When Trouble Hits Those Holes in Your Head. (Part 1)

You've had a cold for five to seven days and thought you were getting better. Then it grew worse. More congestion, increasing fatigue and now headache or facial pain around your nose or eyes or upper teeth. You guessed it was a sinus infection.

Allergies are extremely common and underdiagnosed. They are a setup for sinusitis. Sneezing, a runny or itchy nose and watery or itchy eyes are all signs of allergy. Allergy testing can help identify those items to which you are most allergic. Remember, the most effective way of addressing allergies is prevention. For example, curtains, carpets and decorative pillows may harbor dust mites that can cause allergy attacks. Also, an air purifier that contains a HEPA filter can be beneficial for lowering airborne allergens, especially when placed in the bedroom.

Depending on the severity of the symptoms, the doctor's examination and inclinations about treatment, you may be prescribed an antibiotic.

But is this what you need to get better?

Chances are, it is not. Most cases of acute sinusitis are caused by viruses, not bacteria, and taking an antibiotic does nothing more than enrich the pharmaceutical companies and increase the chances of being infected with drug-resistant bacteria.

Colds run amok can turn into sinus infections, so don't be nice to your cold. The key is to try to prevent your sinus drainage passageways from getting blocked. One helpful technique is to irrigate your nose and sinuses with a squeeze bottle filled with salt water. You can buy a sinus irrigation kit (also called sinus rinse) at your local pharmacy without a prescription. Most products come with pre-measured salt packets.

The average adult catches two or three colds a year, and 0.5 to 2 percent of them are complicated by bacterial infections. In other words, if antibiotics are prescribed for most sinusitis cases, they are most likely being way overprescribed.

In the course of a year, an estimated 37 million Americans experience sinusitis, the fifth most common diagnosis for which antibiotics are prescribed in outpatient settings.

Also, don't fly with a cold if possible: The change in pressure can stress your sinuses, causing a sinus infection, not to mention a very painful descent!

But how is the doctor to know whether an antibiotic is what is needed? Unless a sample of the pus in the nasal cavities is examined under a microscope - a rare act in most physicians' offices - there is no certain way to tell.

You may have recurrent sinusitis. After one infection clears, another one pops up weeks--or even months--down the line. There's good news for those prone to this stubborn illness prevention is sometimes as easy as using daily salt-water nasal irrigation. The same salt water solution that's used to treat sinus infections can also be used to prevent them.

Doctors are advised to use antibiotics to treat sinusitis when at least three of four signs are present: purulent (yellowish or greenish) nasal discharge predominantly on one side, local facial pain mainly on one side, purulent nasal discharge on both sides or pus in the nasal cavity.

Many physicians as well as patients take purulent nasal discharge lasting seven or more days as the primary indication of a bacterial sinus infection. Yet, study after careful study has shown no reliable benefit of antibiotics when doctors try to apply this or any of the other criteria in deciding on drug treatment.

In general, chronic sinusitis lasts for 12 weeks or longer and is often associated with allergies. Acute sinusitis, however, is usually due to bacterial infections. For those with persistent symptoms who have tried everything, ask your doctor about other treatment options.

In the latest study, published last month in The Journal of Family Practice, no significant benefit over a placebo was found from using the antibiotic amoxicillin among 135 patients with typical indications of a sinus infection. All the patients complained of sinusitis, with pus in the nasal cavity, facial pressure or nasal discharge lasting longer than seven days.

A few natural options that are effective include the following remedies and dietary changes:

Sinupret: This proprietary herbal formula (with sorrel, elderberry, and other herbs) is popular in Europe and helps promote upper respiratory and nasal passage health. Follow label directions for dosage. Several products featuring Sinupret are on the market, including a formula by Bionorica.

A small subgroup of patients receiving the antibiotic became better faster than the others. But the researchers were unable to discern anything about those patients in advance of treatment that indicated a bacterial infection, as opposed to a viral one.

That does not mean that antibiotics are useless in treating sinusitis. But it does mean more research is needed to help doctors determine who is most likely to benefit from the costly and potentially harmful drugs.

Bromelain: Found naturally in the stem of pineapple, bromelain is an excellent anti-inflammatory for acute and chronic sinusitis. Scientific studies show that bromelain can significantly reduce inflammation of the nasal lining, as well as help minimize nasal discomfort and breathing difficulties. Bromelain is widely available in supplement form. Follow manufacturer's directions for dosage guidelines.

Many people who do not seek medical care for an apparent sinus infections try to treat the problem on their own, typically buying one or more over-the-counter "sinus remedies."

Many millions of dollars are spent on such "remedies," none of them getting at the cause of the problem.

So What Is Sinusitis?

Diet: A healthy diet is always important to support your immune system and help fight off sinusitis. Ironically, eliminating some foods may also help. For example, cow's milk products, along with other foods, such as eggs, peanuts, wheat, soy, fish, shellfish and tree nuts, are the most common food allergens. Sensitivities to foods can worsen sinusitis and should be ruled out by an elimination-challenge diet or allergy testing.

Sinusitis is simply an inflammation of the lining of the sinus cavities. There are four pairs of sinuses, which are spaces normally filled with air in the front of the skull: over the eyes in the brow area; inside each cheekbone; just behind the bridge of the nose and between the eyes; and in the upper region of the nose and behind the eyes. The membranes that line the sinus cavities are moistened by thin mucus.

Sinus inflammation has many causes, including infection by viruses, bacteria or fungi;

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an allergic reaction to a food or environmental substance; or the response to an inhaled irritant like tobacco smoke or outdoor or indoor air pollution.