Health Care and Sinusitis

Your sinuses are acting up, you know it right away. Your nose is stuffy, you’re coughing, and you feel tired and achy. You think you might be getting a cold. Later, when the medicines you’ve been taking to relieve symptoms of the common cold are not working and you now have a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms, examining your face and forehead, and perhaps doing a sinus X-ray, the doctor says you have sinusitis, according to the NIH.

When people say, "my sinuses are killing me," they usually are referring to symptoms of congestion and achiness in one or more of four pairs of cavities, or sinuses, known as paranasal sinuses, according to the National Institutes of Health (NIH). These cavities, located within the skull or bones of the head surrounding the nose, include:

•Frontal sinuses over the eyes in the brow area
•Maxillary sinuses inside each cheekbone
•Ethmoid sinuses just behind the bridge of the nose, between the eyes
•Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes.

Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Anything that causes a swelling in the nose—an infection, an allergic reaction, or an inflammatory reaction to a chemical to which you may get exposed--can affect your sinuses, per the NIH. Air trapped within a blocked sinus, along with pus or other secretions may cause pressure on the sinus wall that can cause the intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.

Commonly the symptoms of sinus infection are headache, facial tenderness, pressure or pain, and fever. However, as few as 25% of patients may have fever associated with acute sinus infection. Other common symptoms include:

•Cloudy, discolored nasal drainage,
•A feeling of nasal stuffiness,
•Sore throat, and
•Cough.

Some people notice an increased sensitivity or headache when they lean forward because of the additional pressure placed on the sinuses. Others may experience tooth or ear pain, fatigue, or bad breath. In noninfectious sinusitis, other associated allergy symptoms of itching eyes and sneezing may be common, but may include some of the symptoms listed above for infectious sinusitis. Nasal drainage is usually clear or whitish-colored in people with noninfectious sinusitis. According to MedicineNet.com, sinus infection is most often diagnosed based on a history and examination made by a doctor. Because plain X-ray studies of the sinuses may be misleading and procedures such as CT and MRI scans, which are much more sensitive in their ability to diagnose sinus infection, are so expensive and not available in most doctors offices, most cases of sinus infection are initially diagnosed and treated based on clinical findings on examination. These physical findings may include:

•Redness and swelling of the nasal passages,
•Purulent (pus like) drainage from the nasal passages (the symptom most likely to clinically diagnose a sinus infection),
•Tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses, and
•Swelling about the eyes and cheeks.

Occasionally, nasal secretions are examined for secreted cells that may help differentiate between infectious and allergic sinusitis. Infectious sinusitis may show specialized cells of infection (polymorphonuclear cells) while allergic sinusitis may show specialized cells of allergy (eosinophils). Physicians prescribe antibiotics if bacterial infection is suspected. Antibiotics are not effective against viral infections; many physicians then treat the symptoms. If sinus infection fails to respond to the initial treatment prescribed, then more in-depth studies such as CT or MRI scans may be performed, according to MedicineNet. More detailed info can be found at http://www.medicinenet.com/sinusitis/article.htm .

Sinusitis simply means your sinuses are infected or inflamed, according to the NIH. But this gives little indication of the misery and pain this condition can cause. Health experts usually divide sinusitis cases into the following:

•Acute, which last up to 4 weeks.
•Subacute, which last 4 to 12 weeks.
•Chronic, which last more than 12 weeks and can continue for months or even years.
•Recurrent, with several acute attacks within a year.

The Centers for Disease Control and Prevention estimates that close to 31 million adults suffer from chronic sinusitis, resulting in 15 billion doctor visits and more than 200,000 sinus surgical procedures every year. Acute sinusitis is more common, though there are no good estimates for the number of people who experience an episode of acute sinusitis every year. According to WebMD.com, the chief goal of treatment is wiping out bacteria from the sinus cavities with antibiotics. This helps to prevent complications, relieve symptoms, and reduce the risk of chronic sinusitis.

