 tsp. baking soda

* 1 qt boiled water


Mix the ingredients.

After the solution has cooled, lean over a sink and use a piston syringe that delivers low pressure to spray 4-8 ounces of the mixture into each nostril. Allow the liquid to drain from your nose, and do not tilt your head back. Repeat 2-3 times a day.
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Title Annotation:Ear, nose and throat
Publication:Men's Health Advisor
Date:Mar 1, 2008
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