Sinusitis

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is sinusitis?

If your cold, flu, or allergy simply won’t quit, it may have transformed itself into sinusitis, an infection of the sinus cavities. The sinuses are four pairs of air-containing spaces in the front of your skull. They are connected to your nasal passages through narrow passages whose tiny openings called ostia normally let mucus drain and air flow in and out. When you have an allergy or a respiratory infection like a cold, the lining of your sinuses can swell and block these passages. The blockage traps mucus in your sinuses, where it builds up and thickens, inviting normally harmless bacteria to multiply.

When this happens you’ll feel it. Sinusitis’ calling card is thick, yellowish-green mucus, a sense of pressure in your face, a headache, and difficulty breathing through your nose. You may also have pain in your upper teeth, a persistent cough, a low fever, and/or fatigue.

Who is at risk for sinusitis?

If this is your first sinus infection, or you get them only rarely, you probably have acute sinusitis. This is usually caused by the bacteria Streptococcus pneumoniae or Haemophilus influenzae; with treatment, it lasts about three weeks. If your sinus infection continues for two months or longer, despite treatment, the diagnosis is probably chronic sinusitis.

While chronic sinusitis may result from a hard-to-treat bacterial infection, damaged mucous membranes from unsuccessfully treated acute sinusitis may also play a role, or it may be the result of polyps or cysts—small benign growths—in your nasal passages. A blockage could result from a deviated septum, a common structural abnormality in which the septum (the bone and cartilage in the center of the nose) is crooked. Hay fever and asthma (both associated with allergies), contribute to chronic sinusitis as well (in fact, about 70% of people with chronic sinusitis also have allergies). For some people, sinusitis is worsened by sensitivity to certain foods, such as dairy products or wheat. Evidence has shown that some types of chronic sinusitis are triggered by an immune response to fungi naturally found in the nose.

Treatment for sinusitis

Because about half of acute sinus infections eventually clear up on their own, your doctor may want to take a wait-and-see approach for a few days before prescribing an antibiotic. During this time, there are a number of self-care measures—from inhaling steam to simply reducing stress—you can try at home.

While bacterial sinusitis can make you feel temporarily miserable, complications are rare. However, swelling around an eye, impaired vision, a high fever, or a change in mental status, is a sign that the infection has spread. You should go to an emergency room immediately.

Treating chronic sinusitis is more complex because of all the potential underlying causes. Antibiotics and aggressive self-care measures are usually tried first, though they won’t work if a polyp is causing your problem. If your condition persists, you’ll probably be referred to an ear, nose, and throat specialist (otolaryngologist).

Medications for sinusitis

For acute bacterial sinusitis, a variety of antibiotics work quite well. The drug your doctor initially prescribes will probably depend on which strain of bacteria is the common culprit in your geographic area. (Because reports from local hospitals provide this information, your mucus won’t need to be tested.) Amoxicillin, a broad-spectrum antibiotic with a proven track record in treating this infection, is most doctors’ first choice unless you have an allergy to penicillin. Other effective antibiotics include amoxicillin/clavulanate (Augmentin), cefuroxime (Ceftin), loracarbef (Lorabid), cefprozil (Cefzil), levofloxacin (Levaquin), and sparfloxacin (Zagam).

To be effective, an antibiotic must generally be taken for at least 10 days. Some doctors even prescribe a full two weeks to reduce the risk of relapse. You’ll probably start to feel better after just four days—and the infected yellow mucus will begin to clear up—but don’t stop taking the drug. If you do, the infection won’t be wiped out, and you could end up with chronic sinusitis. If your symptoms don’t start to disappear after four or five days, call your doctor. Most doctors are now prescribing a corticosteroid nasal spray along with antibiotics to reduce swelling in the nasal passages.

Other medications can be taken alone or with antibiotics to treat specific sinusitis symptoms and speed recovery. For example, over-the-counter analgesics such as NSAIDs (aspirin or ibuprofen) or acetaminophen soothe sinus pain and headache, and nasal or oral decongestants reduce swelling of the sinus linings and help you breathe more easily. Popular OTC decongestants include Sudafed and Drixoral, which contain pseudoephedrine, and Afrin, Dristan 12-Hour, and Neo-Synephrine 12-Hour, which include oxymetazoline. Be sure to consult your doctor before trying a decongestant spray; in some cases, it can make congestion worse. Always limit use to three to four days to prevent a rebound effect: As the decongestant wears off, it may actually cause swelling in your nasal passages.