For acute, uncomplicated cases, a synthetic penicillin is used-most commonly amoxicillin (such as Amoxil, Polymox, Trimox). This antibiotic has good effectiveness against the usual microorganisms and is relatively inexpensive. Amoxicillin's main side effects include allergic reactions (throat swelling, hives) and stomach upset. People allergic to penicillin can take a sulfur-containing antibiotic called trimethoprim/sulfamethoxazole or TMP/SMX (such as Bactrim, Cotrim, Septra). This drug is not recommended for people who are allergic to sulfur. People who have several episodes of partially treated acute sinusitis or those who have chronic sinusitis may become resistant to amoxicillin and TMP/SMX. Newer synthetic penicillins such as Augmentin, Ceftin, and Lorabid can clear most of the resistant organisms that cause sinus infection. Overuse of these "broader-spectrum" antibiotics will eventually lead to organisms evolving that can resist even the most potent antibiotics currently available. Therefore, simpler antibiotics such as amoxicillin should be used first and taken for the entire duration (14-21 days). The basic rule of thumb is to take the antibiotic until the symptoms disappear, then continue to take the antibiotic for 1 more week.
According to the University of Maryland Medical Center (UMMC), Bacterial sinusitis is nearly always harmless (although uncomfortable and sometimes even very painful). If an episode becomes severe, antibiotics generally eliminate further problems. In rare cases, however, sinusitis can be very serious.

--Osteomyelitis. Adolescent males with acute frontal sinusitis are at particular risk for severe problems. One important complication is infection of the bones (osteomyelitis) of the forehead and other facial bones. In such cases, the patient usually experiences headache, fever, and a soft swelling over the bone known as Pott's puffy tumor.

--Infection of the Eye Socket. Infection of the eye socket, or orbital infection, which causes swelling and subsequent drooping of the eyelid, is a rare but serious complication of ethmoid sinusitis. In these cases, the patient loses movement in the eye, and pressure on the optic nerve can lead to vision loss, which is sometimes permanent. Fever and severe illness are usually present.

--Blood Clot. Blood clots are another danger, although rare, from ethmoid or frontal sinusitis. If a blood clot forms in the sinus area around the front and top of the face, symptoms are similar to orbital infection. In addition, the pupil may be fixed and dilated. Although symptoms usually begin on one side of the head, the process usually spreads to both sides.

--Brain Infection. The most dangerous complication of sinusitis, particularly frontal and sphenoid sinusitis, is the spread of infection by anaerobic bacteria to the brain, either through the bones or blood vessels. Abscesses, meningitis, and other life-threatening conditions may result. In such cases, the patient may experience mild personality changes, headache, altered consciousness, visual problems, and, finally, seizures, coma, and death.

The relationship between sinusitis and asthma is unclear, per the UMMC. A number of theories have been proposed for a causal or shared association between sinusitis and asthma. Successful treatment of both allergic rhinitis and chronic sinusitis in children who also have asthma may reduce symptoms of asthma. It is particularly important to treat any coexisting bacterial sinusitis in people with asthma. Patients might not respond to asthma treatments unless the infection is cleared up first. Pain, fatigue, and other symptoms of chronic sinusitis can have significant effects on the quality of life. This condition can cause emotional distress, impair normal activity, and reduce attendance at work or school. According to the American Academy of Allergy, Asthma, and Immunology, the average patient with sinusitis misses about 4 work days a year, and sinusitis is one of the top 10 medical conditions that most adversely affect American employers. Here are some resources:
•www.entnet.org -- American Academy of Otolaryngology - Head and Neck Surgery
•www.aaaai.org -- American Academy of Allergy, Asthma, and Immunology
•www.acaai.org -- American College of Allergy, Asthma, and Immunology
•www.niaid.nih.gov -- National Institute of Allergy and Infectious Disease
•www.american-rhinologic.org -- American Rhinologic Society
•www.cdc.gov/vaccines -- National Immunization Program

Sinus headaches can be extremely painful, and sinusitis can be even more discomforting. If not treated right away, sinusitis can lead to more severe health care issues. If you feel that you are suffering from a sinus infection, go see your doctor or visit an urgent care clinic. Don't waste time feeling bad. The faster you are able to get medical attention, and perhaps applicable medication, the quicker you'll be on the road to recovery.

Until next time. Let me know what you think.