Chronic Sinusitis at a Glance
By Bruce Kaler M.D.
Sinusitis makes you and almost 30 million people each year feel miserable. The combination of facial pressure, headache, fatigue, sneezing, runny nose, drainage of thick colorful mucus from the nose and severe nasal congestion contribute to the misery. The worst part is it is often difficult to treat, in many people is very slow to improve, and recurs frequently. The chronic recurring condition known as chronic sinusitis or rhinosinusitis is a bit of a puzzle. We do not really understand all the factors that promote the symptoms that make you so vulnerable to recurrence.
Although the causes are not understood, there are several theories and observations floating around. Clearly, this is a stubborn condition often slow to resolve. Infections are a common component but not the only piece to the puzzle. Research suggests there is a certain amount of swelling and inflammation in the sinuses and nasal passages that cause the congestion blocking airways and connections between sinus cavities. Any time there is warm moist closed off space in the human body it predisposes to problems. Many factors may stimulate the swelling and inflammation. Environmental allergies are common and probably underrated contributor to the inflammatory response. The presence of some kinds of bacteria without actually causing an infection may also irritate the immune system to produce inflammation. Structural abnormalities to the septum or polyps, which also result from chronic inflammation, may serve to block nasal airways as well. Other medical conditions can be part of the problem. This can range from simple allergies, acid reflux from the stomach reaching nasal passages while asleep, cystic fibrosis, or any chronic conditions that affect immune system response. The importance of identifying chronic sinusitis and initiating management can help provide greater comfort and prevent serious complications.
The history and clinical findings are most helpful in identifying this condition. Diagnostic testing may include nasal culture from the nose or imaging studies such as x-rays or MRI. If allergies are suspect, more in depth allergy testing may be helpful to identify triggers. Treatment should aggressively address infections when they are present. Since so many clues point to the role of inflammation nasal steroid sprays have become a cornerstone of management. There are several non-sedating antihistamines available without prescriptions that are effective when allergies play a role. Many people find benefit from daily use of saline irrigation done with an inexpensive neti pot or irrigation bottle. Regular use of simple saline spray also is very helpful to help open and provide added moisture to nasal airways. Over the counter decongestants such as Sudafed or Afrin nasal spray should be avoided. Although they provide quick short-lived relief, they just as quickly become less effective and can actually stimulate rebound congestion. This means they become part of the problem rather than the solution. Surgery should be left as a last resort for only extreme cases that have failed all other measures.
Chronic sinusitis is undoubtedly a stubborn and all too common problem. Although we do not understand completely why, many treatment options are available. Consult your health care provider to tailor a regimen that suits your needs. Do not ignore it and keep suffering. There is help!
As a physician with over thirty years of diverse clinical experience, Dr Kaler recently published the Owners Manual for Injury Prevention by Bruce Kaler M.D. It is a user friendly guide to understanding prevention and injury care. He also authored a mystery novel Turnabout by Bruce Kaler MD an engaging medical thriller and must read for all mystery buffs. Both are available through Amazon.com, http://Smashwords.com and many other retail outlets. Visit his website http://seattledoc.com