By Thomas S. Higgins, MD, MSPH, www.higgins-sinus.com

Okay, the sinus doctor got a sinus infection. And yes, he recovered. And WITHOUT antibiotics.

I tell my patients to try remedies other than antibiotics for the first few days of feeling a sinus infection. Now, there are exceptions: high fever, severe symptoms, a scope examination clearly showing a bacterial infection, etc. However, most early infections are viral or inflammatory, so they do not necessarily require antibiotics.

So, back to my sinus infection. On Friday, I started feeling the congestion. Then came the thick yellow drainage and difficult breathing. By Saturday, I was fatigued, had facial/sinus pressure, and felt warm. I took my temperature: 97.8 degrees Fahrenheit. No fever.

This is the day when many people think that an antibiotic is the answer. I have to say, the thought crossed my mind, but I resisted. I, instead, started “The Dr. Higgins’ Nose & Sinus Relief Routine”:

• Warm soup.
• Humidification.
  
• Nasal decongestant and acetaminophen (sometimes in combination formulas) by mouth every 4-6 hours during the day.
  
• Sedating antihistamine (such as diphenhydramine) and acetaminophen at night just before bedtime.
• Nasal decongestant spray twice a day followed by nasal saline irrigations.
  
• Nasal saline irrigations several times a day, particularly after using the nasal decongestant spray.
  
• Nasal saline spray as needed.
  
• Nasal steroid spray twice a day.
  
• Try to stay upright and be moderately active.
  

The first two days of fatigue were tough, but I could breathe through my nose because of The Routine. I believe allowing myself to breathe served two purposes: (1) It made me feel much more comfortable and (2) It prevented the mucus from getting backed up in my nose, which could prolong or worsen the infection. I started noticing some improvement on days 3 and 4. I started taking the decongestants less often. For the next week, I continued an occasional irrigation to clear thick yellow mucus in the back of my nose. By the end of the week, however, I was off nasal decongestants and irrigations. I felt back to normal, except for a lingering cough, which I knew typically would last on average at least 10 days. I continued the nasal steroid spray until the cough disappeared.

And, aaaahhhhhh. Back to normal. No antibiotics, but aggressive treatment. Now, when I have a true bacterial infection, I do not have to worry that I could have previously created an environment for a resistant bug, and my body will be ready.

Dr. Higgins was the invited lecturer for the University of Louisville Department of Family Medicine and Geriatrics Ground Rounds on January 11, 2013. Discussing nose and sinus disorders of the elderly, he described the different conditions common in the elderly and management options. "The aging process causes changes in nasal structure as well as physiology," said Dr. Higgins, "The aging nose has weaker cartilage support, causing a longer, droopy nose that can contribute to obstruction. In addition, the cilia that moves mucus in the nose are not as effective, causing thick mucus drainage...We also have to consider that some elderly are poor candidates for surgery, but we still have to be diligent in managing their sinusitis, particularly in patients suffering from recurrent pneumonia related to sinusitis."

Dr. Higgins is the invited lecturer for the Grand Rounds lectureship for the Department of Geriatrics at the University of Louisville this Friday at Jewish Hospital. He will talk about: "Nose & Sinus Disorders in the Elderly: Nothing to Sneeze At".