Acute Bacterial Sinusitis

Acute bacterial sinusitis complicates colds in both adults and children. From a 1% to 5% of colds have this complication. (46-47)

The major causes of the acute bacterial sinusitis are the bacteria called pneumococcus, Hemophilus influenza, Moraxella, other Streptococcus species, and Staphylococcus. (48) Bacterial sinusitis also complicates tooth root infection, in which case it is caused by anaerobic bacteria.

When a common cold has lasted for 7-10 days and is no better or worse, acute bacterial sinusitis may have developed and additional medical care may be required. (48)

Acute bacterial sinusitis requires antibiotic treatment to reduce the duration of infection and illness and to prevent serious complications such as infection around the eye, bacterial meningitis, and brain abscess. (49) Chronic sinus disease is thought to be another complication of untreated or inadequately treated acute bacterial sinusitis.

The antibiotic treatment selected for acute sinusitis should be effective against most strains of pneumococcus and hemophilus. (45) The recommended course of antibody treatment for acute bacterial sinusitis is 10-14 days.

With proper antibiotic treatment, over 90% of cases of acute bacterial sinusitis are cured. (48, 50)

The possible benefit of using steroid nasal sprays for treating acute bacterial sinusitis has not been adequately studied. This treatment is not recommended because of its additional costs to the treatment program and because antibiotic treatment alone is highly effective.

Nasal and oral decongestants are commonly used for supportive treatment of acute bacterial sinusitis. The benefit of decongestant treatment for this disease has not been studied, but decongestants open the areas in the nasal passages into which the sinuses drain. (48) Decongestants do not open the passages which drain the sinus itself because these small passages are encased in bone (see Anatomy of the Nose).

Cases of acute bacterial sinusitis which do not respond to an initial course of antibiotics should receive a second course of antibiotic treatment. (48) Also, a sinus puncture and irrigation should be considered for diagnosis and treatment.

Cases of acute bacterial sinusitis that do not clear after a few months of appropriate medical treatment may require sinus surgery. (48)

Acute Bacterial Middle Ear Infection

Middle ear infection is mainly a problem in children, although it also occurs in adults.

During colds, the tube from the back of the throat to the middle ear (eustachian tube) no longer functions well and pressure in the middle ear is abnormal in up to 75% of patients. (42-45)

Ear Anatomy

The narrow eustachian tube connects the back of the throat with the middle ear and maintains normal air pressure in the middle ear. A common cold may cause swelling of the adenoid or accumulation of thick secretions in the eustachian tube leading to its obstruction. If this happens, fluid collects in the middle ear causing serous otitis media. If bacteria are trapped in the middle ear, an infection results (bacterial otitis media).

The abnormalities in eustachian tube function and middle ear pressure usually clear after a cold. (42-45) With closely spaced colds, such as occur in children, repeated eustachian tube and pressure abnormalities may lead to fluid collection in the ear.

The eustachian tube and middle ear pressure abnormalities of colds are thought to be a major predisposing factor for the collection of sterile fluid in the middle ear and also for secondary and bacterial infection at this site. (51)

Bacterial infection of the middle ear typically causes ear pain. Also, examination of the ear drum may show redness, bulging, and pus behind the drum. (51)

The important bacteria causing middle ear infection are the pneumococcus , Hemophilus influenza, Moraxella, and other Streptococcus species. (51)

Bacterial infection of the middle ear requires antibiotics treatment to reduce the duration of infection and illness and to prevent serious complications such as bacterial mastoiditis and meningitis. (51) Also, chronic draining ears and hearing loss may occur in children who do not receive proper antibiotic treatment for acute bacterial otitis media.

Some children have repeated episodes of acute bacterial infection of the middle ear. More often children have recurrent collections of sterile fluid in the ear. Prolonged antibiotic administration has been used in recent years to reduce the occurrence of recurrent otitis media in children. This practice may have contributed to the rapid increase in antibiotic resistance of the pneumococcus in the United States in recent years. (52) Antibiotic administration to prevent recurrent otitis media is not recommended as standard practice. An acceptable alternative for this problem with no ecological consequences is placement of ear drainage tubes.

Asthma Attacks

Common colds are a frequent cause of asthma attacks, especially in children. (53-55)

The reasons for this are not well understood and are being actively studied. (56, 57)

Management of such episodes is primarily directed at treatment of the asthma.

People with asthma should, when possible, avoid persons with fresh colds (days 1-3) and should take precautions to reduce the risk of acquiring infections (see Reducing the Risk of Catching Colds).

Chronic Bronchitis

Common colds can cause acute worsening of chronic bronchitis in patients with this condition. (58-60) These episodes are characterized by increased cough, sputum, shortness of breath, and sometimes fever. The fever is presumably due to a secondary bacterial infection and not the viral cold.

Treatment with antibiotics is usually recommended in acute attacks of chronic bronchitis. (61) People with chronic bronchitis and other types of serious lung and heart disease should, when possible, avoid people with fresh colds (1-3 days). Also, they should take precautions to reduce the risk of catching colds from other people (see Reducing the Risk of Catching Colds).