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Sinusitis- Understanding, Prevention, and Treatment
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Approximately one million Americans suffer from acute sinusitis yearly costing an estimated $3 billion. Additional intangible costs are lost work time and decreased productivity.

What are sinuses?

Sinuses are literally holes (cavities) in our head. We have pairs in our cheeks, nasal bridge, middle half of our eyebrows, and behind our eyes. These cavities have small openings into our nasal passages called ostia. Bacteria reside in our sinuses and viruses will enter when we get a cold. If the cilia that line the cavity effectively clear these organisms, we will never experience problems.

What is sinusitis?

When viruses and bacteria are trapped in the sinuses, they continue to grow leading to a sinusitis. Symptoms are nasal congestion, facial pressure, and thick nasal discharge.

What are the causes of sinusitis?

1. Mechanical obstruction from a deviated septum or nasal polyp.
2. Swelling- Swollen mucus membranes in your nose will block the ostia. This occurs with
   
   • Seasonal allergies
   • Head colds
   • Vasomotor rhinitis- This is a condition where swelling is caused by dilated blood vessels in the nose. Triggers include cold weather, weather changes, stress, and irritants such as perfumes and air pollution.
3. Drying- Thin watery mucus easily clears from our sinuses. Thick pasty mucus does not. Dehydration, certain medications, and low humidity will dry and inhibit the flow of mucus.
4. Nonfunctioning cilia- Cilia that line our sinuses sweep organisms and debris out. Dry, matted mucus will prevent the cilia from working properly and tobacco products will disable them completely. Even irregular smoking will do this.

Treatment of sinusitis

Most sinus infections are viral and don't respond to any antibiotic. Only 2% are bacterial. Even those which are bacterial will resolve without resorting to antibiotics 75% of the time. Implement the following as soon as you feel a sinus infection developing. Consider starting one or more techniques you've found effective when a cold, allergies, or certain weather conditions place you at high risk of developing a sinus infection.

1. Hydrate- Staying well hydrated keeps your nasal mucus thin and free-flowing.
2. Salt water spray- This also helps keep nasal mucus thin and may help cilia function more effectively.
3. Nasal lavage- This is even more effective at clearing debris and activating cilia. Examples are a bulb syringe or nasal lavage system. Many find this to be the single most effective way to prevent or treat a sinusitis.
4. Humidified air- A bedroom humidifier is most effective. It is especially important to humidify air in dry climates and during cold winter months. In winter months, the relative humidity indoors can drop to extremely low levels when outdoor air is warmed.
5. Mucus thinners (guaifenesin, Mucinex, Entex) - These medications work by pulling fluids into mucus secretions. Drinking plenty of fluids is important to allow mucus thinners to work properly.
6. Systemic decongestants (pseudoephedrine, Sudafed) - Although a prescription is not needed, you must get them from the pharmacist. They are frequently combined with a mucus thinner (Mucinex D). If you have high blood pressure, check with your doctor before using these. Be aware that they cause palpitations in some people.
7. Nasal decongestants (Afrin, Dristan)- These are very effective, but may only be used for 2-3 days as you can become dependent on them.
8. Allergy medications- Optimal treatment of allergies is critical for many to avoid sinus infections, especially when they get a cold or in certain weather conditions. There are two categories:
   • Nasal steroids- These can be very effective in reducing swelling around the sinus openings.
   • Antihistamines- These should be used with caution because they have the potential to dry and thicken mucus secretions. Drying is less of a problem with newer generation antihistamines such as Claritin and Zyrtec. Older ones like Benadryl and Chlor-Trimeton are more drying.

When should I see my physician?

You should see your physician for high fevers, rapid worsening, or prominent swelling around your eye. Also consider being seen if symptoms suggestive of bacterial sinusitis are not responding to the above treatments. Bacterial infection is suspected when symptoms are lingering more than 7 days and include localized tenderness over one or two sinuses, pain in your upper teeth, thick dark nasal drainage, and especially double worsening. Double worsening is when there is an initial improvement in symptoms before they take a turn for the worse.

If you are placed on antibiotics, anticipate having to use them longer than with other infections. Antibiotics don't readily penetrate the sinus cavities, so it takes longer for them to completely clear the infection. It is always important to complete a course of antibiotics once started. Stopping antibiotics prematurely allows the more resistant organisms to survive and will be the ones that cause your infection next time.

Last changed: Oct 19 2010 at 5:36 PM