Common cold and sinusitis (acute rhinosinusitis)

What is it about ?

It is rhinosinusitis when the mucous membranes of the nose and sinuses are inflamed at the same time.

Sinuses are cavities in the bones of the face (in Latin, ‘sinus’ means ‘hollow’ or ‘cavity’). There are thus different sinuses:

• the sinuses of the forehead bone (the frontal sinuses),
• the sinuses on either side of the nose, in the jaws (the maxillary sinuses),
• the sinuses above and behind the bone of the nose (the ethmoid sinuses),
• the sinus at the height of the temples, in the center of the skull (the sphenoid sinus).

All sinuses are connected to the nose and throat (nasopharynx) by a small opening. Infections can therefore easily pass from the nose to the sinuses. Since all the sinuses are connected to the nose, they often become inflamed at the same time.

Rhinosinusitis can be acute, chronic, or acute relapsing:

• acute rhinosinusitis lasts less than 6 to 8 weeks;
• chronic rhinosinusitis lasts more than 8 weeks;
• recurrent acute rhinosinusitis is common: 4 episodes per year, or more.

What is its frequency?

Acute rhinosinusitis is a common condition. Out of 1000 patients seen in general medicine each year, there are 28 new cases of rhinosinusitis (acute or chronic), with a peak between 30 and 40 years.

How to recognize it?

Rhinosinusitis usually begins with a persistent cold, which is accompanied by:

• a runny nose of the watery and / or purulent type;
• of a stuffy nose ;
• discharge of mucus from the nose to the throat (posterior nasal discharge).

Typical symptoms of sinusitis are

• pain or a painful feeling of tension in the face;
• pain in the upper teeth and pain that increases when chewing or leaning forward;
• you may also feel very sick and have fever.

How is the diagnosis made?

Most often, the doctor will make the diagnosis based on your symptoms and physical examination. It is sometimes difficult to tell the difference between rhinosinusitis and a common cold. The sinuses are often (partially) affected in both conditions. If the symptoms are short-lived (less than a week), it is less likely that it is acute rhinosinusitis.

Additional tests

In case of doubt about the diagnosis, in case of high fever and severe deterioration of the general condition, the doctor may prescribe some examinations. A x-ray can thus exclude the presence of fluid / mucus in the sinuses. The presence of fluid / mucus in the sinuses does not always mean that there is sinusitis.

the CT scan is the best choice to see the extent of the condition, and decide on treatment. This examination may be necessary if it is thought that there are complications or that it progresses to chronic sinusitis. However, the dose of radiation needed for this exam is much higher than for a normal x-ray.

What can you do ?

• If necessary, stop smoking because smoking irritates the mucous membranes.
• Try as much as possible to reduce the transmission of the germs that cause the disease. It is transmitted primarily through contact with the hands and through droplets of saliva produced in the air when coughing and sneezing. Good hand hygiene can prevent transmission.
• Salt water rinses mostly relieve nasal complaints, but they do not speed healing.
• You can inhale hot water (max 60 ° C), three times a day for a quarter of an hour. There is not enough evidence that this speeds healing. Adding products like menthol, chamomile or salt has not been shown to be beneficial.

What can your pharmacist do?

Your pharmacist can start with medications that relieve complaints. For example, it can offer you painkillers like paracetamol or an anti-inflammatory like ibuprofen, and a nasal spray.

The decongestant sprays (eg, based on oxymetazoline) only reduce symptoms. They do not modify the duration of the disease, nor the mechanism of cure. Use them as short as possible, maximum 5 days, because they have side effects. They often cause what is called a ‘rebound effect’: when you stop the spray, the mucous membrane swells even more than before. So you keep using them and it’s even more difficult to do without them.

The cortisone sprays can sometimes be helpful. These sprays, unlike decongestant sprays, can be used for longer. They are only really effective after 3 to 10 days of use. So don’t stop them too quickly. The side effects of these drugs are:

• irritated nose;
• runny nose after use;
• sometimes nosebleeds (some time after starting treatment). In this case, it is better to stop the treatment for a few days. This is often due to misuse. Indeed, you should not send the spray to the wall that separates the two parts of the nose (the nasal septum).

If you want to use a cortisone spray for a longer period of time, it is best to seek advice from your doctor. In addition, these sprays are reimbursed only with a doctor’s prescription.

What can your doctor do?

The antibiotics are generally not indicated in acute rhinosinusitis.

Your doctor may still consider prescribing an antibiotic in certain cases:

• in case of severe rhinosinusitis with severe pain, fever and severe impairment of general condition.
• to prevent progression to chronic rhinosinusitis in people with mild to moderate rhinosinusitis that has not improved after 7-10 days of symptomatic treatment. It is still preferable, also in this situation, to wait for a spontaneous improvement because it has not been shown that antibiotics reduce the risk of chronic sinusitis or complications.

If the doctor sees signs of complications, such as redness and swelling in the face, eye abnormalities or signs of damage to the nerves in the brain, he will refer you to a specialist right away.

Want to know more?

• Facial sinus anatomy (image) – Larousse

• Acute rhinosinusitis – mongeneraliste.be – SSMG – Scientific Society of General Medicine

• The radiography, here, Where to find on this page of Cliniques St Luc UCL
• The scanner, here, Where to find on this page of Cliniques St Luc UCL

• Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
• Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
• Nasal vasoconstrictors (decongestant sprays) – CBIP – Belgian Center for Pharmacotherapeutic Information
• Oxymetazoline – CBIP – Belgian Center for Pharmacotherapeutic Information

Sources

• Belgian clinical practice guide ‘Acute rhinosinusitis’ (2005) – BAPCOC – Belgian Commission for the coordination of antibiotic policy – ebpracticenet
• Belgian guide to anti-infective treatment in outpatient practice ‘Acute rhinosinusitis’ (2019) – BAPCOC – Belgian Commission for the coordination of antibiotic policy
• ‘Acute rhinosinusitis’ care form for the elderly – CBIP – Belgian Center for Pharmacotherapeutic Information