Treatment for Chronic Sinusitis
Determining and Treating any Underlying Conditions. A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.
Initial Treatment of Sinusitis. For treatment of chronic sinusitis itself, some doctors recommend:
- A wide spectrum antibiotic (one that can eliminate a wide range of bacteria) taken for at least 30 days
- Alternatively, an antibiotic that attacks anaerobic pathogens
- A corticosteroid nasal spray --some experts also suggest a short trial of oral corticosteroids for patients who do not respond to nasal corticosteroids or for those patients who have nasal polyps
- Saline nasal washes
- The expectorant guaifenesin with a decongestant taken by mouth
- Antihistamines
If the condition dramatically improves between 1 to 2 months, then the antibiotics are stopped. The patient should continue with both the steroid and saline nasal solutions. If there is no improvement after this time, the surgery may be considered. For some people with chronic sinusitis, however, the condition is not curable, and the goal of treatment is to improve the quality of life.
Antibiotics for Chronic Sinusitis
Chronic sinusitis is often the result of damage to the mucous membrane from a past, untreated acute sinus infection. The aerobic and anaerobic bacteria present in chronic sinusitis are often different from those that cause the acute form. The role of antibiotic treatment for chronic sinusitis is controversial. Special types of antibiotics may be used, and treatment may be needed for a longer time.
Intravenous antibiotic therapy may be required for some patients with chronic sinusitis, particularly those with underlying medical disorders that can worsen the condition. They are typically administered 2 weeks before surgery and continued for about month afterward.
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