Q: I think I have sinusitis! What should I do?

A: Runny nose? Thick green mucus? Head and face hurt like the dickens when you bend over? It might indeed be sinusitis. In fact, Acute Sinusitis is one of the most common reasons for provider visits this time of year.

It all starts with the fact that you have holes in your head. Well, not just you, actually, we all do. These holes (that is, air-filled hollow cavities around your nose and nasal passages) are your sinuses. When they get inflamed, normal drainage of mucus can stop, causing the sinusitis symptoms.

Symptoms of sinusitis (both bacterial or viral) may include nasal congestion, green thick mucus discharge, tooth pain and face pain, and foul breath. If you zoom into ZoomCare with some of the above symptoms, your provider's mission is to distinguish bacterial sinusitis from other conditions that might look or feel the same: mainly a bad viral infection (a common cold). This is important because bacterial sinusitis should be treated with antibiotics to prevent some potentially nasty complications.

Who gets bacterial sinusitis? The average adult gets three "colds" per year and a child gets 6-10 per year. Up to 2% of these colds can become acute bacterial sinusitis. (That means that there are 20 million cases of bacterial sinusitis per year). Nose blowing may actually lead to bacterial sinusitis because blowing the nose shoots mucus into the sinuses, where bacteria can then take hold. That is why treating colds with decongestants can be helpful in preventing sinusitis.

The key to sinusitis is deciding when it needs to be treated with antibiotics. This is not an easy decision. There is no convenient, office-based diagnostic test to distinguish bacterial sinusitis from other similar conditions. So it all rests on history, physical exam and experienced medical assessment. Your provider will be looking for the clues to bacterial sinusitis: namely, thick green mucus, facial pain (especially one side of the face), tooth pain, and fever. If your symptoms have lasted for more than seven days, your provider may prescribe antibiotics.

Antibiotics cure most cases of bacterial sinusitis and prevent complications (meningitis, brain abscess, chronic sinusitis). The first line of treatment is high dose amoxicillin used for 10 days. Patients with allergies to penicillin or with other special circumstances have many other antibiotic options.