Sinusitis is highly overrated.

Imagine this scenario. These the doctor. Your patient has waited an hour to see you. Complains of congestion, headache, sinus pressure, and postnasal discharge. Yes, the drain is yellow. No, he has not missed work. He makes a face when you touch his sinuses. He wants you to know how miserable he is. You have to do something, Doc.

Is it sinusitis or is it a cold?

Sinusitis means inflammation of the lining of the sinus cavities. It does not always mean infection. From what I’ve seen in primary care medicine, doctors often, quite often, use the diagnosis of “sinusitis” as an excuse to administer antibiotics. After all, it is what our patients want, at least most of them. Whether antibiotics work or not, patients believe in them.

But colds are much more common than sinus infections, and allergies can cause similar symptoms.

It’s just a coldhe tells the patient. Antibiotics are not indicated.

Your patient looks at you. You know what you need. The next day, he calls his partner and demands an antibiotic, and he gets it. There is no point in being sued for amoxicillin.

This is the point. Unless the situation is bad enough to give you a fever, or to cause you to miss work, or to make you look sick enough for an X-ray, it’s probably just a cold – sinus irritation caused by a virus.

Here are 7 tips to save money on sinusitis:

1. Ask your doctor if it really is bacterial sinusitis.. If you have a compelling argument, ask for a $ 4 antibiotic. You rarely need anything more expensive. The $ 4 antibiotics include amoxicillin, sulfonamides, doxycycline, erythromycin, cephalexin, and ciprofloxacin. Of these, the first four are considered first-line antibiotics for respiratory infections.

2. Otherwise, what you want / need is symptom relief.. We’ll start with pain: facial pain, headache, or even toothache sometimes. You will be surprised how often a patient has not considered standard pain relievers such as Tylenol®, aspirin, Advil® or Motrin® (ibuprofen) or Aleve®; all provide effective relief for most patients. for less than $ 5.

3. Mucus. Bugger. Phlegm. Choose your option. If you have excess mucus, you’ll want to dry it out or make it thin, like maple syrup in the spring (see # 5). Tasty metaphor! Antihistamines like Benadryl® (diphenhydramine) and Zyrtec® dry up mucus. This can be good or bad. For some people, it provides real relief. For others, it makes them feel worse – they can’t get their snot out (see # 4). Over-the-counter drugs are just as good as prescription drugs (most were prescribed some time ago anyway), and costs less than $ 10. And by the way, while Claritin® (loratadine) works great for allergies, the above works best for infections.

4. If you can’t get the snot out, try the nasal douche. Elegant words. If you have a clogged pipe, let water run through it. The same goes for the nose. Use a penny’s worth of warm salt water and pass it around. This removes germs, mucus, chemicals, allergens (things you are allergic to), and sometimes paper clips. Here’s a video from the Mayo Clinic showing you how to irrigate: http://www.mayoclinic.com/health/nasal-lavage/MM00552.

5. If you can’t beat them, join them. Instead of drying the mucus, many patients feel better if the mucus is allowed to flow more freely. Mucolytics, mainly guaifenesin, the active ingredient in Mucinex®, and some cough medicines, make mucus more watery. So it feels like you’re gulping instead of snot, like you’re supposed to. Don’t spend $ 40 on a fancy product. Get a $ 7 store mark.

6. And now my personal favorite, pseudoephedrine. In the good old days, a few years ago, you could buy pseudoephedrine without a prescription. Now you have to ask a pharmacist, thanks to the meth labs. The new Sudafed PE® contains phenylephrine, not as effective in my experience. Pseudoephedrine opens the nasal / sinus passages, allowing mucus and air to flow more freely. It also has a little drying effect. If you could choose just one therapy, it would be this: Relief for less than $ 10. Although the drug is over-the-counter, prescription plans often cover it – even cheaper than over-the-counter! Common side effects include insomnia and heart palpitations, as does excess caffeine.

7. Ask your pharmacist for free advice.. Tell your pharmacist your symptoms and he or she can tell you which medicines will help you the most. They take care of these things every day – they skip the doctor and save $ 50. As you seek to alleviate symptoms, be as specific as possible. If you have multiple symptoms, a multi-relief medicine may be your best option.

Copyright 2010 Cynthia J. Koelker, MD