What is Sinusitis?
Sinusitis afflicts millions of Americans each year. According to the National Institute of Allergy and Infectious Diseases, sinusitis “simply means your sinuses are inflamed, red and swollen, because of an infection or another problem.” Sinusitis can be very irritating to deal with and women are more likely than men to be diagnosed with the infection. Sinusitis affects people from the very young to the very old.
Acute sinusitis can last up to 4 weeks and chronic sinusitis can last more than 12 weeks and persist for months or years after the initial symptoms. The illness can be caused by several factors including viruses, bacteria, allergies, airborne chemicals and a weak immune system.
What are the Symptoms of Sinusitis?
According to the Center of Disease Control and Prevention, those diagnosed with sinusitis usually suffer from the following symptoms:
Sinus pressure can be a real problem during the cold, winter months. Do I take decongestants or antihistamines? Sudafed or Zyrtec? Are my allergies acting up?
Here are some pointers on dealing with sinus infectionsand sinus pressure with some really cool slides at the end:
Most allergens are gone in December-January, so the statement “my allergies are bothering me” is actually misplaced. You are meaning to say that sinus pressure is causing congestion and runny nose. Inflammation and swelling definitely exist in your sinuses, it’s just that your symptoms during the winter are not caused by allergy, but rather sinus infection.
Treatment of a sinus infection is “all or nothing”. In other words, if you only remove 50% of the infection, it is likely your symptoms will quickly recur. Your body requires a mucociliary blanket in the sinuses to gradually remove bacteria and excessive snot. This protective blanket is destroyed during any infection, and won’t grow back until the inflammation subsides. Often it takes 30 days of antibiotics and prednisone to restore the sinuses back to their original condition.
One of the pictures in your slide set (slide 3 of 15) shows what normal mucociliary blanket looks like under the microscope. If this giant vacuum sweeper was operating normally all of the time, you wouldn’t have to use all your medication.
Make sure you eliminate nasal congestion. For the short term, use Afrin or similar equivalent (OTC) if you limit to < 1 week per month. This allows the nasal airflow to drive away the excessive mucous in your nose which would otherwise become a great meal for hungry bacteria. Sick but true!
Find out if you have allergy! The winter season gives you a reprieve from outdoor allergens, but during the spring, summer, and fall, tree pollen, Bermuda grass, and ragweed are more than willing to invade your sinuses and cause irreparable damage to your mucous membranes and make you always sick.
Use your prescribed nasal spray EVERYDAY as prescribed by your doctor. I know, Americans hate to put anything in their nose (except your finger), but regular use of nasal steroids and antihistamines will reduce the swelling in your sinuses and guess what? You got it, fewer infections.
Get smart! Go through the slides below, and if you don’t learn anything new, I’ll buy your favorite drink at Starbucks.
Without a doubt, driving on ice and snow should be reserved for the experienced drivers only. We don’t need more wrecks on Hwy 169 that what we already have to endure. But when the forecast for a winter storm brings on a run for bread and milk, we may have gone a bit too far. We have our own version of Black Friday…it’s called snow storm panic! Here I was shopping at Target to get a few items I really did need. Usually, my wait at the pharmacy is very short, but last night I guess EVERYONE thought it was important to get their medications filled before the storm arrived in case medications would no longer be available. Come on, pharmacies stay open even in Minnesota. Did you happen to go down the bread aisle? Nothing left and not a snowflake on the ground. No wonder you can’t yell fire in a theatre. The most shocking behavior, however, found in Oklahoma in preparation for a winter storm is to cancel school before it even starts to snow. Will you catch us off guard and unprepared? Not a chance. No wonder our kids have never seen snow or had a chance to make those lovely snow angels. They’re never in it. All joking aside, we did have a pretty nasty snowstorm 2 years ago with almost 20 inches in one night. That amount of snow shut the city of Tulsa down for a week! Could it happen again? Sure could, but the video below is enough for me:
Now, you’re probably wondering if I always pontificate about a totally irrelevant topic such as how Tulsans prepare for snow storms. Fortunately, this can have some relevance to cold weather illness:
Asthma can be a real problem during the cold weather. Inhaling cold air causes drying of the airway wall and more severe bronchospasm that moderate temperatures. Don’t think that coughing and shortness of breath is just cold air; it may be your asthma getting out of control. Learn how to cover your nose and mouth with a scarf or mask, even if you’re outside for a short period of time. And most of all, use your regular inhaler (controller) during the winter months if cold air or upper respiratory infections are triggers for your asthma.
Another problem with the winter season is trying to figure out if I have a cold, flu, sinus, or allergy problems. Let me make this much easier for you. Most ragweed is done pollinating by the end of October, so without much pollen in the air, your sneezing and coughing is probably not due to allergy (no exposure). A cold usually lasts < 1 week and any congestion or runny nose that doesn’t resolve from one Saturday to the next is probably a sinus infection. Why does this matter? Sinus infections should be treated with the “all or nothing” approach as any infection left in the sinuses will only result in more infection. Catching the flu makes you feel terrible and you’re already coughing. What could be worse? Add a fever with muscle aches and your diagnosis is most likely some type of influenza. Good motivation to get your flu shot!
Am I Allergic to the Cold? I’m glad you asked. Cold-induced hives stays hidden for most of the year and comes out with a vengeance during cold weather. Some instances can be life-threatening and this condition is nothing to take lightly. Cold-induced urticaria of course, responds best to a vacation at Key West, but if you don’t have the luxury or flexibility to do that, antihistamines are still the backbone of treatment. Be careful when shoveling snow as shortness of breath and chest tightness may be associated with hives and a cold-induced reaction.
