By Lisa Gotto
Sinuses! For some of us they seem to be pesky parts of our facial anatomy that provide regular reminders that we are not feeling our 100-percent best. For others, they can produce chronic cycles of symptoms that seem never-ending and may even have you asking, “Why do we even have these things?”
To that question, we can provide two definitive statements: (1) We DO need these things and (2) there are various methods we can employ to help control them on our own and with the help of a physician.
Dr. Duane Gels, Director of Annapolis and Eastern Shore Allergy and Asthma, explains their importance.
“The sinuses are a complicated group of hollow spaces located towards the front of the skull that warm, clean, and humidify the air we eathe. The largest lie in the forehead and upper cheeks, but well over a dozen more extend out from our nostrils between and behind the eyes.”
He describes them as honeycombed passages lined with mucous mem anes. Their primary function, he says, is to protect the lungs by filtering out the numerous hazardous particles we eathe in every day.
“Sinuses not only filter nuisance particles, such as irritants (smoke, dust) and allergens (animals, pollens, spores), they also provide an important immune function as the first line of defense against bacteria and viruses (from your sneezing neighbor!)”
Beyond these indications, Gels says that the sinuses role in our overall health is significant.
“Sinuses are only one aspect of the continuous ‘united’ airway, integral for respiration. The airway begins at the nostrils and sinuses, but ends at the air sacs of the lungs. Sinus inflammation from allergy, infection, and irritants are associated with a variety of other upper airway complaints affecting quality of life, such as sinus and nasal congestion, fatigue, insomnia, halitosis, sore throat, runny nose, ear blockage, dizziness, hoarseness, post-nasal drip and worsening obstructive sleep apnea.”
Some of the more serious health risks that he sees from sinus disease include wheezing, shortness of eath, and onchitis and asthma attacks, that can lead to acute respiratory distress.
Confusing, yet connected
Conditions relating to the sinuses can range from a mild inflammation or virus that takes a few days to clear, to more substantial bacterial infection.
“Most infections are viral processes similar to the common cold,” says Dr. Peter King of Annapolis Ear, Nose, Throat, and Allergy Associates.
“An average adult gets two to three infections per year and children may average six to eight.”
Bacterial sinus infections often develop after a viral infection due to swelling of the nasal tissues and blockage of sinus drainage. This is often noted by symptoms persisting or worsening after about 10 days. Common symptoms include congestion, difficulty eathing through the nose, facial pain, decreased sense of smell, and nasal drainage. Bacterial infections usually produce thick, discolored, and foul-smelling drainage.”
Unfortunately, for those with mitigating conditions such as allergies, diagnosis and treatment can be a more of a process.
“Environmental allergies and sinusitis can have very similar symptoms,” King says. “Many patients with chronic sinusitis have concurrent allergies. Distinguishing viral from bacterial processes can also be difficult.”
King recommends consultation with an ear, nose, and throat specialist to help sort out any underlying issues.
“Sinus inflammation can contribute to ear pressure/fullness and certain types of hearing loss. Asthma can also be exacerbated by sinusitis. ‘Sinus headaches’ and facial pain in the absence of congestion and nasal obstruction are generally not related to sinus inflammation.”
King adds these indications can often be related to migraines and recommends evaluation by a neurologist.
Treatment…your first line of defense
When a milder viral infection is present, Gels suggests a less-is-more approach to treatment.
“Mild sinus infections usually respond to irrigation with nasal saline, decongestants, like pseudoephedrine or phenylephrine (Sudafed or generic), and over-the-counter nasal steroid preparations, such as fluticasone propionate (Flonase) or triamcinolone (Nasacort) or other generic sprays.”
Gels does caution that not all saline solutions are the same. “Pre-made nasal saline, in a bottle or pressurized can, are easy to use, but contain preservatives. Alternatively, buy a Neti pot or a squirt bottle supplied with supplies to make saline ‘fresh,’ without preservatives, though take care to use bottled, sterile or distilled water, to avoid contamination with organisms that can live in water systems.”
Symptoms of mild infection: Sinus congestion, nasal congestion, runny nose, sneezing, post nasal drip, cough, headache; rarely fever
For sinus pressure and headache, Gels recommends oral decongestants such as, pseudoephedrine or phenylephrine are over-the-counter (the former requires an ID for purchase).
“Nasal decongestants are only to be used for a couple days, as they lead to ‘rebound’ congestion,” Gels cautions.
When to see the doctor
Okay, so you have been feeling lousy for a couple of days and your go-to saline self-treatments are providing only minimal to no relief. It’s time to make the call.
“If days turn to weeks, and symptoms worsen, this may indicate secondary bacterial infection, and contacting your provider for oral antibiotics would be important,” says Gels. “There is some nuance here: adding antibiotics too early during a viral infection won’t help, and only add to the growth of resistant bacteria in both your sinuses and in the community at large, making all infections harder to treat.”
Of course, taking precautions to not catch a cold or being able to control allergies would be key to reducing the number of infections one develops. Regular hand washing is a good bet, says Gels, as well as treating the baseline underlying congestion stemming from allergies.
“See a board-certified allergist who can determine your specific allergies, and reduce, or in many cases eliminate (through immunotherapy) the underlying allergy that is responsible for causing sinus infections. Imaging studies (such as CT scans) can identify physical obstruction that may need correction through surgery. Lastly, frequent sinus infections may indicate time to do blood tests screening for immune deficiency, appearing in up to every few hundred Americans.”
When surgery is indicated
While rarer, there are instances where surgery for specific conditions is indicated for sinus. These include when nasal polyps occur in some cases—although polyps have often been known to grow back—and for complex infections where certain specific fungi are present.
Dr. Lee Kleiman of Severn River ENT says surgery is indicated when patients fail medical management and when an infection spreads to the eyes and ain. “Surgical candidates will benefit after surgery with less infections,” says Kleiman.
However, he also sees new hope for certain sinus conditions in an in-office endoscopic treatment for some patients.
The treatment, known as Balloon Sinus Dilation, is a minimally-invasive procedure that takes about an hour to perform using local anesthesia. Tiny balloons are inserted into problem sinus pathways to reshape them and keep them from closing up and causing the air pockets that lead to infection to form.
“In-office balloon sinus dilation has been a game-changer in aborting the progression of sinus disease into a disease requiring a full sinus operation,” says Kleiman.
This procedure is also used for chronic ear disease and Eustachian tube dysfunction with good outcomes, Kleiman adds.
There is a Season & Other Reasons Why Your Sinuses Act Up
Sinus issues caused by upper respiratory infections typically increase in September, when kids head back to school, and peak with the “cold and flu” season through the holidays.
If pollen allergy is your “kryptonite,” expect March-May and August-September to be troublesome.
Sinus pain ramps up any time the barometric pressure suddenly dips with big weather systems, such as hurricanes, Nor’easters, and spring weather fronts.
Pressure differences that occur during air travel can also affect the sinuses.
Though pets are with us year-round, pet allergies seem to worsen in the winter, when we are all confined more and the heating system is on.
They can act up following long periods of rain, when mold spore counts peak, even days after the rains have stopped.
Periods of low humidity during the winter put added burden on sinuses, as well. (Add a humidifier and shoot to keep indoor relative humidity at 30-50%.)
