OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Michelle Facer, DO, MS

Have you got another Cold

By Michelle Facer, DO, MS

Have you ever had a cold or allergy attack that just would not go away? If so, there’s a good chance you actually had sinusitis. Health care experts estimate that 37 million Americans are affected by sinusitis every year. In addition, health care costs associated with sinusitis are staggering. In 1996, health care expenditures attributable to rhinosinusitis in the United States were estimated to be over $5.8 billion dollars.

So, what is sinusitis? Sinusitis is defined as any inflammation of the mucosal lining of the sinuses. Sinuses are hollow air spaces in the human body. There are four pairs of paranasal sinuses located within the skull or bones of the head surrounding the nose. These include: the frontal sinuses over the eyes in the brow area, the maxillary sinuses inside each cheekbone, the ethmoid sinuses behind the bridge of the nose and between the eyes, and the sphenoid sinuses behind the ethmoid sinuses deep in the skull.

The duration of symptoms also determines whether it is acute sinusitis that can last up to 4 weeks or chronic sinusitis that lasts
3 months or longer.

The most frequent cause of acute sinusitis is the common cold, which is caused by a virus. The resulting nasal congestion and swelling (stuffy nose) traps mucus in the sinuses. Normally this mucus drains from the sinuses into the nose. But when a patient has a cold and mucus becomes trapped, the sinus serves as a breeding ground for bacteria and a sinus infection may occur. Other predisposing factors for acute sinusitis include irritants such as cigarette smoke, paint, latex, and perfumes. Patients with allergic rhinitis or hay fever often develop acute or chronic sinusitis. People with allergies to fungi can develop a condition called “allergic fungal sinusitis.” Finally, patients with immune deficiency deseases (e.g. HIV) or abnormalities (e.g. cystic fibrosis) in the way mucus moves through the nose can develop sinusitis

Symptoms for sinusitis depend on the duration of the infection and which sinuses are affected. Symptoms include: facial pain or pressure, headache, toothache, stuffy nose, yellow-green drainage from the nose, bad breath, sore throat, a “cold” lasting more than a few weeks, swelling around the eyes, loss of the sense of smell, cough, fever and fatigue. Symptoms of chronic sinusitis may be less severe than those of acute sinusitis.

Diagnosis of acute sinusitis is based on a discussion of symptoms with your doctor and a physical exam. The physical exam may include placing a small flexible endoscope into the nose to look for any active pus indicating an acute infection. Sometimes, a physician will obtain a CT scan of the sinuses as well.

Treatment for acute sinusitis may include your doctor recommending oral or nasal decongestants to reduce the stuffy nose, antibiotics to control a bacterial infection, or allergy medications to relieve allergy symptoms. In addition, a nasal steroid spray often reduces swelling in the nose and can help to minimize the recurrence of sinus infections. Nasal saline irrigation and topical antibiotics applied in the nose can be helpful in chronic sinusitis. Sometimes severe chronic sinus infections even require oral steroids like prednisone. If medical management fails or a patient develops a complication of an acute sinus infection, surgery may be the only alternative. The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings of the sinuses are enlarged to allow drainage into the nose. This type of surgery is less invasive than conventional sinus surgery and serious complications are rare. At the time of sinus surgery, other factors such as nasal polyps or septal deviations which can contribute to recurrent sinusitis can also be addressed by your doctor.

To prevent the development of sinusitis during a cold or allergy attack, you can keep your sinuses clear by using an oral decongestant or a short course (3 days or less) of nasal spray decongestant. It is also helpful to avoid things that trigger allergy attacks. If these triggers cannot be avoided, antihistamines or prescription nasal sprays aid in controlling attacks. Avoid air travel if possible. If not, use a nasal spray decongestant prior to take-off.

For more information, call Northern Pines Ear, Nose &Throat > 715-830-9990