Diagnosis

The diagnosis is made by physical examination and the taking of smears from nasal secretions and rhinoscopy (rhinoscopy). If complications occur during the treatment of the sinusitis or if the course of the disease is chronic or even if surgery is planned for treatment, an MRI examination of the sinuses can be performed to obtain further information about the inflammation. However, an MRI is not necessary if the course of the disease is without complications!

Therapy

Acute sinusitis is treated with decongestant nasal drops or sprays containing xylometazoline (Otrivin®) or oxymetazoline (Nasivin®). They facilitate the drainage of secretions from the small openings of the paranasal sinuses. After one week, however, the nasal drops/sprays should be discontinued, as otherwise our nasal mucous membrane will get used to continuous application and will not swell any more without it (privinism).Some ear, nose and throat doctors (ENT doctors) also offer the possibility of directly sucking off the purulent, inflammatory secretion.

An insert with a decongestant medication into the nasal passage (“high insert”) should also allow the mucus to drain off. The patient should inhale regularly at home. Inhalations with chamomile vapour (Kamillosan®) or salt (Emser-Salz®) have an anti-inflammatory and pleasant effect.

After applying decongestant nasal drops/sprays, nasal rinsing with a saline solution (Emser-Salz® solution) can cleanse the nose by rinsing out viscous secretions. The saline solution also has a disinfecting and decongestant effect. In addition, the patient can be offered outpatient radiation with short waves, microwaves or red light after decongestant measures.

This is intended to stimulate blood circulation and the healing of the inflammation. The purulent paranasal sinus inflammation must also be treated with an antibiotic. If the paranasal sinus inflammation still has not healed after two weeks, the ENT specialist may recommend a minor procedure.

During this procedure, he will puncture the inflamed paranasal sinus and rinse it with a solution containing antibiotics. Sinupret ®forte and Sinupret® drops are used as herbal medicines. The treatment of a sinusitis should have three objectives.

On the one hand, this can be attempted with numerous alternative remedies, which are mainly known from naturopathy. But also numerous conventional medical preparations can be used. In order to reduce the swelling of the nasal mucosa, in most cases medicines of the active substance group alpha 1 adrenoreceptor agonists are used.

The alpha adrenoreceptors are located on the vessels of the mucous membranes and cause the blood vessels in the area of the mucous membranes to contract when a messenger substance docks onto the receptor. The substance xylometazoline and its derivatives are able to dock to exactly these receptors on the mucous membranes and achieve this corresponding effect. For this reason, nasal sprays containing this substance are used for sinusitis.

Already with the first contact of the substance with the mucous membrane, the swelling begins to decrease noticeably. The administration of decongestant nasal drops also has some disadvantages. The main disadvantage is the relatively short time of action, which requires a frequent repetition with just under 3-6 hours.

In order to bring the medication to the correct place of action in the nose, it is necessary to draw the drops or the sprayed substance in through the nose after application. Some mucus secretion that gets stuck will inevitably reach higher regions of the nose as a result of this maneuver. If this maneuver is repeated frequently, the nasal secretion may become “stuck” in the nose, which can then lead to a complication of ulceration of the paranasal sinuses.

Another disadvantage is the side effects of preparations containing xylometazoline. Particularly with long-term use, the effectiveness of the preparation may be reduced. Furthermore, a phenomenon known as “stinky nose” can also occur.

In this case, after prolonged use of nasal drops, the nose drips more and more, either permanently or intermittently. The outflow is usually of a liquid to viscous consistency and is characterized by its foul odor. If this occurs, the medication should be discontinued immediately and a longer pause in treatment should be taken before the treatment is continued.

In addition to xylometazoline preparations, drugs are used which, mainly due to their salty ingredients, are intended to reduce swelling of the nasal mucosa. Here too, saline substances are administered to the nose in the form of nasal sprays. The effect is not as fast as with the chemical products, but lasts for a similarly long time and does not carry the danger of the side effects mentioned.

Furthermore, a time limit for the use of the drug is not described. The salt composition can also be administered to the nose in the form of an inhaler. The droplet nebulization achieved in this way makes it possible that the salty substance can often be inhaled more deeply and can thus partially penetrate deep into the paranasal sinuses and take effect.

