Medical Care

Inflamed Sinuses: It’s Best to Watch and Wait

Antibiotics often don’t help inflamed sinuses. Take steps to ease symptoms and let the problem heal itself.

As with the lungs, the hollow spaces in your facial bones—the sinuses—are prone to infection by microorganisms of various stripes. Usually, the invader is a virus. In response, the sensitive linings of the sinuses swell up and start to pour out mucus, triggering nasal stuffiness, a runny nose, and facial pain.

Once upon a time, many sinus sufferers headed straight to their doctors to get an antibiotic. But we now know that strategy is usually a waste of time. Most cases of sinusitis are associated with viral infections, which are bulletproof to antibiotics. According to a research review by the Cochrane Collaboration, 80% of people with sinusitis improve within two weeks without taking antibiotics.

The best course of action for occasional sinusitis is to use self-care steps to ease symptoms while the body clears the infection. “Everybody sort of thinks of antibiotics as the magic cure-all, but the vast majority of people will get better without ever having to consider an antibiotic,” says Dr. Jeffrey Linder, a primary care physician and associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital.

First, soothe symptoms

The initial symptoms of sinusitis are similar to those of a cold. You might also experience fatigue, cough, impaired sense of smell, fullness or pressure in the ears, or headache.

While your body fights the infection, use nasal rinses, decongestants, and pain relievers to ease your symptoms. (See “Soothing sinusitis: Here’s what to do.”) Whatever over-the-counter products you use, read the packaging and follow the directions.

When to see a doctor

The latest clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation, released in April 2015, outlines the following rules of the road for when to consider an antibiotic for acute sinusitis:

The symptoms are prolonged. “If you have been doing all the right things for 10 days and it’s not getting better, then it’s totally reasonable to call your doctor and ask about an antibiotic,” Linder says.

The symptoms are severe. Typical alarm signs of a bacterial sinus infection are sharp pain in the cheeks or teeth accompanied by a fever.

The symptoms are getting worse. If you have coldlike symptoms that go away, but then start to have severe pain and fever, antibiotics may be worth considering.

Antibiotics: Don’t expect much

In clinical trials that compared antibiotics to a placebo pill for confirmed bacterial sinusitis, the antibiotic had minimal effect. That suggests that even when you do have bacterial sinusitis, antibiotics usually don’t help. Yet you still have to take on the potential side effects, such as stomach upset and diarrhea. In addition, inappropriate use of antibiotics can breed antibiotic-resistant strains of bacteria that are hazardous to all of us.