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10
Most Dangerous Toxins in Your
Household
Biological
Pollutants in your home
Clear
your home of Asthma
Triggers
Preventing
Sinusitis
Residential
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Should
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What
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Sinusitis
You're coughing and sneezing and tired and achy. You think that
you might be getting a cold. Later, when the medicines you've
been taking to relieve the symptoms of the common cold are not
working and you've now got a terrible headache, you finally drag
yourself to the doctor. After listening to your history of symptoms
and perhaps doing a sinus X-ray, the doctor says you have sinusitis.
Sinusitis simply means inflammation of the sinuses, but this
gives little indication of the misery and pain this condition
can cause. Chronic sinusitis, sinusitis that recurs frequently,
affects an estimated 32 million people in the United States. Americans
spend millions of dollars each year for medications that promise
relief from their sinus symptoms.
Sinuses are hollow air spaces, of which there are many in the
human body. When people say, "I'm having a sinus attack," they
usually are referring to symptoms in one or more of four pairs
of cavities, or spaces, known as paranasal sinuses. These cavities,
located within the skull or bones of the head surrounding the
nose, include the frontal sinuses over the eyes in the brow area,
the maxillary sinuses inside each cheekbone, the ethmoids just
behind the bridge of the nose and between the eyes, and behind
them, the sphenoids in the upper region of the nose and behind
the eyes.
Each sinus has an opening into the nose for the free exchange
of air and mucus, and each is joined with the nasal passages by
a continuous mucous membrane lining. Therefore, anything that
causes a swelling in the nose-an infection or an allergic reaction-also
can affect the sinuses. Air trapped within an obstructed sinus,
along with pus or other secretions, may cause pressure on the
sinus wall. The result is the sometimes intense pain of a sinus
attack. Similarly, when air is prevented from entering a paranasal
sinus by a swollen membrane at the opening, a vacuum can be created
that also causes pain.
Symptoms
Sinusitis has its own localized pain signals, depending upon
the particular sinus affected. Headache upon awakening in the
morning is characteristic of sinus involvement. Pain when the
forehead over the frontal sinuses is touched may indicate inflammation
of the frontal sinuses. Infection in the maxillary sinuses can
cause the upper jaw and teeth to ache and the cheeks to become
tender to the touch. Since the ethmoid sinuses are near the tear
ducts in the corner of the eyes, inflammation of these cavities
often causes swelling of the eyelids and tissues around the eyes
and pain between the eyes. Ethmoid inflammation also can cause
tenderness when the sides of the nose are touched, a loss of smell,
and a stuffy nose. Although the sphenoid sinuses are less frequently
affected, infection in this area can cause earaches, neck pain,
and deep aching at the top of the head.
Other symptoms of sinusitis can include fever, weakness, tiredness,
a cough that may be more severe at night, and runny nose or nasal
congestion. In addition, drainage of mucus from the sphenoids
down the back of the throat (postnasal drip) can cause a sore
throat and can irritate the membranes lining the larynx (upper
windpipe).
Causes
Most cases of acute sinusitis are caused by viruses and will
clear up without treatment within two weeks. Viruses can enter
the body through the nasal passages and set off a chain reaction
resulting in sinusitis. For example, the nose reacts to an invasion
by viruses that cause infections such as the common cold, flu,
or measles by producing mucus and sending white blood cells to
the lining of the nose, which congest and swell the nasal passages.
When this swelling involves the adjacent mucous membranes of the
sinuses, air and mucus are trapped behind the narrowed openings
of the sinuses. If the sinus openings become too narrow to permit
drainage of the mucus, then bacteria, which normally are present
in the respiratory tract, begin to multiply. Most apparently healthy
people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus
influenzae, in their upper respiratory tracts with no ill effects
until the body's defenses are weakened or drainage from the sinuses
is blocked by a cold or other viral infection. The bacteria that
may have been living harmlessly in the nose, throat, or sinus
area can multiply and cause an acute sinus infection.
Medicines, too, can set off a nasal reaction with accompanying
sinusitis. For example, intolerance to aspirin and other related
non-steroidal anti-inflammatory medications, such as ibuprofen,
can be associated with sinusitis in patients with asthma or nasal
polyps (small growths on the mucous membrane lining of the sinuses).
Sometimes, fungal infections can cause acute sinusitis. Although
these organisms are abundant in the environment, they usually
are harmless to healthy people, indicating that the human body
has a natural resistance to them. Fungi, such as Aspergillus and
Curvularia, can cause serious illness, in people whose immune
systems are not functioning properly. Some people with fungal
sinusitis have an allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages (rhinitis) also can
lead to sinusitis. Allergic rhinitis or hay fever (discussed below)
is the mostcommon cause of chronic sinusitis and is a frequent
cause of acute sinusitis. Vasomotor rhinitis, caused by humidity,
cold air, alcohol, perfumes, and other environmental conditions,
also can result in a sinus infection.
Chronic Sinusitis
Chronic sinusitis refers to inflammation of the sinuses that
continues for weeks, months, or even years.
As noted above, allergies are the most common cause of chronic
sinusitis. Inhalation of airborne allergens (foreign substances
that provoke an allergic reaction), such as dust, mold, and pollen,
often set off allergic reactions (allergic rhinitis) that, in
turn, may contribute to sinusitis. People who are allergic to
fungi can develop a condition called "allergic fungal sinusitis."
As body cells react against these inhaled substances, they release
chemical compounds, such as histamine, at the mucosal surface.
These chemicals then cause the nasal passages to swell and block
drainage from the sinuses, resulting in sinusitis.
Damp weather, especially in northern temperate climates, or
pollutants in the air and in buildings also can affect people
subject to chronic sinusitis.
