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

Foley Catheter to Stop Nosebleed???

A foley catheter, as shown above, is normally used to drain urine from the bladder, but it can also be used to stop severe nosebleeds... albeit under dire circumstances and when there is no other suitable alternative.

Normally, for a severe nosebleed, the nose can be packed with a tampon like packing material. The packing material I like best is a rapid rhino which is illustrated below.

Nasal packing like the rapid rhino exerts pressure within the nose to the point whereby the bleeding stops (like putting direct pressure on a leg wound to stop bleeding).

However, if there's no nasal packing around and the person is having a severe life-threatening nosebleed which almost always is due to a posterior bleeding site, and all you have is a foley catheter...

Use the foley catheter!

Insert the foley through the nose on the side that is bleeding just like an naso-gastric tube...

Once inserted so the catheter can be seen in the back of the mouth, inflate balloon with saline. After inflating the foley balloon, pull the foley catheter back out as if to take the foley catheter out. However, given the foley balloon is inflated, it will snug up in the back of the nose such that it can't be taken out.

Pull on the foley catheter with enough pressure to equal the amount of pressure desired to stop the nosebleed. Once at the correct tension, clamp the foley at the nasal entrance to prevent it from falling back into the nose. Packing with gauze in the front of the nose can also be performed to prevent bleeding coming out the front.

Of course, this is a TEMPORARY measure and should be replaced as soon as possible with appropriate nasal packing material.

But, it certainly works when in a bind.

US Gymnast Maroney Suffers Nasal Fracture

World vault champion McKayla Maroney on the US gymnastics team suffered a nasal fracture during pre-meet training when she over-rotated at the end of a tumbling run and fell hard earlier this month. She also suffered a concussion. A visit to the ER revealed her injuries. Apparently no surgical intervention was pursued.

This case illustrates that most nasal and even facial fractures do NOT require surgical repair.

The key elements that lead towards a decision for facial and/or nasal fracture surgery are the following (not all-inclusive, but general pointers):

- Any functional deficit including inability to open and close the jaw.
- Change in your occlusion (the way your teeth come together).
- Double vision (blurry vision does not count).
- Cosmetic deformity due to nasal/facial fracture (bruising and swelling does not count).
- Nasal obstruction not due to swelling.

The two main specialties able to assess whether surgery is required or not is ENT and Plastic Surgery as well as some oral surgeons.

Source:
Maroney suffers concussion, nasal fracture. ESPN 6/10/12