Succeed in Medicine

What Med School Misses about Sinusitis, Colds, and Allergies | Ep489

Oct 28, 2025
In this insightful discussion, Dr. Block dives into the nuances of sinusitis, colds, and allergies. He emphasizes that bacterial sinusitis often follows a viral infection. The concept of 'second sickness' helps identify worsening symptoms. Waiting ten days before prescribing antibiotics is crucial, as many infections can self-resolve. Dr. Block highlights that facial pressure usually indicates migraines, not sinus issues. He also explores effective treatments for allergies and debunks misconceptions about various medications and procedures.
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INSIGHT

Sinusitis Usually Follows A Cold

  • Bacterial sinusitis usually follows a viral cold because the virus disrupts sinus mucosa and mucus clearance.
  • Look for a "second sickness" where symptoms worsen after initial improvement to suspect bacterial infection.
ADVICE

Wait 10 Days Before Antibiotics

  • Avoid prescribing antibiotics for acute sinus symptoms for at least 10 days unless complications arise.
  • Use time as the primary discriminator because many bacterial sinus infections are self-limited.
INSIGHT

Facial Pressure Often Means Migraine

  • Facial pressure and worsening when leaning forward are poor discriminators for sinus infection.
  • Brad Block notes most facial-pressure presentations are primary headaches, usually migraine, not sinusitis.
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