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Sinus Infections

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One of the most common wintertime phone calls/office visits/e-mails I receive from my patients is the desperate need for something (namely, an antibiotic) for self-diagnosed sinus infection.

Most people are quite good at making this diagnosis. Typical sinusitis develops a week after a cold that almost seemed to go away. Then you realize it’s back with a vengeance. Your head is congested with thick mucus and you feel pressure behind your cheekbones. You’ve got a singularly annoying post nasal drip and a tickly cough, especially when you lie flat.

For years, everybody–doctors and patients alike–was confident this situation called for about ten days of an antibiotic. Come wintertime, the antibiotic drug reps pour into my office, each claiming their product superior to that of their competitors.

But now it seems that antibiotics might not be the best course. In an article recently published in the Journal of the American Medical Association, researchers divided sinusitis patients into three groups: those who received antibiotics, those who used steroid nasal sprays, and those who did nothing. The outcome? All three groups got well with equal speed. No single treatment was superior.

The explanation was attributed to two factors. First, about half of sinus infections are caused by viruses, which don’t respond to antibiotics. Second, infections that are bacterial usually clear up without antibiotics.

No one argues that severe bacterial sinusitis (fever, pus-like mucous drainage, and progressive worsening of symptoms) does require antibiotics, but this represents a relatively small percentage of sinus patients. For most, antibiotics were shown to be unnecessary. In a time when bacteria are becoming increasingly resistant to antibiotics, this is important information.

The research above didn’t include self-care steps or nutritional supplements, but my plan does.

Here’s what I suggest when you’ve self-diagnosed a sinus infection:
• Afrin (or Dristan) nasal spray, one spray into each nostril every 12 hours for no more than four days. This “opens up” the whole system and facilitates drainage of infected mucus. It bears repeating: no more than four days (just like it says on the package).

• 30 to 60 minutes after spraying, rinse your sinuses with warm, lightly salted water using a neti pot. If you don’t have a neti pot, pour some of the saltwater into your cupped palm and sniff it up each nostril (you won’t drown, I promise). Throughout the day, you can keep the linings of your nasal passages moist with either Ocean (available at most pharmacies) or Euphorbium Spray. The latter is a homeopathic remedy for sinusitis.

• Two supplements are helpful: Bronchoril (guaifenesin), which thins the thick mucus, allowing it to empty from your sinuses, and Sinatrol, an herbal combination that is antiviral and antibacterial with an immune-boosting component. Guaifenesin is also sold in drug stores as Mucinex, but like many former prescription medications it’s highly overpriced.


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DIAGNOSE-IT-YOURSELF: COVID-19

Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.

ALLERGIES

• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

COLD
• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

STREP THROAT
• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

CORONAVIRUS-COVID 19
• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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