By: Allen Adinoff, MD
Hollow cavities in the skull bone surrounding the nasal passages form the sinuses. Normally, the sinuses drain into the nose. Although their function is a bit of a mystery, the sinuses cause plenty of problems. When they become inflamed and infected, the term “sinusitis” is used. Acute sinusitis often follows a respiratory infection or “cold” and lasts a week or two and many people refer to this as a “Sinus Infection”. Chronic (long term) sinusitis refers to nasal-sinus symptoms that last for many weeks or months. Chronic sinusitis is the topic of this discussion.
What is Chronic Sinusitis?
Millions of individuals in the US suffer from chronic sinusitis. It causes significant illness, loss of work, and discomfort. People with this condition experience persistent nasal drainage (often discolored), nasal blockage, facial pain, and loss of smell. Generalized symptoms of fatigue, poor sleep, and generally feeling “crummy” are common. Recurrent episodes of acute sinus infections are also common.
There are many causes of chronic sinusitis. Recent thinking suggests that chronic irritation (called inflammation) and low grade infection are the most common causes. The inflammation is often related to allergies. The infection is often “low grade”. The bacteria hide themselves in “biofilms” making it difficult for the immune system or antibiotics to attack them.
The evaluation of chronic sinusitis is best done by an allergist skilled in this condition. Asking detailed questions about your nasal-sinus symptoms is most important. It’s also essential to examine the nasal passages thoroughly. This is best done with a flexible nasal scope that can look into the deep passages of the nasal cavity. Samples of sinus mucus can determine the cause of infection. Laboratory tests include looking for evidence of allergy, and to check for problems with the immune system. Often it’s important to get a detail sinus X-ray, called a CAT scan.
Treatment is geared toward treating the allergic causes, restoring free sinus drainage, reducing the nonspecific inflammation, and treating the infection. If allergies are felt to be a strong trigger for your sinusitis, allergy shots (immunotherapy) may be helpful. Irrigation of the nasal passages with gentle salt water (saline) is often extremely effective in flushing out irritated mucus and allergens, adding moisture, and reducing inflammation. Nasal steroid sprays help reduce the inflammation. Often a nasal steroid can be mixed with the saline irrigations. Nasal steroids are extremely safe and don’t get into the general blood stream. A small amount of baby shampoo can be mixed with the saline and can have a “detergent” effect on those nasty biofilms. Occasionally, nasal antibiotics, anti-fungal medicines, or even probiotics can be helpful. This intense approach is usually effective. However, occasionally, surgery may be needed to open up the sinuses and restore free drainage. Only a skilled ears nose and throat surgeon (ENT) can do this. But opening the “plumbing” does not cure this condition; it still requires treatment of the underlying causes of allergy, inflammation, and infection.
Think you may be suffering from sinusitis? Make an appointment with a CAAC allergist today!
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