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  • Writer's pictureDr. Koralla Raja Meghanadh

Tailored Sinusitis Treatment: Acute, Subacute, Chronic

Updated: May 13

Sinusitis is not taken seriously as it heals without a doctor's intervention in most cases. But, sinusitis is a dangerous disease that can lead to difficulties when untreated. Its slow progression has created a lack of attention regarding sinusitis.

Sinusitis treatment differs from stage to stage. Doctors mostly try to treat sinus infections with antibiotics and go for surgery only when the patient is not responding as expected.

Acute Sinusitis Treatment

If bacteria cause acute sinusitis, it must be treated with anti-bacterial medication or antibiotics for at least ten days. Otherwise, it should go on for another five days after the symptoms are reduced.

Sinusitis treatment - acute, chronic, subacute with antibiotics and surgery

In acute sinusitis, the bacteria that grow in the sinuses are gram-positive bacteria. The medication, i.e., antibiotics that act on gram-positive bacteria, will disturb the bacterial flora of our intestines. This leads to diarrhea and loose stools. So to counter this, doctors generally prescribe lactobacillus, which helps to recover the lost flora of our intestines.

Along with the antibiotics, other supportive medicines are also essential, like antiallergic medications if there is an allergy, and decongestants like xylometazoline and oxymetazoline - otrivin nasal drops.

So, this is the treatment protocol for acute bacterial sinusitis.

If a viral infection causes acute sinusitis, it must be treated with antivirals.

The treatment should be a little more aggressive and prolonged if the patient has some anatomical anomalies. These anomalies can increase the chance of progression into chronic sinusitis.

In acute sinusitis, patients don't need surgeries as they respond to medical treatment if given adequately. Along with this, steam inhalation is beneficial in reducing the viscosity of the phlegm, which eases the clearing of phlegm. So this is the treatment of acute sinusitis.

Similarly, other home remedies for sinusitis can help in the recovery process very effectively in the case of acute sinusitis.

In acute sinusitis, doctors do a CT scan only when a patient is not responding the way they think or if any odd factors are present. In acute sinusitis, usually, there should be a 50% resolution of the complaints within 48 hrs. Doctor's suggest a CT scan if the symptoms don't subside withinthree days.

Subacute Sinus Infection Treatment

Subacute sinusitis treatment is similar to acute sinusitis. But it is a little longer, i.e., a minimum of 15 days, and we must see the resolution carefully. The chance of subacute turning into chronic is always on the higher side. So, in the subacute, we investigate using a CT scan, endoscopy, etc. If the results are not as expected from antibiotics, an ENT doctor might suggest minor surgery to facilitate faster healing and prevent the subacute from turning into chronic sinusitis.

Treatment for chronic sinusitis

In chronic, we do the CT scan and other investigations to understand what is happening and what are the factors responsible for this kind of sinusitis. After studying all the factors, we will start with medical treatment. Here the treatment will be a little longer, from 2 weeks to six weeks, sometimes even up to 6 months.

The antibiotics used for chronic sinusitis are different from the antibiotics used in acute Sinusitis because, in acute, the antibiotics are given against gram-positive, but in chronic, it is given against gram-negative bacteria. When acute changes to chronic, gram-positive will change to gram-negative. So, the antibiotics used are macrolide and ciprofloxacin. Ideally, these antibiotics should be given for six weeks for chronic sinusitis.

We consider the surgical procedure if there is no improvement despite the medication for six weeks.

In acute or chronic, we usually don't do surgeries. We give more aggressive medication. Suppose they keep getting more acute attacks ,i.e., acute on chronic. For example, if someone is getting more than 5 to 6 attacks, in that case, we think of surgery.

Home remedies for sinus infection

We can fight sinus infection by maintaining a proper balance between infection and immunity. So, to keep this balance, we can use some home remedies which boost our immunity. Good immunity can combat acute sinusitis, but when it advances to chronic, our immunity alone cannot fight it. So, the antifungals and antibiotics will help our immunity to combat sinusitis.

Click here to check for home remedies for sinusitis.

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What is the best treatment for sinusitis?

The best treatment for sinusitis is using both home remedies and treatment suggested by an ENT doctor.

You can read our article "Home Remedies for Sinusitis" for more details.

The results of any treatment will depend on the stage of sinusitis. The earlier you treat, the better the results will be obtained for any given treatment. The longer you wait for the treatment, the antibiotics course will increase, and you might even require surgery. In acute sinusitis, within 15 days of the start of the infection, you will not require any surgery mostly.

Do you need to treat sinusitis?

Yes, we recommend seeking treatment for sinusitis from an ENT doctor as soon as possible, even though it can sometimes heal on its own. This is because there is a risk of complications, including the possibility of it developing into fungal sinusitis. These complications can occur, or the disease can worsen whenever our immunity lowers.

What happens if you don't treat sinusitis?

In most cases, sinusitis can heal without medication and complications. But, any superficial viral infection like the common cold can impact your immunity and thus worsen the disease and might contribute to complications. Even mental stress from any accidents or exams can also aggravate this illness.

Chronic sinusitis complications can include asthma, bronchitis, laryngitis (voice box infection), and middle ear infections. Acute sinusitis and "acute on chronic" sinus infection complications are much rarer and can impact the eyes and brain.

Please read our article on complications of sinusitis for more details.

Who needs sinus surgery?

Sinusitis patients who primarily don't respond to antibiotics as expected will need sinus surgery. Minor surgery is performed in cases of subacute sinusitis to prevent it from becoming chronic or when a person has anatomical abnormalities. Most surgeries are avoided in the acute stage because patients respond to antibiotics well, and the chances of getting surgery increase in the chronic phase.

For fungal sinusitis, surgery is required for non-invasive and fulminant patients. A small biopsy is performed in invasive cases for diagnosis purposes.

When should you see a doctor for a sinus infection?

We should see a doctor ASAP for a sinus infection. Better to see a doctor for a common cold and have medication prescribed and treat it on time to prevent sinusitis.

Prolonging the consultation and treatment for sinusitis, can make it more challenging to recover. Read above article for more details.

What is the best treatment for acute sinusitis?

The best treatment for acute sinusitis is a combination of antibiotics and home remedies. The bacteria in acute sinusitis are gram-positive, so we give antibiotics that act on them. These antibiotics are prescribed for a minimum of ten days or five additional days after the symptoms have subsided. Usually, surgeries are not necessary for acute sinusitis as medical treatment often resolves the condition. (Note: this treatment is only applicable for acute sinusitis, i.e., the first fifteen days of the infection, not for subacute or chronic sinusitis.)

What is the fastest way to cure sinusitis?

Combining antibiotic medication with home remedies is the fastest way to cure sinusitis. In the early stages, sinusitis often resolves on its own, but it can worsen if left untreated. When it comes to the speed of recovery, it depends on individual factors such as immune response and the severity of the sinus infection. The most effective approach to treating sinusitis is by following the prescribed antibiotic medication provided by a doctor and a few home remedies. Few additional supporting medications, like anti-allergic medication, might be prescribed based on the patient's condition.

In certain cases, a small number of patients may not experience positive results from antibiotic medication for sinusitis due to many anatomical anomalies or have a severe infection in the sinuses or a severe complication from sinusitis. In such situations, sinusitis surgery might be necessary. The decision to proceed with surgery is made by an ENT doctor after considering multiple factors.

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