Didn’t see this study when it first came out in JAMA, but happened to read a synopsis of the study in another medical journal.
First the study participants needed to meet two of four criteria to actually be diagnosed as having sinusitis (pus coming out of the nose, pus coming out of both sides of the nose, pus on inspection inside the nose, and localized pain to one side of the face).
Then the study randomized patients to get antibiotics, nasal steroids, both antibiotics and steroids, or sugar pills.
Participants kept a journal of their symptoms, including ratings on variables such as pain in the face, pain in the head, nasal blockage, nasal discharge, general well-being. They turned in the journal at the end of the study.
A “cure” was defined as having either no or very little problems with all indicators.
Results? People taking steroids and people taking antibiotics took just as long to get well as did those taking sugar pills.
There were some minor differences in symptom improvement, but these differences were not felt to be more likely than chance.
I think this study shows a few important points:
- A little pressure in your face does not necessarily mean that you have a sinus infection.
- Even if you have pressure in your face and pus coming out of your nose, antibiotics aren’t going to help a lot more than sugar pills will.
- Nasal steroids are expensive and are also of little help in improving symptoms of sinusitis.
A few days of nasal decongestants (Afrin/NeoSynephrine or store brand equivalents) coupled with nasal washes have always worked for me.
UPDATE MARCH 5, 2008
OK, Ian busted me in the comments about posting my anecdotal experience with nasal washes and nasal decongestants without backing up my personal preferences with medical studies. They exist, I just should have posted them. So here goes:
Practical Approach to the Patient With Sinusitis – “Saline irrigation may help remove mucus, as well as irritating eosinophilic proteins in the nasal mucus, and may help decrease the risk of crusting near the sinus ostia.” “Time-limited use of topical decongestants (eg, phenylephrine and oxymetazoline) may improve sinus drainage but may cause additional problems, such as rebound nasal congestion, if used longer than 3-5 days.”
Acute Bacterial Rhinosinusitis in Adults: Part II. Treatment – “Decongestants often are recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion.” “Nasal irrigation with hypertonic and normal saline has been beneficial in chronic sinusitis and has no serious adverse effects.”
Pediatric Sinusitis – “Adjunctive measures include saline irrigation, steam inhalation, nasal and systemic steroids, mucolytics, and decongestants.”
US News Article on Nasal Wash – Nasal saline wash of the nose can be one of the most helpful treatments for both acute and chronic sinus problems.
Cochrane Review From 2007 – “Saline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis.”
Finally, here’s a good sampling of the different nasal wash products on the market.
Oh, and here’s another study concluding that “Antibiotics and inhaled nasal corticosteroids are being used more often than their published efficacies would encourage.”
Now am I off the hook?