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Slate's Medical Examiner: Steroids for Sinus Pain


Many doctors are tempted to prescribe antibiotics when patients complain of sinus trouble. But antibiotics aren't always the best treatment for sinus problems.

Dr. Sydney Spiesel of the Yale Medical School has seen his share of stuffy noses. He is the medical contributor for the online magazine Slate and for us here at DAY TO DAY.

Dr. Spiesel says antibiotics are necessary for a sinus infection, but he told me there is a difference between infection and pain.

Dr. SYDNEY SPIESEL (Medical Contributor, Slate Magazine): The pain that we feel, and the runny nose, and the misery that television commercials have accustomed us to think of as sinus problems, are not really infections. They're just fluid that's trapped and under pressure, and is dying to get out.

BRAND: Well, how would I know the difference? And how would I know not to call my doctor for an antibiotics prescription?

Dr. SPIESEL: Well, I kind of hope that your doctor isn't going to want to give you an antibiotic prescription automatically. Although, it turns out that an awful lot of them do. The kinds of clues that doctors use to figure this out is how miserable the patient is in terms of, for example, is the patient running a fever. If a doctor taps on a patient's face and it hurts, that's often a sign that there's some real serious inflammation going on inside sinus. If there's yellow pus coming out of a patient's nose and it smells terrible, yeah, that's a pretty good clue of infection.

BRAND: Well, researchers in San Diego, I understand, recently conducted a study on an alternative to antibiotics. And tell us about that.

Dr. SPIESEL: What these in researchers in San Diego did is they took a group of patients with this condition, which had a runny nose and some suspicion of sinus problems, but no high fevers. And they treated them with a choice of either an antibiotic, amoxicillin, or a steroid nasal spray, which causes the tissues inside the nose to shrink; or placebos, dummies for both the antibiotics and the nasal spray.

And what they found was interesting. Yeah, they got some improvement when they used amoxicillin. And they got at least an equal amount of improvement, and sometimes more improvement, when they just used the steroid nasal spray, which didn't carry the risk of people developing an allergy to penicillin.

BRAND: Is that steroid nasal spray on the market?

Dr. SPIESEL: Oh, yeah. There are a lot of steroid nasal sprays on the market. And frankly, they're all pretty much the same. I had occasion to compare the literature on them all recently. And I don't think there's a substantial difference between them.

BRAND: Okay. Steroid nasal sprays available over-the-counter? Or is that also a prescription?

Dr. SPIESEL: No, this is a prescription. These are a prescription item.

BRAND: And, as I understand, the study was done on children. Would the results be the same for adults?

Dr. SPIESEL: Yeah, this study was done on children. But similar studies using just antibiotics were done on adults. And the results pretty much overlap this study.

BRAND: Expert opinion from Dr. Sydney Spiesel, a practicing pediatrician and contributor to

Thank you, Syd.

Dr. SPIESEL: Thank you. Transcript provided by NPR, Copyright NPR.

Madeleine Brand
Madeleine Brand is the host of NPR’s newest and fastest-growing daily show, Day to Day. She conducts interviews with newsmakers (Iraqi politicians, US senators), entertainment figures (Bernardo Bertolluci, Phillip Seymour Hoffman, Ricky Gervais), and the everyday people affected by the news (an autoworker laid off at GM, a mother whose son was killed in Iraq).