The aim of the treatment was to prevent the inflammation from progressing further and to bring it to a standstill.
The mucous membranes, which are inflammatorily thickened in the case of sinusitis, should increasingly subside.
Corresponding accompanying symptoms should be reduced.

If a sinusitis does not heal after a few days, a chronic course must be assumed.This makes a slightly different treatment necessary. In chronic cases of sinusitis, the once-introduced decongestant treatment is dispensed with and the cause of the chronic form of the disease is treated instead. The reason is often an allergic reaction.

Especially the hardly avoidable house dust is often seen as the cause of chronic sinusitis. Nasal sprays containing a drug from the group of antihistamines can be used for this purpose (especially for local treatment) or the antihistamine can be administered as a tablet. A major disadvantage of the treatment are the side effects, which are mainly due to increasing fatigue when taking the drug for a long time.

In the case of chronic inflammation of the paranasal sinuses, an attempt can also be made to treat the actual inflammatory reaction first. Even if the actual cause of the chronic inflammatory reaction remains unnoticed at first, an attempt can be made to reduce the body’s inflammatory reaction with the help of medication containing cortisone. Nasal sprays are also available for this purpose.

In severe and chronic cases, a systemic therapy with cortisone tablets can be carried out. However, the numerous side effects should also be taken into account here. Long-term use can lead to thinning of the skin, increased blood sugar, osteoporosis and insufficiency of the adrenal cortex.

However, this is only possible with long-term use of high-dose cortisone. As a rule, chronic sinusitis is also not treated in the long term and the cortisone tablets are not given in the high dosage. In addition to sprays, ventilation-accelerating medication can also be given.

These are in most cases on vegetable basis and have as contents materials menthol, mint etc. In the case of persistent sinusitis, which persists despite the above-mentioned drug treatment, treatment with an antibiotic must be considered. The decision whether to use one is usually made easier by the occurrence of severe and above all high accompanying fever attacks and should be initiated under these circumstances in any case.

Most antibiotics, such as cefuroxime or amoxicillin, are used here. Especially in cases of bacterial acute sinusitis caused by pneumococci, Haemophilus influenzae, Moraxella catarrhalis, S. aureus, streptococci or the so-called anaerobes, antibiotics called cefuroxime axetil, cefpodoxime proxetil, aminopenicillins or levofloxacin should be given. Alternatively, treatment with the so-called macrolides, to which clarithromycin and azithromycin belong, may be given.

The treatment should be carried out consistently for 14 days. As with any longer intake, the classic side effects such as diarrhea may occur. In principle, there is also a risk of the bacteria developing resistance if antibiotics are used frequently and inappropriately.

According to a recent study from the USA, antibiotic treatment has almost no advantages over purely symptomatic treatment. In this study, one group of patients suffering from sinusitis was treated with symptomatic, purely decongestant therapy, while the other group of patients, who also suffered from sinusitis, were treated with an antibiotic. The results showed that patients in both groups recovered at about the same time and that the antibiotic group had no time advantage over the symptom-oriented group.

It remains to be seen whether this study will result in a change in the treatment concept. In principle, antibiotic therapy should (currently still) be initiated in cases of severe and very long courses of disease. This should ensure that, if the period of illness is not reduced, at least the complication rate could be minimized.

This is because the spread of pathogens in sinusitis is probably less likely with antibiotic treatment. In most cases, paranasal sinusitis heals within a few weeks with adequate, conservative (i.e. drug therapy). However, in some patients, there are frequent relapses or severe, long-lasting courses.

This is particularly the case when, as described above, anatomical conditions or nasal polyps obstruct the flow of secretions from the paranasal sinuses and thus promote the clinical picture. In these cases, surgery can help to significantly improve the recurring symptoms. Nasal polyps are benign growths of the nasal mucosa.In the so-called polyposis nasi, these growths occur more frequently and hinder not only nasal breathing but also the self-cleaning mechanism of the nose.

A polypectomy, i.e. the removal of the polyps, can also help to relieve the sinuses. This also applies to the straightening of a crooked nasal septum. Although the nasal septum is not absolutely straight in any person, gross deviations can lead to a shift in the flow of secretions from the paranasal sinuses and thus promote chronic sinusitis. In particularly severe cases of sinusitis, the bony walls of the sinuses may be affected in addition to the mucous membrane. This condition can lead to dissolution of the bone substance and often requires surgical repair of the site of inflammation.