ask the expert


December 20, 2007|By Holly Selby

Sniffling. Headache. Fatigue. You know the feeling. The symptoms are common, but if they linger or are recurrent, their cause could be something other than the common cold, says Douglas Reh, assistant professor at the Johns Hopkins Sinus Center. Between 30 million and 35 million people in the United States may suffer from these symptoms as part of sinusitis. Sinusitis is the most commonly self-reported illness in the country -- and one that is the impetus for some 20 million to 25 million doctor visits each year.

What is sinusitis?

The general public and, perhaps, general practitioners call it sinusitis, but we call it rhinosinusitis. It is an inflammation of the nose and sinuses. And if you get inflammation of the nose, you get inflammation in the sinuses. Patients can have acute sinusitis or chronic sinusitis. Any patient who has had the symptoms for more than 12 weeks has chronic sinusitis. Some people get it once a year and it resolves itself so that is no problem. But some people get it again and again.

What causes sinusitis -- or rhinosinusitis?

Well, when we talk about sinusitis -- needing medication or even surgery -- we're typically talking about a bacterial infection. A cold like a viral upper-respiratory infection can cause inflammation (and sinusitis), but we don't treat a viral upper-respiratory infection.

I divide causes of sinusitis into two categories: anatomic and inflammatory. The sinuses drain through small openings into the nose, so anything that causes inflammation of the nose or blockage blocks the drainage of the sinuses.

Some people have anatomical blockages -- either the bone or the tissue is blocking the drainage of their sinuses. These are people who may benefit from surgery. Other people have inflammation. Many things can cause inflammatory sinusitis. There can be allergies or environmental causes like tobacco smoke.

And some people have genetic abnormalities such as those caused by cystic fibrosis that cause inflammatory sinusitis.

Do doctors understand why one person suffers from chronic sinusitis and why another does not?

In some cases, there is an identifiable problem such as anatomic blockage. And there are multiple theories about why some [other] people have chronic inflammation. We don't understand it; a lot of what we do here at Hopkins is trying to understand why that is.

Can you further describe the difference between a cold and sinusitis?

A cold does have very similar symptoms as sinusitis: nasal congestion, facial pain, nasal discharge. But with a cold (caused by a virus), it is chicken soup and seven to 10 days later, you feel better. Early on in the disease, you can't really tell if it is a cold or sinusitis, but with patients who are getting worse at seven to 10 days, we start treatment.

What is the treatment?

There are three categories of treatment. With acute sinusitis -- a patient who has one episode -- we treat with antibiotics. If the patient doesn't get better, we treat him with anti-inflammatories (nasal or oral steroids).

But with chronic infections -- patients who keep getting sinus infections -- the treatment becomes a topical anti-inflammatory such as nasal steroids and sino-nasal irrigations (the patient uses a bulb syringe to rinse out the sinuses). Some patients do it every day; others only do it when they get a cold.

You often hear of people getting CT scans when they have really bad colds -- or suspected sinusitis. What are the doctors trying to discover?

When they think patients have sinusitis, doctors may order a CT scan, and that is problematic because everyone with a cold will have graying of their sinuses on their CT scan. I can't tell the difference between a person with a cold or sinusitis. They both look obstructed. Sinusitis is a clinical diagnosis and it is based on the time frame. CT scans are helpful in patients with chronic sinusitis (or sinusitis that lasts longer than 12 weeks).

And with patients who have chronic sinusitis that doesn't get better, we use surgery. Years ago, we had to make an incision above the lip, but now we do the surgery with an endoscope and go through the nose to enlarge the sinus passages.

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