In addition, certain other drugs can be effective:

• If you have a nagging cough and are losing sleep from postnasal drip, you might want to try a cough suppressant with dextromethorphan (Robitussin DM and Vicks 44). If your cough is severe, ask your doctor to prescribe a cough suppressant with codeine (Promethazine VC/Codeine, Phenergan with Codeine).
• If you need to loosen mucus, an expectorant that contains the mucolytic (mucus thinner) guaifenesin, the active ingredient in Robitussin and Glycotuss, can help. Stronger versions (Fenesin, Humibid) are available by prescription.
• If an allergy is triggering your sinusitis, your doctor may recommend OTC antihistamines containing the drug diphenhydramine (Benedryl-25, AllerMax) or a prescription corticosteroid nasal spray (such as Beconase or Nasacort) to reduce inflammation. Some nonsedating prescription and OTC antihistamines available are Allegra and Claritin. Don’t use either if you have bacterial sinusitis. They can thicken mucus, making a bacterial infection worse.
• If you have chronic bacterial sinusitis, you may require intense treatment with a more potent antibiotic such as clarithromycin (Biaxin) or cefadroxil (Duricef). You’ll have to take the drug for three to eight weeks. Your doctor may also recommend that you use a corticosteroid nasal spray, as well as the expectorant guaifenesin and an oral decongestant. This powerful combo works for many people.

Lifestyle Changes

You can do many things on your own to thin mucus and unclog your blocked sinus passages. Perhaps the easiest method is steam inhalation. Simply boil some water, pour it into the basin, and add a teaspoon of Vicks VapoRub. Then place a towel over your head and the basin. Slowly inhale the steam for 10 minutes, morning and evening. Have tissues handy to blow your nose, but don’t blow too vigorously. This can force infected mucus deeper into your sinuses.

Another method that loosens mucus and reduces swelling in the nasal passages is sinus irrigation with a saline solution. You can use an ear-bulb syringe or a more unusual device called a neti pot, which is available at health food stores. Irrigate at least three times a day for acute sinusitis and once or twice a day for a milder condition.

It’s also important to drink plenty of clear liquids—8 to 10 glasses a day—to keep nasal discharge thin. Warm beverages can be quite soothing, and the steam from a cup of hot tea or chicken broth will temporarily open your nasal passages.

Even though you might not feel like working out when you have sinusitis, exercise can stimulate the flow of mucus and boost production of infection-fighting white blood cells. So take a brisk walk, go for a bike ride, or choose any other aerobic activity you like, but don’t do exercises (like toe-touches) where you lower your head. This will increase sinus pressure. If exercise worsens your congestion, stop working out.

Related Procedures for Sinusitis

If your sinusitis doesn’t clear up after a couple of months of antibiotics along with good home care, your doctor may recommend that you see an ear, nose, and throat specialist for nasal endoscopy, a nonsurgical procedure under a local anesthetic. The doctor will use a flexible, lighted telescope-like device called an endoscope to visually inspect your sinuses, then extract a sample of the infected mucus. This procedure detects small abnormalities in the sinuses and helps the doctor determine why the medications are ineffective.

In some cases of chronic sinusitis, your doctor may order a computed tomography (CT) scan. This sophisticated x-ray helps find infection hidden in the deeper air chambers. Depending on the results, sinus surgery may be recommended. The surgery uses a tiny fiberoptic scalpel that does not scar and can drain your sinuses, remove any polyps or cysts, or widen the openings into your nasal passages (a procedure known as functional endoscopic sinus surgery, or FESS). Most sinus surgery is done under general or local anesthesia. You’ll go home the same day. Although surgery is never a guaranteed cure for sinusitis, studies show that the majority of people who have it report fewer symptoms.

Alternative Therapies for Sinusitis

For temporary relief from congestion, try spicy foods. Chili peppers and cayenne pepper contain capsaicin, a powerful compound that breaks up mucus. Mustard and horseradish, which contain the natural chemical allyl isothiocyanate, can act in a similar way. Fresh ginger is a natural antihistamine. Experiment to see which foods unstuff you best.

Questions for Your Doctor

• Is there a chance that my “sinus headaches” could really be migraines?
• Could my recurrent sinus infections be caused by an obstruction in my nasal passages?
• I use a steroid nasal spray, but it irritates my nose. Are there any alternatives that would work for me?
• Would simply treating my hay fever cure my sinusitis? Should I be seeing an allergist?

Living with Sinusitis

If you’re living with sinusitis, here are a few quick tips to help you take control:

• Reduce your stress level. Studies show that stress and anger can weaken the immune system, and a weakened immune system contributes to the frequency and severity of sinus infections. Learn to defuse your stress with meditation and other relaxation techniques.
• Take precautions when you fly. Changing air pressure during takeoffs and landings forces mucus into your sinuses. Chew gum or swallow often, or use an OTC nasal spray during these times to reduce sinus pressure.
• Learn to blow the right way. Even if you’re totally congested, never blow your nose forcefully. Inhale through your mouth, then blow gently through one nostril at a time. Press the other nostril closed as you do so. If your nose gets raw, use a little petroleum jelly inside and below the nostrils.
• Sniff some eucalyptus oil. Putting a few drops of eucalyptus oil on a tissue and sniffing it periodically during the day can relieve swollen nasal tissues. When inhaled, eucalyptol, the oil’s key medicinal ingredient, tightens and thus soothes inflamed mucous membranes.
• Create an irritant-free zone. If dust or pollen aggravates your sinusitis, turn your bedroom into a sanctuary. Remove carpeting and drapes. Keep the room well dusted, wash linens weekly in hot water, and bar the door to pets.