Sinusitis

Everybody has sinus problems these days, eh?

Most people describe any sensation of nasal congestion as "sinus" probably because of TV commercials with their excellent art and animation while selling a "sinus" medication. The proper terminology for an Infection is to use the suffix "itis" after the organ involved. Hence, there is tonsillitis, bronchitis, and yes, even sinusitis.

Here I go with another sinus infection – what's the deal?

The first question we think about is "do you really have a sinusitis or do you have a common cold or something else". "Wait a minute", you might say, "Do you think I'm a dummy? I had this same thing a while back". Well maybe you are right and maybe not. The reason we try to make this decision is that antibiotics don't help viral infections. Since the average person may have 4-6 colds a year and numerous other processes if allergic, it would be easy to have you on unnecessary antibiotics a great deal of the year. We often are very aggressive, treating people for 21 days at a time.

Here is the process we go through in thinking about your complaint:

Symptom	Possible other cause
Headache, facial pain	Dental disease Temporal mandibular joint syndrome (TMJ) Tumor (rare) Vascular Tension Headache
Malaise (fatigue)	Allergic conditions Depression Medication side-effects
Nasal drainage, post nasal drip, cough	Asthma Hiata hemia or gastro esophageal reflux Nasal membrane problems other than allergy Nasal polyps

How do you tell the difference between a cold and a sinus infection?

There are a number of physical findings we think are critical congestion, colored nasal drainage, fever, and facial pain. On physical examination we push over the sinus areas listed below and look for a response. But the ultimate diagnosis is made with an X-Ray usually a one view front face X-Ray is sufficient. However, there are times when a more sophisticated exam is needed, a CT scan. We see thickening in the membranes of the sinus cavity, or and a fluid level, or completely "opacified" sinus. A "cold" may feel similar to a sinus infection because of the nasal congestion, but the X-Ray is clear. Usually "colds" get better in 3-5 days, sinusitis may hang on interminably unless antibiotics are used.

Here's what causes sinusitis:

Sinuses are cavities lined with membranes that make mucus to wash and cleanse the sinuses.

If anything obstructs the drainage for any sinus, the mucus may back up and become infected by germs that always linger in your nasal area. The most common ways the drainage area become slowed or obstructed includes allergy (you know that swelling), colds (yes, they lead to sinus infections in many cases), structural problems like polyps or deviated septum) and other medical conditions. Once the drainage is obstructed, the pressure mounts and the typical feelings of sinusitis begin.

Here's how we treat it:

Antibiotics are typically used for several weeks if you've had it before or if there is positive X-Ray. You have to take all the antibiotics, even though you are feeling better after a few days. Otherwise, the sinus infection will not be completely treated and the symptoms will recur. This accounts for the recurring cycle of infection, improvement, and infection that occurs so commonly.

Here's how to prevent it:

Environment:	Personal	Drugs	Diet
Fresh air in the office may help Filter the air in your bedroom If allergic, get the animals OUT of the bedroom When flying in an airplane, make sure that you are decongested with some medications if necessary – changes in barometric pressure are a problem	Get sleep No smoking Don't watch TV in bed Get your eyeglasses checked Wash your hands and use Kleenex	Watch drying Drugs (antihistamines, anti-depressants, and tranquillisers) Check about aspirin Birth Control may hurt	Ask about food elimination, and watch alcohol ( it dries and congests)

"What's watching TV have to do with it?" TV watching is bad for your health in general, but watching it from bed is particularly bad. Studies show that when you lie down, nasal congestion increases because of hormonal changes (you've noticed that). The openings to the sinus become congested an additional 20% -sometimes that's all it takes. If your eyeglasses are pinching your nose, you may be obstructing your nasal drainage pattern. If you fly a lot -pray a lot and be careful, Airplane air does not come from the sky – it is, for the most part, the same air as you take off with. With folks coughing and hacking around you. there is some danger. If congested, it sometimes helps to use a few drops of nasal spray in each side before take-off.

