Does the patient have a cold or a sinus infection? We physicians are faced with making this clinical decision on a daily basis. Treatment recommendations differ depending on the source and nature of the infection.
There are more than 200 viruses and several bacteria that cause these infections. Transmission is usually through hand-to-hand contact with an infected individual which spread to the nostrils and the eyes by contaminated fingers. Sometimes these infections are spread through the air through coughing or sneezing.
Most of these infections are self-limiting. Typical symptoms include congestion, irritated eyes, sore throat and sometimes cough. Symptoms usually peak in 3-4 days and generally clear in a week. Occasionally, the cough will last longer, even 2 weeks.
In contrast to the common cold, patients, at times, develop more significant clinical symptoms including headache, facial pressure or pain, jaw or tooth pain or fever. Although these symptoms can occur with colds, they typically come on after the patient has had the cold symptoms (sore throat and congestion, etc) for several days. We refer to these infections as rhinosinusitis or more commonly, sinusitis. The sinuses are mucous-lined pockets in the bones of the face. They are connected to, but not considered a part of, the nasal and throat cavity.
Most sinus infections are also caused by viruses. In fact, they are the same ones that are associated with causing the cold as discussed above. However, there are several bacteria that can infect the sinus cavities as well. It is commonly believed that the presence of discolored nasal discharge indicates that the sinuses are infected. This is not true although this does happen on occasion. In most patients a viral sinusitis will improve in 7-10 days with supportive care (fluids, rest, decongestants). The formal diagnosis of bacterial sinusitis is made if symptoms persist for longer than 10 days or those that worsen after 5-7 days.
Many patients expect that they should be given an antibiotic for their “sinus symptoms”. However, the medical literature does not support using antibiotics for all cases of sinusitis. As mentioned previously, most cases of sinusitis are caused by viruses (which do not respond to antibiotics). Appropriate antibiotics use as proposed by the American Academy of Otolaryngology would be when the signs of sinusitis do not improve within 7 days or if they worsen at any time; in those with fever >101 degrees; and in those individuals who are immunocompromised such as those on chemotherapy.
Other therapeutic options for patients besides antibiotics that have been shown to be helpful include decongestants, saline (salt solution) nasal irrigation, and nasal corticosteroid sprays.
Hope this information is helpful. Remember that the best defense against infection is good hand washing and getting plenty of rest! Hope your winter is a healthy one!
Stephen C. Fuller, M.D.
Family Practice