Over the last few weeks one of the recurring topics I run into is sinus infections, or more appropriately sinusitis. A patient and I were discussing the recommendations that he had received from his family practitioner regarding his sinus symptoms, and the information was surprising. He had been told that the current thought was not to prescribe antibiotics as they are ineffective. I didn’t make much of it until today sitting in a lecture at the Chicago Midwinter meeting on pharmacology with Dr. Harold Crossley. The lecture turned to the topic of prescribing medication for a sinus infection and here again Dr. Crossley stated that new evidence supported that antibiotics are not effective or needed in most cases of sinusitis.
I jumped on my computer to see what I could find, and sure enough there is a body of literature in the medical community beginning in 2007 to support over-prescribing of antibiotics for sinus infections. ( Hadley J. Sharp, BS; David Denman, MD; Susan Puumala, MS; Donald A. Leopold, MD. Treatment of Acute and Chronic Sinusitis in the United States) Studies support that only about 3-5% of all of the reported cases of sinusitis are of bacterial origin. The majority are virally induced and the symptoms are caused by an acute or chronic inflammation of the membranes lining the sinus and nasal passages.
Toothache is a reported symptom that accompanies a sinusitis, along with nasal congestion, runny nose, facial pain or pressure and fatigue. Once we have ruled out a dental issue we should refer the patient back to their physician for further diagnosis and treatment of sinus symptoms. The current recommendations will be to make sure the patient is well hydrated, drinking lots of fluids. The use of warm compresses, nasal saline sprays and OTC nasal decongestants are also beneficial. Patients should not take anti-histamines due to their drying effect. They may be prescribed a nasal steroid spray if the symptoms persist.