A Care Model for Treating Chronic Sinus Infections
A sinus infection results from the growth of pathologic bacteria in the sinus cavaties that the body is not able to destroy on its own. Healthy sinuses have bacteria in them at all times, in low concentrations and usually non-disease producing. These organisms usually pose no threat to us. However, with sinusitis, an environment has been created by the blockage of normal aeration and sinus drainage (usually due to allergy, colds, flu, etc.) that allows the concentration of the bacteria in the sinus to dramatically increase. Bacteria produces many toxic substances that cause direct damage to the mucosal lining of the sinuses, further aggravating the pre-existing inflammatory process. A vicious cycle ensues. Your body will mount a vigorous defense to fight the growth of bacteria. Fluid and white blood cells are drawn into the blocked sinuses. By this point, you have developed the classic signs of sinusitis- facial pain and pressure, runny nose, congestion, postnasal drip, and headache.
Most cases of acute sinusitis can be treated with appropriate oral antibiotics administered over 14-21 days. If symptoms don´t resolve, the physician may repeat the course of therapy. Unfortunately, some patients with acute sinusitis fail to respond to initial or repeated courses of standard oral antibiotic therapy. If symptoms of sinusitis persist for longer than 3 months, or patient has more than 4 episodes per year, most experts consider the patient to be suffering from chronic sinusitis (CS). Most patients with CS will be treated with a combination of oral antibiotics, decongestants, saline nasal sprays, and if the patient has allergies, antihistamines may be used.
Important note: Many patients begin to feel better after a few days of therapy and discontinue the antibiotic early. The most common cause of recurrent sinusitis is failure of the patient to take the entire course of therapy as their physician prescribed. Misuse of antibiotics can prolong symptoms.
When symptoms of chronic sinusitis remain or return quickly after two complete courses of antibiotics, the physician must consider factors related to: selection of antibiotic, dosage, and length of therapy, as well as complicating medical conditions. Given this, it is recommended that if you have had symptoms of sinusitis for longer than 3 months, have failed to respond to two full courses of therapy, or if symptoms reoccur rapidly, you should consult an Otolaryngologist, more commonly known as an ENT.
A CT scan of the sinuses can be used to identify physical and/or anatomical changes and help define the extent of the disease. Cultures may also be obtained to identify specific bacteria. A culture can help an Otolaryngologist determine the appropriate antibiotic regimen. The physician may perform an in-office endoscopic examination of the sinus utilizing a special lighted scope inserted through the nose.
A chronic infection is treated based upon the specific circumstance of the patient's sinus anatomy and the identified bacteria causing the infection. When a patient fails to respond to oral antibiotics, an intravenous (IV) antibiotic therapy may be considered. The IV route of administration avoids the problems of reduced or delayed absorption that occurs with oral medication which first must pass through the digestive tract. IV administration allows for much higher concentrations of the antibiotics to penetrate into the sinus cavaties, mucosa, and the underlying sinus bone, which increases the likelihood of clinical response.
Some patients with CS have significant anatomic problems that must be corrected surgically: resistant or large polyps, outlet obstruction, or deviated septum. Your ENT may discuss Functional Endoscopic Sinus Surgery (FESS) as a minimally invasive procedure designed to remove bacteria from surrounding tissue. These procedures may allow medications to have their intended curative effect. Surgical procedures also repair and remove anatomical structures that may be a source for continued sinus symptoms. For CS sufferers, IV antibiotic care can complement FESS and other surgical procedures by improving long term outcomes.
Finally, CS patients are monitored intensely by SinuCare and our affiliated physicians. The care model is intended as a general protocol for the treatment of sinus infections. Each patient will have unique factors that will contribute to their ongoing medical concerns. We have provided the care model as a springboard for discussion with your physician of choice. SinuCare knows that appropriate dialogue between patient and physician allows for a better diagnosis and a more effective treatment plan. You can learn more about SinuCare physician locations by calling 800-774-SINUS (7468).
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