Go-to therapy for chronic sinus condition doesn’t work that well
The sinuses are inflamed in people with chronic sinusitis
Scientific photo library / Alamy
Surgery is generally a last resort for people with a chronic or flowing blocked nose. But in some cases, this can actually work better than antibiotics which are systematically prescribed to treat the condition.
Chronic sinusitis affects around 9% of people around the world and occurs when the cavities producing mucus – the sinuses – around the nose become ignited. Common symptoms include a blocked or flowing nose, reduced smell and facial pain, with these persisters for more than 12 weeks. The cause of the condition is generally not clear but may involve viral infections or a modification of the nose microbiome.
The first line of treatment involves anti-inflammatory nasal sprays and rinsing the saline solution through the nose daily. But if the symptoms persist, doctors often prescribe a three -month course of antibiotic clarithromycin. This is used for its anti-inflammatory properties rather than its properties killing bacteria, explains Carl Philpott at the University of East Anglia in the United Kingdom.
As a last resort, people can undergo surgery to expand sinuses and eliminate any benign, or polyps, nasal growth, which form and aggravate symptoms in approximately 5% of cases. However, no previous study compared surgery directly with antibiotics.
To fill this gap, Philpott and his colleagues recruited more than 500 adults with chronic rhinosinusitis. In surveys, participants evaluated the severity of 22 symptoms, such as facial pain and how their nose was flowing, with an average score of 55 out of 110.
The team then randomly assigned participants to take a clarithromycin course, placebo pills or undergo nasal surgery. All participants also used nasal sprays and rinsed their noses with a saline solution.
Six months later, those who took clarithromycin or placebo pills reported a reduction of about 10 points of the severity of their symptoms compared to treatment before treatment, a level that would significantly improve their quality of life, explains Claire Hopkins to King’s College. But as the effect was observed in antibiotic and placebo groups, this was probably due to nasal sprays and rinsing, she said.
Those of the surgery group have seen an improvement of around 30 points in their symptoms in relation to surgery before, which suggests that doctors should offer this instead of antibiotics, explains Hopkins.
However, there is a significant warning. About 80% of participants had nasal polyps, perhaps because the study took place during the COVVI-19 pandemic, and the capture of the coronavirus can trigger the type of inflammation that leads to polyps, explains Hopkins. Other studies are necessary to verify whether the results apply to those who do not have polyps, which we know to different types of inflammation, she says.
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