Straightening Out Your Sinuses

sinusYou’ve probably suffered through  sinus problems at some time in your life–pain and tenderness around your eyes, nasal congestion, postnasal drip. A lingering cold can turn into sinusitis that may need treatment. Sometimes a short-term sinus problem  becomes chronic.

The sinuses are actually holes or hollow air spaces in the bones between your eyes, in your forehead and behind your cheekbones. There are eight in all–four on each side of the face.

Some have speculated that the main function of the sinuses is to keep the head from becoming too heavy. They also produce mucus which keeps the nasal passages moist and protects against dust, germs, pollutants and allergens.

But they are located near enough to the nasal passages that they often become clogged during an upper respiratory infection.

Acute (or short-term) sinusitis is often the reason that a cold lingers far too long or seems to have a second wind, causing symptoms that may be even worse than initially. The infection can be either viral or bacterial, but doctors often assume that an upper respiratory infection that has persisted or gotten worse probably has at least some bacterial involvement. More than one fifth of all antibiotic prescriptions written in a given year are for treatment of acute sinusitis.

Another option in the treatment guidelines is watchful waiting and deferral of antibiotic treatment for up to seven days after diagnosis. If symptoms worsen or do not clear by that time, the antibiotic can be started. The idea is to avoid over-use of antibiotics and the risk of antibiotic resistance.

Chronic or Recurrent Problems

If short-term bouts after a cold are your only experiences with sinusitis, you are fortunate. Chronic sinusitis, lasting eight weeks or longer, is also common, particularly among young and middle-aged adults but also children. And some persons have recurrent sinusitis with several episodes yearly.

Symptoms are basically the same:

     •       a thick yellowish or green discharge from the nose or down the back of the throat;

     •       difficulty breathing through the nose because of congestion or obstruction;

     •       pain and swelling around the eyes, cheeks, nose or forehead.

You might also have coughing, sore throat, fatigue and a reduced sense of smell and taste. Fever is not as common with chronic as with acute sinusitis.

One particularly annoying symptom is postnasal drip. The mucus that helps lubricate and clean the nasal passages is normally drained and swallowed unconsciously. When this mucus becomes excessively thick, you can feel it accumulating in the throat or dripping from the back of your nose.

Chronic sinusitis can be caused by a bacterial, viral or even a fungal infection, but, in an adult, there are many other possible causes.

 Regular exposure to pollutants such as cigarette smoke can increase the risk of chronic or recurrent sinusitis.

About 20 percent of persons with chronic sinusitis also have asthma. If you have asthma, you are vulnerable to sinusitis. In turn, sinusitis can cause an asthma attack. Hay fever and other allergies that cause inflammation in the nasal passages are also likely to block the sinuses.

 Other common causes of chronic sinusitis include:

         •       nasal polyps (small tissue growths);
 
         •       a deviated or crooked septum (the wall between the nostrils);
 
         •       trauma to the face or a fracture of the nose or other bones of the face;
 
          •      other medical conditions such as cystic fibrosis, gastroesophageal reflux, HIV or other immune-related diseases.       

 Some persons simply have longer, narrower passages that make sinus blockages more likely.

If you are sensitive to certain foods or irritants in the environment, the first step is identifying the triggers and trying to avoid them. Avoid cigarette smoke,  strong chemical odors or any other environmental factor that might be causing a reaction in the blood vessels of the nasal passages. Hair spray and cleaning products are possible triggers.

Your doctor might suggest decongestants, antihistamines, a nasal steroid spray or, in some cases, allergy shots. And there are non-medical approaches that can be effective.

To thin the mucus, make sure you are drinking plenty of fluids. A warm, moist wash cloth applied to your face several times a day may relieve some of the pressure and pain.

Many patients experience problems in the winter when air in their homes is warm and dry. When nasal membranes are dry, mucus isn’t cleared as effectively. On the other hand, an overly moist (greater than 50 percent humidity) environment is conducive to dust mites, a potential allergic cause.

As for use of room humidifiers or vaporizers, opinion is divided. If you do use such a device, make sure that you clean it daily. It’s also important to change the filters frequently on your heating and cooling system.

Salt water nasal rinses can be done at home. Mix a pint of lukewarm, distilled, sterile or previously boiled water with a teaspoon of salt and use a bulb syringe to flush the nasal cavities. You can also buy a kit or a neti pot to accomplish the same.

When sinus symptoms are severe or long-lasting, an allergist or otolaryngologist (ear, nose and throat specialist) should probably direct treatment.

A CT scan may be the most effective way of diagnosing what is causing the problem, but the benefits should be weighed against the risks of radiation. Another diagnostic tool is the endoscope–a long, thin, flexible tube with a light and a camera at the end inserted through the nose. Although the procedure may sound scary, it’s more uncomfortable than painful and is a way of detecting nasal polyps or other abnormalities.

Surgery may be called for if polyps,  a deviated septum or other structural abnormalities are blocking the passages. Most surgical procedures can now be performed through use of the endoscope, inserted through the nose, reducing pain and bleeding and allowing a quicker recovery.

Balloon catheter technology can also be used to widen the natural drainage pathways without removing bone or tissue.

Surgery is, as always, a last resort for severe cases. Sinus problems are common but can usually be managed through lifestyle changes, natural remedies, medications and other treatments.

 

REFERENCES:

American College of Allergy, Asthma & Immunology, “Sinus information,” 2014.

Laurie Barclay, M.D., “Adult sinusitis guidelines updated,” Medscape Medical News, April 3, 2015.

Marc Dubin, M.D., Jivianne Lee, M.D., Troy D. Woodard, M.D. and Sarah K. Wise, M.D., “Endoscopic sinus surgery,” American Rhinologic Society, revised February 17, 2015.

Kathleen Doheny, “Sinus problems: home remedies and tips,” WebMD Feature, reviewed by Michael W. Smith, M.D., January 16, 2014.

Mary Ellen Ellis, “Sinus-stricken? Symptoms of an infection,” Healthline, medically reviewed by George T. Krucik, M.D., MBA, September 13, 2013.

“Endoscopic sinus exam for sinusitis,” WebMD Medical Reference from Healthwise, November 14, 2014.

Chris Iliades, M.D.. “The basics of post–nasal drip,” Everyday Health, medically reviewed by Lindsey Marcellin, M.D., MPH, last updated February 21, 2013.

Denise Mann, “10 natural remedies for sinus pain,” Everyday Health, reviewed by Pat F. Bass, III, M.D., MPH, last updated December 1, 2015.

Mayo Clinic Staff, “Chronic sinusitis,” MayoClinic.com, July 2, 2013.

John E. McClay, M.D., “Allergic fungal sinusitis,” Medscape Reference, updated June 22, 2015.

Jennifer Nelson, “What to do when good sinuses turn bad,” WebMD Feature, reviewed by Michael W. Smith, M.D., January 16, 2014.

“An overview of sinusitis,” WebMD Medical Reference, reviewed by Luqman Seidu, M.D., May 18, 2014.

Ankit Patel, M.D., “Surgical treatment of chronic maxillary sinusitis surgical overview,” Medscape Reference, May 8, 2015.

Gordon H. Sun, M.D., M.S., “The many faces of rhinosinusitis: case challenges,” Medscape, September 22, 2015.

 

      

 

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