If you've ever had a cold that just wouldn't go away, it may have been sinusitis — an inflammation of the paranasal sinuses, the cavities within the bones that surround the nose. The sinuses are lined with a thin membrane that produces mucus, which is normally swept along by hair cells and drains through small openings into the nasal cavity. Sinusitis (also called rhinosinusitis) starts when this drainage system becomes blocked, usually from swelling due to inflammation caused by infection or allergy. Soon, your head hurts, you feel facial pressure or pain, and thick mucus clogs your nose. The symptoms may clear on their own, but often they persist or repeatedly return.
What triggers sinusitis?
There are millions of bacteria in our noses, and most of the time, they're harmless. Even when a few creep into the sinuses, they don't cause trouble, as long as they keep draining into the nose along with mucus. But if sinus drainage is blocked, glands in the sinuses continue to produce mucus, and the resulting pool of backed-up mucus provides "the perfect culture medium." The bacteria grow out of control, causing infection, and the immune system kicks off an inflammatory response. The result: swelling, which causes headache and facial pain; mucus buildup, which produces congestion; and an influx of white blood cells to fight the bacteria, which thickens the mucus and may tint it yellow or green. Other symptoms include loss of smell or taste, cough, bad breath, fever, toothache, and fullness in the ears.
Treatment begins with simple remedies, such as nasal irrigation and, if necessary, progresses to more advanced strategies, such as prescription drug therapy or surgery.
Most people with acute sinusitis get better without treatment, although you can ease the symptoms and reduce the likelihood of needing stronger medicine if you keep your nasal passages clear with a few low-tech preventive techniques (see "Preventing sinusitis"). It's hard to predict who will develop chronic sinusitis, but knowing more about the two main types can help you decide how to treat your symptoms and when to see a clinician. Here are the basics:
Acute sinusitis. Acute sinusitis usually starts with a cold. Viruses, not bacteria, cause colds, so it's useless to treat them with antibiotics. But when a cold turns into sinusitis, it means that blocked nasal passages have set off a secondary infection caused by bacteria and you may eventually need an antibiotic. If symptoms are severe and last for more than a week, you may want to see your primary care clinician. If you do have sinusitis, you may be prescribed an antibiotic, especially if preventive drainage strategies aren't helping.
For the pain, try a warm compress on your face, or inhale steam (see "Preventing sinusitis"). An over-the-counter pain reliever such as aspirin, ibuprofen, or acetaminophen can also relieve facial pain, as well as headache and fever.
Chronic sinusitis. If symptoms linger or keep returning, you may have chronic sinusitis, a more complex disorder that calls for evaluation by an ear, nose, and throat (ENT) specialist
Nasal irrigation and decongestants can help in the treatment of chronic sinusitis by keeping mucus loose and nasal passages clear. The mucus-thinning agent guaifenesin (Mucinex) is another option. Nasal steroids may be added to help counter inflammation. Oral steroids are also effective, especially in reducing large polyps, but they can have serious long-term effects, such as weakened bones and greater susceptibility to infection.
Sometimes the main problem is anatomical, such as nasal polyps, a deviated septum, congenitally narrowed paranasal passages, or tissue thickened by years of infection. In this case, minimally invasive surgery may help, reducing the number and severity of sinus infections and sometimes restoring normal sinus function.
There are many things you can do to reduce your chance of developing sinusitis or to relieve early sinusitis symptoms. Here are some suggestions:
Bathe your nasal passages daily. Run water gently into the nasal passages to help clear excess mucus and moisten membranes. Good times to do it are in the morning and at night, when you brush your teeth.
Drink lots of water. Good hydration helps keep the mucus thin and loose.
Inhale steam. Linger in a hot shower. Or bring water to a boil, and pour it into a pan; place a towel over your head, and carefully bend over the pan to inhale the steam.
Avoid dry environments. A humidifier in your home (and where you work can help prevent nasal passages from drying out.
Sleep with your head elevated. Mucus pools in your sinuses at night when your head is down, so have your head propped up during sleep.
Be nice to your nose. Blow your nose gently, one nostril at a time. Forceful blowing can irritate the nasal passages and propel bacteria-laden mucus back up into your sinuses.
Avoid antihistamines unless prescribed. Antihistamines make mucus thick and hard to drain.
Be careful with decongestants. Tablets containing pseudoephedrine act on blood vessels to shrink membranes and keep nasal passages open. Nasal sprays also work well — and quickly. But using topical nasal decongestants for more than a day or two runs the risk of setting off a spiral of dependency as a result of rebound — increased swelling after the medication wears off. Oral decongestants can cause jitters and increase blood pressure, so if you have high blood pressure, don't use them without consulting a clinician first.
April 2009 update
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