When Trouble Hits Those Holes in Your Head. (Part 2)

Sinusitis refers to inflammation of the sinuses, which is generally caused by an infection (viral, bacterial, or fungal). The sinuses are air-filled spaces around the forehead, cheeks, and eyes that are lined with mucous membranes. Healthy sinuses are sterile (meaning that they contain no bacteria or other organisms) and open, allowing mucus to drain and air to circulate in the nasal passages. When inflamed, the sinuses become blocked with mucus and can become infected. Each year, over 30 million people (adults and children alike) get sinusitis in the United States at some point. Sinusitis can be acute (lasting anywhere from 2 to 8 weeks) or chronic, with symptoms lingering even longer than that.

Each sinus cavity has an opening into the nose to allow a free exchange of air and mucus. But if something causes swelling within the nose, air can be trapped inside a sinus cavity, along with pus and other secretions, causing increased pressure on the wall of the sinus. Or the congestion can create a vacuum in a sinus cavity. Either causes pain when air can no longer pass freely in and out of a sinus cavity.

Typical symptoms of sinusitis depend on which cavity or cavities are involved. These are some of the symptoms:

• A headache upon awakening.
  
  
• Pain when the forehead is touched.
  
  
• An ache in the upper teeth or jaw or a cheek that is tender to the touch.
  
  
• Swollen eyelids and tissues around the eyes and pain between the eyes.
  
  
• Loss of smell, stuffy nose and tenderness on the sides of the nose.
  
  
• Earaches, neck pain and a deep aching on the top of the head.
  
  

Sinusitis typically follows an upper respiratory infection (for example, the common cold) or an allergic reaction (like hay fever, also called allergic rhinitis). These can cause inflammation and swelling that prevents the sinuses from draining properly. This makes the sinuses a great place for organisms like bacteria, viruses, and fungus to live and grow rapidly.

There are three ways to characterize sinus attacks: acute, lasting three weeks or less; chronic, three to eight weeks and, perhaps, months or years; and recurrent, referring to several acute attacks a year.

It is reasonable to conclude that you have acute sinusitis when a cold becomes worse after a week or persists for more than two weeks, especially if it is accompanied by a purulent nasal discharge that fills paper tissue after tissue.

Your health care provider can generally make the diagnosis of sinusitis from your history (that is, asking you a series of specific, appropriate questions) and by examining you, with a focus on the sinuses and upper respiratory system. The simplest way to test for sinusitis is by percussing (tapping) or pressing over your sinuses (that is, on the forehead and cheekbones). If those areas are tender, there is likely to be inflammation and there may be an infection. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to test for sinus inflammation; if the light does not shine through, this indicates congestion.

Chronic sinusitis, on the other hand, is most likely a result of an airborne allergy to substances like mold, dust and pollen that cause chronic allergic rhinitis (nasal inflammation).

Seeking Treatments.

The treatment for sinusitis is best determined by its likely cause. With or without antibiotics, most cases of acute sinusitis clear up in two weeks.

An acute attack, at the outset, is best treated symptomatically.

If the diagnosis is not entirely clear, if an acute infection recurs, or if your symptoms have been ongoing (chronic), then additional tests that your doctor may consider include an xray, CT scan, or magnetic resonance imaging (MRI). Sometimes, a referral to a specialist (known as an Ear Nose and Throat (ENT) doctor [also called an otolaryngologist]) is necessary. This specialist may perform a rhinoscopy (also called nasal endoscopy) using a fiber optic scope to look at your sinuses or a sinus puncture to test for different organisms that may be causing your sinusitis.

The most important action is drinking lots and lots of liquids, which help thin secretions in the nose and sinuses and promote drainage. Hot soup and spicy foods help, as well. You can also use a saline nose spray or even a nasal saline wash (each is sold over the counter), as many times a day as needed to loosen secretions. And each is harmless.

Humidifying the air also helps, as long as you prevent mold growth. The preferred method is to wet a washcloth with hot water, or heat a wet cloth in the microwave for about two minutes. Hold it over the nose and mouth and breathe the warm moist air.

The goals of treatment for sinusitis are to alleviate symptoms by reducing inflammation and to cure the infection. The latter requires the use of antibiotics (see Medications) to get rid of bacteria and other organisms. To lessen inflammation, on the other hand, there are many possible methods ranging from using a humidifier (see section entitled Lifestyle) to surgical drainage. Several dietary supplements and herbs may help prevent colds, shorten the duration of your cold or flu, or work together with antibiotics to treat your infection and support your immune system. How well many of these substances work can be very individual; talk to your doctor about safety and appropriateness.

Another approach is to use a portable battery-operated humidifier that delivers moist air through a mask over the nose and mouth. If you use a humidifier or vaporizer, you must thoroughly clean the equipment every day and refill it each time with clean water to prevent the growth of allergenic molds.

During a sinus attack, avoid alcoholic beverages, which increase nasal and sinus swelling. Flying can also make things worse. If you're using an oral or a nasal decongestant, limit treatment to three days, lest you create a rebound reaction that worsens the inflammation.

In addition, like many individuals, you may experience a significant improvement in sinusitis symptoms from acupuncture or homeopathy, especially if your symptoms are chronic.

If inflammation seems chronic and persists despite 10 days' antibiotic therapy, consider consulting an allergist to find the cause. While self-treatments described above can reduce symptoms, significant relief can result from the use of a prescribed nasal steroid that is inhaled.

Humming can also help by increasing air flow to the sinuses, as can nasal strips that widen the nasal passages. But there is no scientific evidence - only testimonials - to support the benefit of colloidal silver nose drops.