Warm saltwater rinses can sometimes help – but be careful to mix the solutions just right. The formula is 1/4 tsp. of salt (measure it) to 7 oz of water (measure it). Some patients breathe the steam form a hot cup. Others report that using a damp washcloth heated in a microwave helps (careful or you'll get washcloth flambeau). Give us a call early – and expect us to do some extra things (like x-rays) if this problem seems recurrent.

Possible other cause

Headache, facial pain Dental disease

Temporal mandibular joint syndrome (TMJ)

Tumor (rare)

Vascular Tension Headache

Malaise (fatigue) Allergic conditions

Depression

Medication side-effects

Nasal drainage, post nasal drip, cough Asthma

Hiata hemia or gastro esophageal reflux

Nasal membrane problems other than allergy

Nasal polyps

How do you tell the difference between a cold and a sinus infection?

There are a number of physical findings we think are critica congestion, colored nasal drainage, fever, and facial pain. On physical examination we push over the sinus areas listed below and look for a response. But the ultimate diagnosis is made with an X-Ray usually a one view front face X-Ray is sufficient. However, there are times when a more sophisticated exam is needed, a CT scan.  We see thickening in the membranes of the sinus cavity, or and a fluid level, or completely "opacified" sinus. A "cold" may feel similar to a sinus infection because of the nasal congestion, but the X-Ray is clear. Usually "colds" get better in 3-5 days, sinusitis may hang on interminably unless antibiotics are used.

Here's what causes sinusitis:

Sinuses are cavities lined with membranes that make mucus to wash and cleanse the sinuses.

If anything obstructs the drainage for any sinus, the mucus may back up and become infected by germs that always linger in your nasal area. The most common ways the drainage area become slowed or obstructed includes allergy (you know that swelling), colds (yes, they lead to sinus infections in many cases), structural problems like polyps or deviated septum) and other medical conditions. Once the drainage is obstructed, the pressure mounts and the typical feelings of sinusitis begin.

Here's how we treat it:

Antibiotics are typically used for several weeks if you've had it before or if there is positive X-Ray. You have to take all the antibiotics, even though you are feeling better after a few days.  Otherwise, the sinus infection will not be completely treated and the symptoms will recur.  This accounts for the recurring cycle of infection, improvement, and infection that occurs so commonly.

Here's how to prevent it:

Environment:	Personal	Drugs	Diet
Fresh air in the office may help Filter the air in your bedroom If allergic, get the animals OUT of the bedroom When flying in an airplane, make sure that you are decongested with some medications if necessary – changes in barometric pressure are a problem	Get sleep No smoking Don't watch TV in bed Get your eyeglasses checked Wash your hands and use Kleenex	Watch drying Drugs (antihistamines, anti-depressants, and tranquillisers) Check about aspirin Birth Control may hurt	Ask about food elimination, and watch alcohol ( it dries and congests)

"What's watching TV have to do with it?" TV watching is bad for your health in general, but watching it from bed is particularly bad. Studies show that when you lie down, nasal congestion increases because of hormonal changes (you've noticed that). The openings to the sinus become congested an additional 20% -sometimes that's all it takes. If your eyeglasses are pinching your nose, you may be obstructing your nasal drainage pattern. If you fly a lot -pray a lot and be careful, Airplane air does not come from the sky – it is, for the most part, the same air as you take off with. With folks coughing and hacking around you. there is some danger. If congested, it sometimes helps to use a few drops of nasal spray in each side before take-off.

Warm saltwater rinses can sometimes help – but be careful to mix the solutions just right. The formula is 1/4 tsp. of salt (measure it) to 7 oz of water (measure it). Some patients breathe the steam form a hot cup. Others report that using a damp washcloth heated in a microwave helps (careful or you'll get washcloth flambeau). Give us a call early – and expect us to do some extra things (like x-rays) if this problem seems recurrent.