Oral Steroids No Help in Sinus Infections?

Media outlets such as Fox News reported yesterday that oral steroids do not help with sinus infections. This claim is based on a small study of 174 patients with clinical symptoms of an acute sinus infection and given either 30 milligrams per day of prednisolone or placebo pills for one week. Of note, antibiotics were not given.

No significant difference in symptom resolution was found.

Now why would one even think to give oral steroids for sinusitis in the first place?

Steroids decrease inflammation and swelling which theoretically would allow for the sinuses to drain more easily and effectively therefore expediting sinusitis resolution.

Also, there have been studies that suggest steroid nasal sprays do help with resolve sinusitis to a certain extent.

Keep in mind that steroids are NOT antibiotics and do not kill the germs that cause an infection. Furthermore, many viral upper respiratory infections are misdiagnosed as sinus infections.

What this study suggests is that at least for acute sinusitis, oral steroids alone do not help resolve an acute sinus infection.

HOWEVER, keep in mind that oral steroids have been shown to help with nasal polyps and chronic sinus infections when given in the setting of antibiotics and sinus surgery.


Source:
Oral steroid doesn't clear up sinus infections. Fox News 8/7/12

References:
Systemic corticosteroid monotherapy for clinically diagnosed acute rhinosinusitis: a randomized controlled trial. CMAJ August 7, 2012 First published August 7, 2012, doi: 10.1503/cmaj.120430

Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol. 2011 Oct;128(4):693-707; quiz 708-9. Epub 2011 Sep 3.

Treatment outcomes and predictors for systemic steroids in nasal polyposis. Acta Otolaryngol. 2012 Jun;132 Suppl 1:S82-7.

Intranasal Corticosteroids in Management of Acute Sinusitis: A Systematic Review and Meta-Analysis Ann Fam Med May/June 2012 vol. 10 no. 3 241-249

Xylitol Nasal Flushes Helps Prevent Chronic Sinusitis

Over the years, there has been much about how beneficial a safe food additive called xylitolis in preventing infections. This naturally-occurring plant-based sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties. Given these properties, daily xylitol gum chewingor xylitol nasal sprayuse has been shown to help prevent recurrent acute ear infections and sinus infections... safe for use even in infants.

How may this occur? Toronto researchers figured out that xylitol inhibits the adherence of germs (burkholderia in the study) to airway linings thereby helping to prevent recurrent infections.

Another beneficial practice found to be helpful in preventing sinus infections are saline flushes to the nose. For those who don't realize the difference, saline flushes are different from saline nasal sprays in the volume of irrigation performed (think garden hose versus squirt bottle). Nasopurenasal flushes is being shown in the picture above (there are many different stylesbut all basically do the same thing).

Now what if we combine saline flushes with xylitol for those who suffer from particularly difficult chronic sinus infections???

Stanford University researchers conducted a small study (20 subjects) to see whether xylitol flushes (rather than nasal spray) to nose works even better than plain saline flushes to the nose. In spite of its small size, it was a prospective, randomized, double-blinded, controlled crossover pilot study.

What they found, at least in the short term, is that xylitol nasal irrigations resulted in greater improvement of chronic rhinosinusitis symptoms as compared to saline irrigations.


Reference:
Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study. The Laryngoscope Volume 121, Issue 11, pages 2468–2472, November 2011

A novel model to study bacterial adherence to the transplanted airway: inhibition of Burkholderia cepacia adherence to human airway by dextran and xylitol. J Heart Lung Transplant. 2004 Dec;23(12):1382-91.

A Story About a Sugar: The X-Factor. Blog by Dr. Faust

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

NCIS Character Tony DiNozzo Gets Acute Laryngitis

On October 19, 2010, there was a CBS episode of NCIS (Naval Criminal Investigative Service) called "Cracked" in which Special Agent Tony DiNozzo developed acute laryngitis.

The show's chief medical examiner, Dr. Ducky Mallard, examined Special Agent Tony DiNozzo and instructed him on strict voice rest for 24 hours which Tony ignored.

If I was on the show, I would have performed a much more thorough examination that would include fiberoptic laryngoscopy (and/or stroboscopy) in which the vocal cords could be directly examined as shown in this video:

Based on his hoarseness, lack of productive cough, and acute onset, I suspect Tony developed acute VIRAL laryngitis. Here's an example of what I suspect I would have seen on laryngoscopy if one was done (video is actually stroboscopy, a much more intensive examination than laryngoscopy):

This exam is different than acute BACTERIAL laryngitis in which pus on the voicebox would be seen as shown in this video (also stroboscopy):

Overall, treatment for acute viral laryngitis is strict voice rest as the esteemed Dr. Mallard recommended, though 24 hours is a bit optimistic. I probably would have prescribed a course of steroids to help with the swelling as well as hydration.

Should Tony keep on talking in setting of acute laryngitis, he runs the risk of developing muscle tension dysphonia.