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Ever so often I would ask a patient about their medical history or about allergies, and the response would be, “Oh, I does get sinus oui doc.”

I realize what they mean is that they have allergies which affect their sinuses (which everybody has) or that their sinuses sometimes act up, as in ACUTE SINUSITIS, which is what we’ll talk a bit about today.

OVERVIEW

If you’ve had a cold that lasts longer that a week, still have trouble breathing through your nose, have a throbbing pain in your face when you lean forward, then you may not have just a cold anymore, but sinusitis, an infection of the sinus cavities.

Not everyone with a cold develops this, but colds are the most common cause of acute sinusitis.

Sinuses are air-filled, hollow spaces within the facial bones surrounding your nose.  When their linings become infected, usually by bacteria or viruses, they may swell and cause an obstruction and interfere with the normal drainage of mucus.  Sinusitis can cause much discomfort, and can lead to more serious infections if left untreated.  It can become chronic, but most cases don’t, and treatment lasts about two weeks.  Just for information, you have frontal, maxillary, ethmoid and sphenoid sinuses, one on each side of your face, and they each have an opening through which mucus from them drains into the nasal passage.

SYMPTOMS AND SIGNS

Acute sinusitis gives symptoms and signs which include:

•    Congestion (stuffiness) that makes it difficult to breath through your nose
•    Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
•    Headache
•    Fever
•    Sore throat (from postnasal drip)
•    Cough
•    Reduced sense of smell or taste.
•    Tooth pain
•    Bad breath
•    Fatigue

If you’ve had signs and symptoms for longer than a week, you may have sinusitis.

CAUSES

A viral, bacteria, or fungal infection of the air passages in the nose, sinuses, and throat – including, of course, the common cold virus – can lead to acute sinusitis.  When a cold or any infection inflames and swells mucous membranes (the outermost smooth lining) in your nose, these swollen membranes obstruct the sinus openings and keep mucus from draining into the nose.  As drainage becomes blocked, an environment is created in which bacteria and virus trapped in the mucus, can grow.  The sinuses themselves are membrane-lined.  These can also swell enough to obstruct their own opening into the nose.

Other conditions may cause you to develop sinus obstructions and make you more likely to get sinusitis.  These include:

•    Allergies.  No big surprise here.  The inflammation they cause may block your sinuses.

•    Deviated nasal septum.  In this case, the wall between the nostrils is crooked (usually from birth). This may restrict or block sinus passages, setting up an environment for infections.

•    Nasal polyps.  These are abnormal growths of tissue within the nasal passages; they slow drainage and allow infections to grow.

•    Other medical conditions.  People with cystic fibrosis, a disease which causes mucus to be abnormally thick and stagnant, HIV-positive and other immune-deficient patients, are more likely to develop sinusitis.

Smoking and exposure to air pollution can cause further irritation or inflammation, leading to blockage associated with sinusitis.

WHEN TO SEE DOC

You can self-treat mild symptoms.  If no improvement in a few days, time to come in, and especially if you have the following:

•    Fever greater than 100.5 F
•    Severe headache
•    Stiff neck
•    Confusion
•    Pain, swelling or redness on your face or around your eyes.

DIAGNOSIS

The doc will ask if you’ve had a recent cold, whether you smoke or have allergies.  We’ve already talked about the role of these.

On examination, he will feel for tenderness in your sinus areas and examine your nasal passages for inflammation, secretions or deformities.  A thin tube with a light may be used to look up you nasal passages to detect things like nasal polyps.  A small sample of material on a swab like a Q-tip may be taken from inside your nose to determine at the lab which, if any, bacteria or fungus, is contributing. CAT scans and MRI’s may sometimes be used to diagnose sinusitis.
COMPLICATIONS

Sinusitis can aggravate asthma.  If you have the latter and develop the former, see your doc.

Serious complications are rare but may threaten your life if infection spreads beyond your sinuses.  You may develop:

•    Meningitis.  Infection may spread to the bones of your eyes or to the membrane lining your brain (meninges), causing brain damage.
•    Visual problems. Reduced vision or even blindness can result if the infection spreads to your eye sockets.
•    Blood vessel complications.  Infection spreading to the veins around your sinuses can cause aneurysms (weakening of the blood vessel wall at certain points) and blood clots that interfere with the blood supply to your brain.

TREATMENT

Most will get better without antibiotics.  If you haven’t had sinusitis before, over the counter decongestants and pain relievers may help.  If they don’t, see the doctor.

You may get an antibiotic for 10 to 14 days.  Take it all.  If symptoms persist, it could be extended or changed.

Doctor may also recommend.

•    Treating any contributing underlying allergy.
•    Using prescription decongestants, nasal corticosteroid sprays or oral corticosteroid pills to relieve stuffiness.
•    Taking over-the-counter pain relievers.
•    Spraying a saline solution in your nose several times a day.

PREVENTIVE MEASURES

•    Minimize your risk of infections, like the cold.  Minimize contact with people who have it and/or wash hands often with soap and water.
•    Don’t smoke.  We’ve talked about this.
•    Avoid polluted air.  Indoor or outdoor contaminants can irritate and inflame your lungs and nasal passages.

SELF – CARE MEASURES

•    Steam your sinuses.  Inhale steam several times a day to stimulate sinus drainage.  You may add something mentholated like Vicks, if you like.
•    Apply warm compresses around your nose, cheeks and eyes to ease facial pain.
•    Drink lots of fluids to dilute secretions and promote drainage.
•    Don’t drink alcohol.  Here we go again!!  It can worsen the swelling of the sinus and nose linings.

See you next week.

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