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Sinusitis is an infection of the hollow, bony sinus cavities in the skull that directly connect, and usually affect the nose. Infection can be caused by viruses and bacteria. Fungi can also cause infection, but this tends to occur in people with a weakened immune system or diabetes. The guiding principals of treatment are to open the natural drainage sites of the sinuses into the nose and eradicate infection with antibiotics. Swelling of the lining of the nose (mucosa), from infection or allergy is the most common cause of obstruction.

Regardless of whether allergies are present, nasal steroid sprays will shrink the mucosa and aid drainage from the sinuses. A decongestant nasal spray such as oxymetazoline will also shrink the mucosa, but a rebound in swelling occurs if used beyond a maximum of five days. Saline nasal spray can be used frequently, which thins the mucous and washes out the sinuses. Antihistamines should not be given while being treated for a sinus infection because they slow down the natural infection clearing properties of the mucosa lining the sinuses. Antibiotics need to be given at least two weeks beyond clearing of symptoms. Some of the antibiotics approved by the Food and Drug administration for acute sinus infection include Augmentin, Omnicef, Cefzil, Cipro, Biaxin, Tequin, Levaquin, Lorabid and Avelox. None have an indication for chronic sinusitis but are still useful.

Therapy usually begins with a narrow spectrum antibiotic for two weeks. Broader spectrum antibiotics are added next and treatment is continued up to eight weeks. The last course of therapy may involve the addition of an antibiotic that kills bacteria that grow without oxygen (anaerobes) as well as an oral steroid such as methylprednisolone. Long term control of allergies with immunotherapy is necessary to prevent recurrence. If symptoms and disease do not respond to medical therapy, then endoscopic sinus surgery to drain the sinuses may be necessary. This type of surgery is minimally invasive, and removes only small amounts of diseased tissue at the points of sinus drainage. Older types of sinus surgery were more destructive of normal sinus tissue and left many people "nasal cripples".