Although you must be careful with cold weather illness, you have to do something outside or you’ll get cabin fever. The link below is from AAAAI on how to control your asthma and still participate in winter activities. It’s a good read in front of the fireplace with a cup of hot chocolate. In the meantime, I’m heading for the slopes!
You won’t sleep well if you can’t breathe! Unfortunately, sinusitis is quite common during the Christmas Holidays.
Often patients don’t know what can be done about it. But let’s start from the very beginning…..
What are the signs and symptoms of chronic sinus infection?
1. Nasal congestion (can’t breathe through my nose) is always present during chronic sinusitis. No exceptions. I can hear this when you talk to me in the exam room–if you’ve had sinus infections for any length of time, you become accustomed to hyponasal speech. You can’t hear it, but I can (and ask your spouse or mother).
2. Repeated courses of antibiotics that just DON”T work after 10 days.
3. If the nasal drainage is clear…can you still have a sinus infection? YES. The color of nasal drainage doesn’t predict if you will have chronic sinus infection. Only a CT scan of your sinuses can show you any inflammation or mucous thickening in the sinuses
4. Don’t forget that many asthma patients have a flare sending them to the ER because of Sinus infection.
OK….so now I know what’s going on, but how do I get rid of it?
1. Remember, the engine that drives movement of mucous in the sinuses is nasal airflow. Without nasal airflow, secretions accumulate and you can’t blow your nose enough to get rid of the SNOT. I know it’s gross, but this is the key to keeping your sinuses open.
2. The purpose of nasal sprays (steroids/antihistamines) is to reduce the size of enlarged turbinates and allow nasal airflow.
3. Don’t worry about the side effects of nasal steroids. Exposure is very low and often not detectable in the bloodstream. And besides, the clinical researchers trying to find side effects of nasal steroids put themselves and their own kids on this type of medicine.
4. Persistence is the key! Use at least one spray in each nostril per day (the rest is gravy)….up to 4 sprays per day may be needed during colds or upper respiratory infections.
5. Tilt your head forward to use the spray and avoid “snorting” the spray down the back of your throat.
6. If nasal sprays don’t work because of your congestion, I recommend using NasoNeb II from ASL pharmacy. Any nose spray works better if you “pretreat” with Afrin™ or other 4-way spray, simply because you open the nose for better penetration. Your limit on use of Afrin or similar OTC nose spray is < 1 week per month–don’t worry about addiction if you stay within these boundaries.
So there you have it….no one should suffer from sinus headaches during the Christmas holidays if you follow some simple steps:
Find out if you have sinus infection–CT is best
Use your nasal spray (from the doctor, not OTC) everyday as prescribed!
Put your money where your mouth is and use correct technique with any nasal inhaler…what goes down the back of your throat can’t help.
Want to know more on this subject? The link below will take you to the most recent guidelines on treatment and management of sinusitis. In the meantime, sleep tight and enjoy the Holidays!
Chronic RhinoSinusitis (CRS) is a source of increased medical costs and decreased quality of life for many adult & pediatric patients each year. Evidence-based, clinical practice guidelines include recommendations for the use of nasal saline irrigation (NSI) as a significant treatment component or effective adjunct therapy for CRS; however, the research reviewed did not clearly support or refute it. Currently, saline irrigations are being used as a treatment for CRS and you can find many formulations and products OTC. Until further research is conducted to refute this practice, this treatment modality provides a safe and economically astute alternative to the costly conventional treatments available for CRS.
Are Saline Irrigations Effective in Relieving Chronic Rhinosinusitis Symptoms: A Review of the Evidence
Thornton A, Alston M, Dye H, Williamson S J Nurse Pract. 2011;7:680-686
Background. Chronic rhinosinusitis (CRS) is a common disorder that affects 14% of the adult population of the United States and has been estimated to account for more than $3 billion in healthcare expenditures. Yes, that’s 3 BILLION! Furthermore, CRS, typically caused by a virus, is frequently treated with antibiotics, contributing to the growing problem of antibiotic resistance. For this reason, both patients and healthcare providers have increasingly turned to alternative therapies including nasal saline irrigation. For this study, the researchers defined CRS as symptoms persisting for 12 weeks or longer. The purpose of this study was to examine the evidence for efficacy of this therapy.
Methodology. Numerous databases, including Cochrane, MEDLINE, and CINAHL, were searched for studies that answered the research question: In adult primary care patients, does the use of saline irrigations (compared with no treatment) improve the symptoms of CRS? Overall a good search of the literature on this topic. Unfortunately, no big studies are available to compare.
Results. The investigators concluded that the evidence for efficacy of saline irrigations was contradictory. No conclusion could be drawn as to type of solution (isotonic, hypotonic, or hypertonic) that produced consistently positive results or was best tolerated, which may indicate that patient preference is the best indication of appropriate solution. No serious adverse effects were found and the treatment appeared to pose no significant health risks, but data were insufficient to support a conclusion that irrigation was of some benefit with minimal side effects.
Not everyone will agree on the use of nasal irrigation. Clearly, an alternative to the widespread use of antibiotics to treat this predominantly viral condition must be found. The investigators do an admirable job of synthesizing the literature and examining the limited data available in support of this cheap and safe therapy. Saline irrigation fulfills the mandate to “first, do no harm,” so it should be included in the armamentarium of therapies for this common condition.
If you’re looking for alternatives, check out this nebulizer (atomizer) from ASL Pharmacy
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