Patient Education

SINUSITIS

Copyright 2002, Regional Allergy & Asthma Consultants, PA

WHAT IS SINUSITIS?

The sinuses are hollow spaces in the bones of our face, located in the cheekbones, bridge of the nose, and forehead. Nobody really knows why we have sinuses.  They certainly make our heads lighter and add resonance to our voices, but generally seem to cause more trouble than benefit, particularly during allergy and cold seasons.

The sinuses are normally filled only with air and connect to the outside world through narrow openings or channels into the back of the nose. As long as these channels remain open, then the sinuses remain healthy; however, if these channels become narrowed or blocked for any reason, then fluid and bacteria can become trapped in the sinuses, leading to infection of the sinuses, or sinusitis.

WHAT ARE THE SYMPTOMS OF SINUSITIS?

The person with a sinus problem may experience headache, thick postnasal drainage, discolored nasal secretions, cough, bad breath or worsening asthma. Since infections cause swelling and inflammation, the nose will often become more stuffy, which in turn further blocks the sinus drainage channels and perpetuates the infection. Most sinus infections seem like a "cold" that won't go away. Unless particularly acute, they usually don't cause significant fever or severe pain, but rather nagging nasal congestion, drainage, and/or cough.

WHO GETS SINUSITIS?

Since some of the sinuses are present even at birth, sinus infections can occur at any age, including infancy. They are more common in people prone to stuffy noses, particularly those with allergies or frequent colds.

WHAT CAUSES SINUSITIS?

Sinusitis is basically a " plumbing" problem. Anything that blocks the normal sinus drainage channels can lead to a sinus infection. Allergies and cold viruses are the most common causes. Exposure to cigarette smoke predisposes to sinusitis by aggravating the lining of the nose, increasing both congestion and mucus production. A deviated nasal septum, polyps, or scar tissue from previous infections or injuries are potential causes of sinusitis as well. Even the occasional toddler who puts something small in his nose and leaves it there may get a sinus infection.

HOW IS SINUSITIS DIAGNOSED?

We are usually able to diagnose sinusitis on the basis of a careful history and thorough exam of the eyes, ears, nose, and throat. X-rays or other tests are usually not needed, except in chronic or recurrent cases of sinusitis that are not responding adequately to treatment. In these cases, we may need to examine the nasal passageways with a fiberoptic scope or obtain a CT scan of the sinuses to better assess the nature and extent of the problem.

IS IT A COLD OR SINUSITIS?

With a cold, the nasal mucus is typically clear for the first day or two, then becomes yellow for up to a week, and eventually disappears as the body rids itself of the virus. If discolored drainage persists beyond 10-14 days, then the cold may have developed into a bacterial sinus infection that could benefit from an antibiotic or additional therapy.

HOW IS SINUSITIS TREATED?

The most important treatment of a sinus problem is to identify and correct any underlying factors that block normal sinus drainage. Any patient with repeated sinus infections should be evaluated for allergies. Often dust, mold, pollen, or animal dander allergies will cause stuffiness and inflammation in the back of the nose that will predispose to sinusitis. With appropriate preventive allergy therapy, the frequency of sinus infections can be greatly reduced. Some patients may also need to be examined by an otolaryngologist to make sure there is no structural blockage that may require surgical correction.  

Patients with sinus problems should not smoke or be exposed to secondhand smoke. Cigarette smoke contains numerous toxic and irritating particles and gases that aggravate the nose and sinuses. The fine cigarette particles harmful to our sinuses stay airborne for up to 24 hours and rapidly spread throughout an entire home. Therefore, cigarette smoking must be moved completely outdoors and out of the car. It is not adequate for other family members to smoke only in a designated room, or to smoke only when the patient is away from home. Even the most sophisticated and powerful air cleaning devices are quickly outpaced by smoke, and are not a substitute for always keeping smoking outdoors.  

Once any underlying factors are adequately addressed, there may still be occasional infections requiring antibiotics. The key here is length of treatment. Many sinus infections may smolder for weeks or months. The infection may seem to clear with seven to ten days of antibiotics, only to flare again after a week or two. Sometimes several weeks of therapy are needed, along with medications to promote drainage, such as a prescription nasal spray, oral decongestant, and/or mucus-thinner.  

Nasal saline spray or mist (obtained over the counter) and/or steam inhalation can be very helpful in clearing a sinus infection. These can be used as often and as long as needed. An over-the-counter nasal decongestant spray, such as Afrin, may be used for a few days only, generally at the beginning of treatment, to help open blocked nasal passages. These should not be used for more than three to four days, as even more severe or "rebound" nasal congestion will develop with long term use.

WHY IS IT IMPORTANT TO TREAT SINUSITIS?

The day-to-day misery of sinusitis--congestion, drainage, cough, discomfort, interference with activities or sleep-- are enough to warrant treatment; however, the potential long-term complications of sinusitis make treatment even more important.

The inflammation of the nasal and sinus passageways caused by sinusitis, particularly when chronic, may lead to long-lasting and even permanent narrowing of the sinus drainage channels, similar to scar tissue. This will predispose to even more sinus infectionsresulting in a vicious cycle, often requiring surgery to reestablish adequate sinus drainage. In addition, an untreated sinus infection may rarely spread to other parts of the head or brain.

Finally, there is a strong association between sinusitis and asthma. Patients with sinusitis are more likely to have difficulty with asthma. This is because the nasal congestion associated with sinusitis interferes with the normal filtering and humidification of inspired air. This unfiltered, dry air is very irritating to the lungs. Furthermore, the postnasal drainage from sinusitis can aggravate the cough and wheeze associated with asthma. Treating a sinus infection in a patient with asthma usually improves asthma symptoms.  

As always, we are here to maximize your long-term health and well-being. We look forward to working with you in a number of ways to most effectively meet that goal.

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