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Sinusitis: Treatments
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The literature was searched in Medline, complemented by Excerpta Medica, from 1966 through March 1999, using the word "sinusitis." Search criteria were limited to human studies and English language and appropriate pediatric terms. More than 1800 citations were reviewed. One hundred thirty-eight articles were fully examined, resulting in 21 qualifying studies. These studies included 5 controlled randomized trials and 8 case series on antimicrobial therapy, 3 controlled randomized trials on ancillary treatments, and 8 studies with information on diagnostic tests. The heterogeneity and paucity of the data did not allow for formal meta-analysis.
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The best precaution against sinusitis is to quit smoking and to avoid cigarette smoke or places that may expose to excessive dust in the air. It is very important to ensure that you do not become dehydrated during an attack of sinusitis and make sure that you drink plenty of fluids and water daily. Whenever you find yourself staying indoors, try to increase the water content of the room by the use of an appropriate humidifier or by using a cool-mist vaporizer at all times of the day and night. To help open up the sinuses on the face, carefully place some warm compresses on the face for sometime each day-this will serve as a direct topical treatment against the sinusitis. A mechanical device known as a sinus irrigator, which can be brought easily in many health-food stores and pharmacies, can be used-this device utilizes saltwater to flush out the excess mucus accumulated in the sinuses on the face.
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Chronic sinusitis lasts longer and can be more difficult to treat. However, treatment is essential, as long-term bouts of sinusitis can develop into dangerous medical conditions. Most cases of sinusitis in the United States are chronic. Chronic sinusitis afflicts more than 33 million Americans annually, according to the U.S. Centers for Disease Control and Prevention.
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Currently there are no data to recommend the use of H1 antihistamines in nonallergic children with acute bacterial sinusitis. There is a single prospective study in which children with presumed acute bacterial sinusitis were randomized to receive either decongestant-antihistamine or placebo in addition to amoxicillin. The active treatment group received topical oxymetazoline and oral decongestant-antihistamine syrup (brompheniramine and phenylpropanolamine). No difference in clinical or radiographic resolution was noted between groups.56
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For many years, the combination of allergic disease and infectious sinusitis has been considered the most difficult form of sinus disease to treat. The patient with uncontrolled nasal allergies frequently experiences a lot of congestion, swelling, excess secretions, and discomfort in the sinus areas. Therefore, the patient should work with a doctor who understands the diagnosis and treatment of allergic diseases to pinpoint the cause of the allergies and follow an allergy care program to help alleviate sinusitis.
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A relatively recent advance in the treatment of sinusitis is a type of surgery called FESS - functional endoscopic sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis. This replaces prior open techniques requiring facial or oral incisions and refocuses the technique to the natural openings of the sinuses instead of promoting drainage by gravity, the idea upon which the Caldwell-Luc surgery was based.[1]
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