Does Everyone You Know Have
Sinus Problems? 

Doctors Say They're Fielding
More Complaints

The Daily Herald
Libertyville / Mundelein / Vernon Hills Edition
Monday, June 7, 1993

Anne Burris Gasior
Daily Herald Staff Writer

Your head is pounding. Your eyes are aching. There is stuff cascading out of your nose that is, shall we say, less than pleasant.

You can't breathe, your upper teeth hurt and your throat is scratchy.

You think to yourself, these common colds sure are getting nasty.

But think again. Because what these symptoms point to is no common cold. They are indicators of a sinus infection, a nasty inflammation and affliction of the sinuses that can leave victims in misery.

Admit it. Sinus infections seem like something only wimps get. When people think of someone with a sinus infection (or sinusitis), they think of a person who snivels all the time, who has a nasal, whiny voice, and who wears plaid pants, argyle socks and a striped shirt.

But that's just not the case. Even the coolest of folk get these maladies. Sinus infections are among the most common chronic illnesses around.

Doctors say they are seeing more of these and there seem to be several theories as to why. Dr. Ray Gustafson, an ear, nose and throat (ENT) specialist at the Mayo Clinic in Rochester, Minn., suggests there may not be more actual infections, just more people going to doctors about them.

"I'm not so sure the incidence is higher, but there is a heightened awareness of nose and sinus disease," he said.

Dr. William Gatti, an ENT on the staff of Condell Medical Center in Libertyville, said the increase in sinus infections is seasonal, attributed in the winter to more cases of upper respiratory flu and in the spring to allergy attacks.

And Alexian Brothers Medical Center ENT John Gorny suggests that pollution might be the culprit. "That's not just outdoor but indoor pollution. We're all aware of sick building syndrome. What we're breathing is a lot of irritants," he said.

Those irritants - including auto emissions, tobacco smoke and industrial pollution - can cause the sinuses to revolt.

The sinuses there are actually four of them are bony, air-filled cavities in the head. They are lined with tiny hair cells called cilia . The mucous membranes which also line the sinuses - and the cilia act together as a transport system for mucus.

The cilia and mucous membranes also protect the sinuses by cleansing them of bacteria, inhaled irritants and other contaminants.

That's in sinuses that work. In those that don't, inflammation and blockage are the unpleasant results.

"Patients complain about dizziness, of headaches. They say they can't think, they can't function," Gorny said. "Sinus infections can be pretty incapacitating."

The most common type of sinus infection is bacterial and usually results from a cold or allergy, Dr. Gustafson said.

"When you have a cold, the symptoms are congestion and a clear mucus drainage. You might have a sore throat," he said. "With a sinus infection, the secretion turns pussy and there is more congestion. There is probably face pain and a headache, as well as tooth pain."

The mucus that drains from the nose becomes thick and is usually a green or dark yellow color. Facial pain might be found behind or between the eyes, in the cheeks, at the temples and in the forehead. Some people also run a low-grade fever and their upper teeth become tender and sore, a result of being, attached to the maxillary sinus.

What has happened to cause these developments is the blockage of a small hole that allows the sinuses to drain.

"Sinus drainage is primarily dependent upon an opening called the ostia," Dr. Gatti said. "When there are factors that interfere with that opening, then there is increased risk of sinusitis.

The two main causes of inflammation, that could block the opening are colds and allergies, but people who have nasal polyps or a deviated septum (the cartilage between the two sides of the nose) could also suffer blockage and be prone to sinus infections of a more chronic nature.

Parents should also be aware that kids can put a lot of things up their noses that could also block the ostia. Dr. Gatti recalls one
young patient who had a chronic sinus infection. When. he finally came to see Dr. Gatti, "I found a foreign body lodged way up in his nose.

Seeing an ENT for diagnosis and treatment is not necessary in most cases, all of these doctors agree.

"I think a family doctor can easily diagnose a sinus infection," Dr. Gustafson said. "But for those with a persistent problem or with a rapid reoccurrence, I would recommend seeing an ENT."

In cases where a patient develops a sinus infection after a cold or allergy attack, a visit to the family doctor can bring relief. The doctor will most likely look into the nose, check the ears and eyes and, by asking about symptoms, be pretty well assured of what he's dealing with.

From there, the treatment is fairly standard, although there is some disagreement about how long the treatment should go on.

Dr. Gustafson said he generally prescribes a broad-spectrum antibiotic for a period of at least three weeks. He says it takes that long for antibiotics to build up a strong enough concentration to be effective in the sinus area.

"We do know that the blood levels of antibiotics that penetrate the sinus area is very low," he said.

Dr. Gatti suggests antibiotic treatment over a period of at least 10 to 14 days and Dr. Gorny - who agrees that an antibiotic would have to be fairly strong to benefit the bony sinus area - said 10 days would likely be the recommended length of treatment, but more might be required in severe cases.

In addition to antibiotics to fight the infection, all of these physicians said patients would benefit from taking oral decongestants and from the use of a steroid nose spray to help shrink the nasal passages.

Another at-home remedy that helps to ease discomfort is steaming the nose by standing in a hot shower, putting your face over steaming water or putting hot, moist compresses on the face.

These doctors do not recommend the use of nasal spray decongestants except on a very limited basis. The sprays, which work well on their initial use, can quickly become addicting and the nose becomes more congested faster requiring more and more spray.

Dr. Gatti also discourages the use of antihistamines for sinus infections, except in cases where the infection is complicated by allergies.

"If you give one to someone with acute sinusitis that is not allergy related, it may thicken the discharge and impair drainage," he said. "Generally, an antibiotic and decongestant are the preferable treatment."

OK, those are the treatments for most people who suffer the occasional sinus infection. But what of those who seem to have a chronic problem, who are congested and drippy and in pain most of the time?

For these unhappy people, the answers become more complicated, but not impossible.

First of all, chronic sinus sufferers should see an ear, nose and throat specialist. The doctor will do a thorough examination and most likely recommend a set of sinus X-rays and possibly a CT scan, which will take detailed pictures of the sinuses, especially the ethmoid sinuses which can't be seen on regular X-rays.

Some doctors still recommend something called a lavage, in which the sinus is punctured and irrigated, washing out the infected areas. More common, however, is a process called endoscopic sinus surgery, in which a telescope is inserted into the nostril and surgery is done to remove the diseased portions of the sinus, or any polyps that might be blocking the ostia.

"Generally, these do not go away on their own," Gustafson said. "And there are possible complications if they are left untreated, including involvement of adjacent structures like the eyes and the brain."

To try and spare yourself the pain and' discomfort that come from sinus infections - and ask anyone who's had one, it's true misery - take a few preventive steps.

  Avoid areas where people are smoking.

  Clean or change furnace filters regularly.

  Keep humidity levels up in your home.

  Drink lots of fluids.

Then, if you still get a sinus infection, take heart: At least you've got lots of company, and not all of your fellow sinus sufferers are wearing argyle socks.