Chronic Sinusitis

Chronic Sinusitis



In the Biblical Book of Job, among his other traits and tribulations, Job no doubt had sinusitis. This human structure of four pockets lined with mucus membranes continues to cause a lot of misery even today. The typical patient comes with pain behind his cheek bone, his nose, or behind his eyes. It hurts more when he leans forward, and it really gets bad on a plane trip last week: pain going up, some relief coming down. He has greenish nasal mucus, post nasal drip, a decreased sense of smell, those headaches behind his cheek bones and nose, maybe pain in the upper teeth, and he coughs at night. When I examine him I find that tapping over his sinuses causes discomfort. I hold a light to his facial sinuses and note that they are dull with inflammation. I see the post nasal drip, a nasal polyp, and I know what the problem is: sinusitis. If I don’t know how extensive it is, I might order x-rays or a CT scan. If he’s had the symptoms 4-8 weeks, we still call it "acute". If it’s longer or occurs more than three times a year, we call it "chronic"



Sinusitis often follows or can precipitate cold or upper respiratory infections. Tiny mucus membrane hairs, called "cilia", don’t work as well to propel the mucus toward the outside. The sinuses openings swell, decreasing their opening size. All of sudden, there is a great place for bacteria to grow. They cling to the mucus membranes and set up a cascade of inflammation, which we perceive as pain, fullness, and the myriad other symptoms. The most common germs are Streptococcus pneumonia, Hemophilus influenza, and Moraxella catarrhalis. These are the bacteria which most often cause bacterial bronchitis, so one can see the two conditions are sometimes related. When the process goes on too long, there can be anaerobic bacteria, fungus infection, and even atypical TB in there. That’s important to treat sinusitis or any infection as early as possible.



Pediatric patients get sinusitis with similar symptoms. It can be inflamed tonsils or adenoids, allergy, or recent colds. When a cold starts to get better, then suddenly worsens again, we look to the sinuses and the middle ears. If a child has dark nasal discharge or cough or a persistent high fever, we have to be sure it’s not sinusitis. It’s interesting that children who go to daycare get sinusitis about twice as often as those who don’t. Sinusitis can be chronic in children who are not treated early. When their immune systems are compromised by underlying disease such as cystic fibrosis, diabetes, leukemia, or HIV, the sinuses can more easily be infected. This is true for adults as well.



The principal treatment for sinusitis is antibiotics. These can be combined with decongestants, saline nasal spray, corticosteroid and medication for allergy (antihistamine) if it is present. Sometimes the sinuses have to be drained by a fiber optic scope or even or even surgery, but most of the time, medication is effective. It usually has to taken longer than an infection such as strep throat. What you can do at home:

1. Apply warm, moist towels to sinus areas;

2. Breath steam three or four times a day;

3. Be sure to take all flu immunizations as they are available;

4. Take Tylenol or Motrin for discomfort or fever;

5. Wash hands frequently especially if you shake hands a lot;

6. Avoid other people with colds;

7. Avoid smoke, pollutants and extremes of temperature;

8. Decrease stress, drink plenty of fluids, and get plenty of rest;

9. Using a humidifier can increase moisture in the nose and sinuses.



Call your doctor if;

1. Symptoms last longer than 5-7 days or return after you have completed your course of therapy;

2. Very mild headaches get worse and are not easily relived by Tylenol or Motrin;

3. You have a fever.



Possible complications of sinusitis:

1. Facial bone infection, also called osteomyelities;

2. Abscess; or sepsis.

3. Crossing the thin bones into the brain cavity and causing meningitis;

4. Serious infection around the eye called orbital cellulitis.



Remember, "It’s just my sinuses," is not a normal or desirable condition. At Doctors Medical Center we can help there are many things we can do to improve sinus health and truly feel better.



John Drew Laurusonis M.D.

Doctors Medical Center

http://www.doctorsmedicalctr.com/