Chronic sinusitis can be caused by structural abnormalities
of the nose, such as a deviated septum (the bony partition separating
the two nasal passages), or by small growths called nasal polyps,
both of which can trap mucus in the sinuses.
Diagnosis
Although a stuffy nose can occur in other conditions, like the
common cold, many people confuse simple nasal congestion with
sinusitis. A cold, however, usually lasts about seven days and
disappears without treatment. Acute sinusitis often lasts longer
than a week. A doctor can diagnose sinusitis by medical history,
physical examination, X-rays, and if necessary, MRIs or CT scans
(magnetic resonance imaging and computed tomography).
Treatment
After diagnosing sinusitis and identifying a possible cause,
a doctor can prescribe a course of treatment that will clear up
the source of the inflammation and relieve the symptoms.
Sinusitis is treated by re-establishing drainage of the nasal
passages, controlling or eliminating the source of the inflammation,
and relieving the pain. Doctors generally recommend decongestants
to reduce the congestion, antibiotics to control a bacterial infection,
if present, and pain relievers to reduce the pain.
Over-the-counter and prescription decongestant nose drops and
sprays, however, should not be used for more than a few days.
When used for longer periods, these drugs can lead to even more
congestion and swelling of the nasal passages.
If symptoms do not improve within 10 to 14 days, the cause of
sinusitis is likely to be bacterial. Most patients with sinusitis
that is caused by bacteria can be treated successfully with antibiotics
used along with a nasal or oral decongestant. A narrow-spectrum
antibiotic -- one that fights the most common bacteria -- is the
initial treatment recommended.
For many years, the combination of allergic disease and infectious
sinusitis has been considered the most difficult form of sinus
disease to treat. The patient with uncontrolled nasal allergies
frequently experiences a lot of congestion, swelling, excess secretions,
and discomfort in the sinus areas. Therefore, the patient should
work with a doctor who understands the diagnosis and treatment
of allergic diseases to pinpoint the cause of the allergies and
follow an allergy care program to help alleviate sinusitis.
Doctors often prescribe steroid nasal sprays, along with other
treatments, to reduce the congestion, swelling, and inflammation
of sinusitis. Because steroid nasal sprays have no serious side
effects, they can be used for long-term treatment. In some people,
however, they irritate the nasal passages.
For patients with severe chronic sinusitis, a doctor may prescribe
oral steroids, such as prednisone. Because oral steroids can have
significant side effects, they are prescribed only when other
medications have not been effective.
Although sinus infection cannot be cured by home remedies, people
can use them to lessen their discomfort. Inhaling steam from a
vaporizer or a hot cup of water can soothe inflamed sinus cavities.
Another treatment is saline nasal spray, which can be purchased
in a pharmacy. A hot water bottle; hot, wet compresses; or an
electric heating pad applied over the inflamed area also can be
comforting.
In treating patients with severe sinusitis, a physician may
use special procedures. One technique requires the patient to
lie on his back with his head over the edge of the examining table.
A decongestant fluid is placed in the nose, and air is suctioned
out of the nose so that the decongestant fluid can shrink the
sinus membranes sufficiently to permit drainage. Or, a thin tube
can be inserted into the sinuses for washing out entrapped pus
and mucus.
Sometimes, however, surgery is the only alternative for preventing
chronic sinusitis. In children, problems often are eliminated
by removal of adenoids obstructing nasal-sinus passages. Adults
who have had allergic and infectious conditions over the years
sometimes develop polyps that interfere with proper drainage.
Removal of these polyps and/or repair of a deviated septum to
ensure an open airway often provides considerable relief from
sinus symptoms. The most common surgery done today is functional
endoscopic sinus surgery, in which the natural openings from the
sinuses are enlarged to allow drainage.
Prevention
Although people cannot prevent all sinus disorders-any more than
they can avoid all colds or bacterial infections-they can take
certain measures to reduce the number and severity of the attacks
and possibly prevent sinusitis from becoming chronic. Appropriate
amounts of rest, a well-balanced diet, and exercise can help the
body function at its most efficient level and maintain a general
resistance to infections. Eliminating environmental factors, such
as climate and pollutants, is not always possible, but they can
often be controlled.
Many people with sinusitis find partial relief from their symptoms
when humidifiers are installed in their homes, particularly if
room air is heated by a dry forced-air system. Air conditioners
help to provide an even temperature, and electrostatic filters
attached to heating and air conditioning equipment are helpful
in removing allergens from the air.
A person susceptible to sinus disorders, particularly one who
also is allergic, should avoid cigarette smoke and other air pollutants.
Inflammation in the nose caused by allergies predisposes a patient
to a strong reaction to all irritants. Drinking alcohol also causes
the nasal-sinus membranes to swell.
Sinusitis-prone persons may be uncomfortable in swimming pools
treated with chlorine, since it irritates the lining of the nose
and sinuses. Divers often experience congestion with resulting
infection when water is forced into the sinuses from the nasal
passages.
Air travel, too, poses a problem for the individual suffering
from acute or chronic sinusitis. A bubble of air trapped within
the body expands as air pressure in a plane is reduced. This expansion
causes pressure on surrounding tissues and can result in a blockage
of the sinuses or the eustachian tubes in the ears. The result
may be discomfort in the sinus or middle ear during the plane's
ascent or descent. Doctors recommend using decongestant nose drops
or inhalers before the flight to avoid this difficulty.
People who suspect that their sinus inflammation may be related
to dust, mold, pollen, or food-or any of the hundreds of allergens
that can trigger a respiratory reaction-should consult a doctor.
Various tests can determine the cause.
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