Dr. Higgins, along with Dr. Douglas Reh from Johns Hopkins Medical Institutions, recently published an invited review article in Current Opinions in Otolaryngology-Head and Neck Surgery that discusses the effect of environmental pollutants on nasal disease. The abstract of the article is available on PubMed here. Many environmental pollutants are associated with chronic rhinitis, including ozone, tobacco smoke (both second-hand and active smoking), particulate matter, and occupational irritants. Some exposures cause local irritation and others can cause severe toxicity to the nasal passages. There are medical options that help limit symptoms, but the most effective therapy is identifying and avoiding the specific exposures.
A study found that antibiotic therapy was no better than placebo in relieving acute sinusitis (see news articles here). This study (see abstract here) published in JAMA (Journal of the American Medical Association) was a trial of subjects who met the criteria for acute sinusitis (that means over 7 days of symptoms or worsening after initially getting better) were randomized to amoxicillin or placebo. All subjects used over-the-counter agents for symptomatic relief. At day 3 and 10 of therapy, there were no differences in symptom scores or recovery from the sinusitis. About 80% of subjects at 10 days had symptom improvement regardless of whether or not they took an antibiotic. Interestingly, there was a slight difference in symptom relief at day 7 of therapy, favoring antibiotics.
There have been many trials looking at this issue, and many have shown no difference in symptom improvement or recovery from sinusitis. Antibiotics can be helpful, and occasionally quite necessary; however, overuse of antibiotics can cause bacterial resistance. This is a tough issue, and the debate continues. Nonetheless, it is certainly a worthy discussion topic to have with your physician!
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