Dear Doctor Column, August 26, 2002

Question:

For the last 3 weeks, I've been treated for a sinus infection. He prescribed antibiotics, but I haven't had any relief. The pressure is now so severe that my neck is starting to hurt. Why can't I get well?

Answer:

It sounds as if your doctor is treating you for sinusitis, which is an inflammation of the lining of the nasal sinuses – the hollow cavities within the cheek bones around the eyes and behind the nose. Their primary function is to warm, moisten, and filter air in the nasal cavity. When this lining is irritated by the common cold, allergies, an infection, cigarette smoke, or dust, the glands in the sinuses produce extra mucus, leading to congestion and pressure in the nasal passages.

Although bacteria are always present in mucus, they normally do not cause problems. But when the sinuses cannot drain, these bacteria can multiply and cause infection. Infection causes swelling, which, in turn, makes it even harder for the sinuses to drain.

The National Institute of Allergy and Infectious Diseases estimate that 37 million Americans are affected by sinusitis every year.

Symptoms of sinusitis may include a stuffy nose; headache; facial pain or pressure that can be worse on one side and increases when leaning forward; cough or sore throat that gets worse at night; thick, yellow, green, or bloody nasal mucus; stopped up ears; dental pain, especially in the upper teeth; decreased or lost sense of smell; fatigue; bad tasting post-nasal drip; and occasionally a fever.

There are two types of sinusitis, acute and chronic. Acute sinus infections may last from 2 to 3 weeks or can linger for as long as 12 weeks. In some instances, acute sinus infections may recur more than several times a year. Most sinus infections are chronic and generally last 12 weeks or longer.

Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, taking X-rays, and if necessary a CT (computed tomography) scan.

Treatment

A sinus infection is commonly treated with a combination of medications, such as an antibiotic to control bacterial infection and a nasal steroid to reduce swelling. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you are feeling better. In cases of severe sinusitis, your doctor may prescribe oral steroids, such as prednisone. For people with chronic sinusitis due to allergies, immunotherapy, or "allergy shots," may be prescribed to reduce susceptibility.

Although home remedies cannot cure sinus infection, they might give you some comfort.

• Inhaling steam from a vaporizer or a hot cup of water may soothe inflamed sinus cavities.
• Saline nasal spray, which you can buy in a drug store, can give relief.
• Gentle heat applied over the inflamed area is comforting.

When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages. Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms.

There are certain things you can do to help reduce the number and severity of sinus infections and possibly prevent acute sinusitis from becoming chronic.

• You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
• Air conditioners help to provide an even temperature.
• Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.

If you are prone to getting sinus disorders, you should avoid cigarette smoke and other air pollutants. An otolaryngologist (ear, nose, and throat physician) can help you determine the cause for persistent sinus problems. If you suspect that your sinus inflammation may be related to dust, mold, pollen, food, or any of the hundreds of allergens that can trigger an upper respiratory reaction, you should consult an allergist/immunologist — a physician trained in the diagnosis and treatment of allergic diseases — or an otolaryngologist, who can use various tests to determine whether you have an allergy and its cause.

For more information:

American Academy of Allergy, Asthma and Immunology www.aaaai.org

National Institute of Allergy and Infectious Diseases www.niaid.nih.gov/factsheets/sinusitis.htm

American Academy of Otolaryngology-Head and Neck Surgery www.entnet.org

American Academy of Allergy, Asthma and Immunology www.aaaai.org