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Paging Dr. Shapiro: Sinus Problems, No Longer

Number 1
March 25, 2005 – It has been said that the nose is the barometer of the body; when your nose is not happy, you're not happy. If you have ever had a stuffy and runny nose with discomfort of your face, you may be one of the 37 million or more Americans who suffer from sinusitis. It is one of the most common debilitating illnesses, responsible for more days of missed work and school than any other. We all have a pair of frontal or forehead sinuses, ethmoid sinuses between the eyes, maxillary sinuses in the cheeks and sphenoid sinuses deep inside the head. Acute sinusitis is an infection and inflammation of one or more of the sinus cavities. It usually begins with a cold, allergy problem or exposure to pollutant or irritant such as cigarette smoke. Believe it or not, the average adult will produce between one to two quarts of mucous from the sinuses each day. If the drainage pathways from the sinuses become blocked, a dark warm moist area in the sinus cavities is eager to become a host for growing bacteria. Frequent recurrent or chronic sinusitis occurs in people who have had persistent problems for three or more months. Chronic sinusitis is usually more difficult to treat and may require a surgical drainage procedure.
Diagnosing sinus problems used to be a combination of guesswork and luck. With the advent of the nasal endoscope, however, a small telescope can now be gently passed into the nose to visualize the drainage pathways from the sinuses into the nose. This drainage region, called the ostiomeatal complex, is responsible for the health and wellbeing of the sinuses. When the complex is blocked, the sinuses cease to function normally. An ear, nose and throat doctor can further evaluate the bony architecture of the sinuses by utilizing a CT scan, a highly detailed x-ray test that requires no injections and usually involves less radiation than regular x-ray films. Once the diagnosis of sinusitis has been made, appropriate treatment can be started. Because sinus problems are often caused by inhalant or food allergies, patients may undergo allergy testing. Testing can be performed via skin or blood testing and can help isolate the causative agent responsible for the recurrent sinusitis symptoms. Immunotherapy, or allergy shots, is sometimes required to alleviate chronic problems.
Simple acute sinusitis can often be treated with a short course of routine generic antibiotics. However, chronic sinusitis often requires a more prolonged course with a stronger antibiotic to treat bacteria with potential resistance to weaker medications. On occasion, the fungal and mold spores will invade the sinuses causing a debilitating and potentially life-threatening infection. It is not uncommon to have to treat someone for 4 to 6 weeks with a combination of antibiotics, anti-fungals, nasal sprays and mucolytic agents to liquefy the mucous. Antihistamines are excellent for the treatment of allergy symptoms, however, they have no role in the treatment of sinusitis. These medications will thicken the mucous and contribute to the blockage of the sinus drainage pathways. People who are inadequately or inappropriately treated can become afflicted with long term, debilitating sinus problems, so-called "sinus cripples". In extreme situations, the infection can spread to the eye, causing blindness, and to the brain resulting in meningitis and brain abscesses.
Although children's sinuses continue to develop until late adolescence, young children and infants can also suffer from sinus troubles. This will usually occur as a result of an upper respiratory infection, allergy or exposure to second-hand smoke. Often a child's adenoid tissue behind the nose can harbour bacteria and block the drainage pathways. Swift treatment is essential, especially in young children who may not be able to verbalize complaints.
Endoscopic sinus surgery is a technique that can greatly relieve sinus problems. Originally developed in Austria and Germany in the 1980s, this technique has become the standard of care for treatment for chronic sinusitis in the United States. The procedure is performed in the operating room – usually under general anaesthesia on an out-patient basis. With the aid of the endoscope, the natural drainage pathways to the sinuses are gently opened and the diseased tissue is removed. This is performed using a video monitor with microscopic instrumentation. A small dissolvable piece of foam is gently placed in the nose. No longer do sinus surgeons need to use large uncomfortable packs in the nose. Patients are almost always greatly improved after they have healed. Of course, surgery is suggested only for those who have not improved after an intensive course of medical therapy.
The progression of a cold or allergy attack to a sinus problem can be avoided by following some simple hints:
– gentle blowing of the nose
– drinking as much fluids as possible
– avoiding caffeine and alcohol
– staying away from cigarette smoke and pollutants
– avoiding air travel and diving with a cold
– using prescription nasal sprays to decrease the swelling inside the nose and sinuses
– seeing your physician if symptoms persist more than 1 week.
Paging Dr. Shapiro is written by Dr. Adam M. Shapiro, an ear, nose and throat physician in practice on St. Thomas and on staff at the Roy L. Schnieder Hospital. More information is available at theVirgin Islands Ear, Nose & Throat Web site. In writing this column, Dr. Shapiro made frequent reference to material published on the American Academy of Otolaryngology Web site.

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