Sinusitis is highly overrated.

Imagine this scenario. These the doctor Your patient has waited an hour to see you. He complains of congestion, headache, sinus pressure, and postnasal drainage. Yes, the drain is yellow. No, he hasn’t missed work. He winces when you touch his sinuses. He wants you to know how miserable he is. You have to do something, doctor.

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, very often, use the diagnosis “sinusitis” as an excuse to give 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 coldyou tell the patient. Antibiotics are not indicated.

Your patient looks at you. He knows what you need. The next day, she calls her partner and demands an antibiotic, and she gets it. No point in sweating from amoxicillin.

Here’s the point. Unless the situation is bad enough that you have a fever, or miss work, or 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 make a convincing argument, ask him for a $4 antibiotic. You rarely need something more expensive. $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, symptom relief is what you want/need. We’ll start with the pain: facial pain, headache, or sometimes a toothache. You’d be surprised how often a patient hasn’t considered standard pain relievers like Tylenol®, aspirin, Advil® or Motrin® (ibuprofen), or Aleve®; all provide effective relief for most patients. for less than $5.

3. Slime. Bugger. Phlegm. Choose your option. If you have excess mucus, you’ll want to dry it up or have it thinned out, 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 former works better for infections.

4. If you can’t get your snot out, try nasal douches. fancy words. If you have a clogged pipe, run water through it. The same goes for the nose. Use a dime of warm salt water and run it back and forth. This removes germs, mucus, chemicals, allergens (things you’re allergic to), and sometimes paper clips. Here is a video from the Mayo Clinic that shows you how to do the irrigation: http://www.mayoclinic.com/health/nasal-lavage/MM00552.

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

6. And now my personal favorite, pseudoephedrine.. In the old days, a few years ago, you could buy pseudoephedrine without a prescription. Now you have to order it from a pharmacist, thanks to meth labs. The new Sudafed PE® contains phenylephrine, which in my experience is not as effective. Pseudoephedrine opens up the nasal/sinus passages, allowing mucus and air to flow more freely. It also has a bit of a drying effect. If I could choose just one therapy, it would be this: relief for less than $10. Although the drug is over-the-counter, prescription drug plans often cover it, even cheaper than the over-the-counter drug! Common side effects include insomnia and palpitations, as does too much 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 everyday things: avoid going to the doctor and save 50 dollars. Since you are looking for symptom relief, be as specific as possible. If you have multiple symptoms, a multi-relief medication may be your best option.

Copyright 2010 Cynthia J. Koelker, MD