Battle plan for repeat sinus infections

Battle plan for repeat sinus infections

Dear Dr. K: I don’t seem capable of getting just one sinus infection. Once I get the first one, I seem to get two or three more before it’s all over. Can anything be done?

At the risk of sounding smart-alecky, first and foremost, don’t get the first infection. By this I mean try to avoid catching colds or URIs (upper-respiratory infections). In general people don’t “catch” a sinus infection; it usually occurs as a sequel to a viral cold/URI that sets the stage. Beyond that, the usual advice applies: avoid exposing yourself to people who are acutely ill, use good handwashing technique, etc.

Regarding the repeated nature of your sinus infections, it actually may be one of two scenarios. First: You actually do get back-to-back-to-back infections. Second: You never fully get over the first infection.

Let’s tackle Scenario No. 2 first. It would be like the old Smoky the Bear forest fire ads: “Be sure the fire is completely out.” For most infections there are standard regimens such as 10 days of penicillin for strep throat. This is not true for sinusitis as it tends to be based more on a clinical response sliding scale. Often, sinus infections require 14 or even 21 days of therapy to eradicate.

It is generally best to continue therapy until the symptoms have resolved and mucus is clear in color.

Scenario No.1 is a little tougher. The two main culprits are: a polymicrobial infection or altered anatomy/physiology. In the first case the individual has two or more microbes causing the infection. This could be two or more bacteria, or a bacteria and a fungus. The person improves initially when the first pathogen dies, but if the second bacteria or fungus isn’t killed, it then flourishes to cause the “recurrent” infection.

In people prone to recurrent infections this is when obtaining a culture can be of great help. Cultures generally aren’t necessary and add to the cost of treatment, but if the polymicrobe scenario is suspected, then a culture can expose this issue.


“. . . By “altered anatomy/physiology” I mean the initial infection

either narrows or blocks the sinus entrance. . .”


The best way to get a sinus culture is during rhinoscopy by an ENT (Ear, Nose and Throat) doctor, but a close second is a simple nasal swab.

By “altered anatomy/physiology” I mean the initial infection either narrows or blocks the sinus entrance, or it alters the self-cleaning sinus membrane.

In the first instance, if the original infection leads to narrowing of the sinus entrance or the development of a polyp that blocks the entrance, you have a “closed space” situation. As the sinuses are not sterile spaces, if their opening is blocked, it’s just a matter of time before the native bacteria multiply to the point of infection.

Avoid this by seeking prompt treatment. If allowed to smolder, the original infection is more likely to lead to the tissue inflammation that can block the sinus. Also, use steroids systemically or topically to reduce this inflammation and restore openness. Finally, short (three-days’) use of a topical inhaled decongestant such as Afrin can sometimes pop open the sinus.

By “self-cleaning” sinus membrane I’m referring to the fact that our sinus cavities are lined with tiny cilia that beat in a way that moves bacteria out of our sinuses. Unfortunately, just as a second-degree burn causes the top layer of our skin to slough off, so too does an infection cause this ciliated epithelium to peel off. Just as our skin regrows, so does our sinus membrane — but it can take four-to-six weeks.

In the meantime, your sinuses are sitting ducks for the next virus/bacteria you’re exposed to. The best way out of this dilemma is sinus irrigation with saline solution. By rinsing your sinuses several times a day you provide a surrogate cleaning mechanism, and thus avoid re-infection during this susceptible period.

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