Dr. Alan Oshinsky, otolaryngologist at Mercy Medical Center (Jed Kirschbaum, Baltimore…)
It's getting to be the time of year when everyone seems to have a runny nose. Sometimes it's a cold or allergies. And sometimes it's sinusitis, or inflamed linings in the sinus cavities. The cavities become blocked and infected. Dr. Alan Oshinsky, an otolaryngologist at Mercy Medical Center, says it's not always easy to self-diagnose sinusitis, but there are treatments that can help.
Question: What is sinusitis, and who is likely to develop it?
Answer: Sinusitis means inflammation and infection in the paranasal sinuses. We are born with eight sinuses around our head and face. These are air-filled bony cavities. When the lining of the sinus gets inflamed (swollen) or infected, you have sinusitis. Sinusitis will likely affect everyone multiple times in their lifetime, from infancy through adulthood. The most common cause of sinusitis is the common cold. Other causes of sinusitis are bacterial infection, inhalant allergies, nasal polyps, exposure to smoke, various systemic diseases and use of illicit substances in the nose.
Q: Everyone's nose runs in the colder months, so how do you tell if you have a sinus problem versus an allergy or cold?
A: The distinction between the symptoms of a cold, allergy and a bacterial sinusitis can be difficult. All of these conditions can cause the nose to run. Most colds have multiple symptoms, including sore throat, nasal congestion, runny nose and cough. These symptoms rarely last more than 10 to 14 days. If they persist, then the cold may have developed into an acute bacterial sinusitis. Allergy symptoms can present with similar symptoms to a cold but people rarely feel as sick and the symptoms usually recur in the same seasons each year. Facial pressure, facial pain and dental pain are among the most specific symptoms of bacterial sinusitis.
Q: How common is sinusitis, and are the number of sufferers increasing?
A: Bacterial sinusitis is relatively uncommon compared with the common cold. Every year approximately 30 million Americans will suffer from a viral cold. Only about 1 percent to 2 percent of these cases will fail to clear and result in an acute bacterial sinusitis. There are also people who suffer with recurrent episodes of bacterial sinusitis and they are diagnosed with chronic sinusitis. It is most important that the patient have an X-ray study to confirm the diagnosis of chronic sinusitis. The standard is to get a CT scan. Many people believe that they have "chronic sinus" only to find out that they just have some type of nasal problem.
Q: Will the problem go away on its own?
A: The common cold will resolve without the use of antibiotics over 98 percent of the time. Bacterial sinusitis may resolve on its own but will usually require antibiotics and other medications such as decongestants. When the natural openings that lead from the sinuses into the nose get blocked, mucus and bacteria may back up in the sinus and cause sinusitis.
Q: What are the best treatments?
A: The best treatment for bacterial sinusitis is an appropriate antibiotic. Decongestant tablets can be of some value but patients with high blood pressure usually need to avoid these medications. Patients will also do well with using saline sprays multiple times per day in both nostrils. No antibiotics should be used for the common cold.
Q: When might the new technique, sinuplasty, be necessary?
A: When patients have persistent symptoms and the X-rays show evidence of chronic sinusitis, additional treatment is usually necessary. Conservative therapy may include a more prolonged course of antibiotics. An allergy evaluation may be helpful if the history indicates the possibility of allergy. Topical nasal sprays containing steroids can also be very helpful and are very safe. If conservative medical therapy fails to resolve the symptoms, then surgery may be an appropriate alternative. We now have a much less-invasive procedure to handle chronic sinusitis called Balloon Sinuplasty. With this technique we use a specially designed balloon to open the natural openings that are blocked because of chronic infection. The operation is quick, practically painless and done as an outpatient. Most patients can return to work in one or two days.