The nose knows: Keeping your sinuses happy and healthy

The cold weather is here — and with it, an increase in the incidence of common infections such as sinusitis or, as some doctors prefer to call it, rhino-sinusitis, since sinus infections almost always include nasal symptoms (the prefix rhino- indicates a relationship with the nose).

Problems with your sinuses can make for miserable conditions — nasal congestion, facial pain, achiness, headache, and fatigue. These are common symptoms of sinusitis. But there is help, and evidence shows that some solutions can be inexpensive and effective. Here’s what you need to know about taking care of your sinuses:

Paranasal Sinuses

Your sinuses are air-filled chambers located in the bones of your face; because they surround the nose, they are also known as “paranasal sinuses.” Each of us has four pairs of sinuses (see figure). Your sinuses make mucus, which cleans and moisturizes your nasal passages.

Sinus trouble begins when openings (ostia) become blocked. The most common way this occurs is due to sinus inflammation. Inflammation causes swelling, which makes it difficult for sinuses to drain. Once drainage is blocked, mucus builds up. This alone can feel uncomfortable, but it also gives bacteria a stagnant, moist environment in which to thrive, which can lead to infection.

The common cold, which is caused by a virus, is the most frequent trigger of sinus trouble. Typically, your body can fight off the virus that’s triggering sinus inflammation and blockage. However, a secondary bacterial infection can take hold.

Many other things though can block your sinuses and lead to infection. The list includes allergies, cigarette smoke and other irritating fumes, changes in barometric pressure during flying or scuba diving, nasal polyps, and a deviated nasal septum.

Symptoms

Painful pressure is the main symptom. Depending on which sinus is involved, the pain is in the forehead (frontal sinusitis), over the cheek or in the upper jaw and teeth (maxillary sinusitis), behind the eyes (ethmoid sinusitis), or at the top of the head (sphenoid sinusitis). Sinus pain usually increases when you bend forward.

Nasal congestion and a thick, dark-colored nasal discharge are also common. When the mucus drips into your throat from the back of your nose, you’ll notice a foul taste, and you may get bad breath or a cough. You may temporarily lose your sense of smell or taste. Finally, you may feel feverish, achy, and tired.

Diagnosis

In most cases, your doctor can diagnose sinusitis simply by asking about your symptoms. If pressing over your sinuses causes pain, sinusitis is likely. CT scans can be very helpful if your sinusitis is unusually severe or if your doctor suspects complications; plain x-rays are less useful. ENT (ear, nose and throat) specialists can also diagnose sinusitis by looking up your nose with a scope.

Treatment: Promoting Drainage

Many people with sinusitis will recover quickly and completely without taking antibiotics simply by promoting drainage. Here s what you should do:

• Drink lots of water. Good hydration helps keep the mucus thin and loose.

• Inhale steam. Linger in a hot shower. Boil a kettle, pour the water into a pan, and bend over the pan with a towel over your head to inhale the steam. Even hot tea or chicken soup will help; the secret ingredient is the steam. One way or another, inhale steam three or four times a day.

• Sleep with your head elevated. If your pain is only in one side, sleep with the pain-free side of your face on the pillow.

• Use decongestants. Tablets containing pseudoephedrine or phenylephrine are very helpful but may sometimes raise your blood pressure, speed your pulse, or make you jittery and keep you up at night. Nasal sprays containing phenylephrine or oxymetazoline don t have these side effects, but if you use them too often or for too long, your nose can become irritated or dependent on them.

• Ask your doctor about prescription nasal sprays containing steroids, particularly if you have allergies or if your sinusitis is stubborn.

• Use a saline (salt water) nasal spray to loosen mucus and rinse your sinuses. Here’s how to do nasal irrigation: Stir one teaspoon of salt into two cups of lukewarm water. Fill a small bulb syringe with the saltwater solution. Lean over your bathroom or kitchen sink, insert the tip of the syringe just inside one nostril, and gently squeeze the bulb. The water will run back out of the nostril and into the sink. Use at least one full bulb of solution. Then, repeat the procedure in the other nostril. If the salt solution stings your nose, use less salt, or add a big pinch of baking soda to the solution, to buffer it.

• Avoid antihistamines. They’re great for allergies and when your nose waters from a cold, but they make mucus thick and hard to drain, the last thing you want in sinusitis.

• A warm compress on your face may soothe sinus pain. Over-the-counter pain relievers such as aspirin or acetaminophen will help reduce pain and fever.

Antibiotics

You may be surprised that antibiotics are not listed as the first step in treatment. Indeed, antibiotics have been a great step forward in treating sinusitis, but they don’t work unless good drainage is achieved, and if good drainage is achieved, antibiotics are often not necessary.

Still, if your sinusitis does not improve with two to four days of drainage therapy — or if it’s very severe to begin with — your doctor may prescribe an antibiotic.

Chronic Sinusitis

Sinusitis that lasts more than three weeks or recurs more than three times a year is called chronic sinusitis. The most common cause is inadequately-treated acute sinusitis — and since the diagnosis and treatment of acute sinusitis have improved so much, chronic sinusitis is less common than it used to be.

Most patients with chronic sinusitis should benefit from an ENT evaluation, including endoscopy and a CT scan. That’s because anatomic problems such as nasal polyp or a deviated septum are sometimes responsible. Since allergies are often present in many cases, allergy testing may help.

As with acute sinusitis, the key to successful treatment is drainage. In the case of chronic sinusitis though, surgery may sometimes be required. Your ENT doctor may have to remove nasal polyps, straighten a deviated septum, or use endoscopic surgery to open a good drainage channel between the sinus and your nose.

Living With Your Sinuses

To protect your sinuses, stay well-hydrated. Avoid tobacco smoke and irritating fumes. If you have allergies, try to avoid the things that trigger symptoms. Do your best to prevent catching a cold by washing your hands properly and keeping your distance from cold sufferers. When you catch a cold, blow your nose properly to keep bacteria from floating into your sinuses. Treat symptoms of sinusitis promptly with steam inhalation, decongestants, and nasal irrigation. If you don’t recover as expected — or if you have serious sinusitis — see your doctor for antibiotics and, possibly, nasal steroids.

Acute sinusitis is common and uncomfortable. But if you know how to keep your sinuses open and draining freely, you can keep them healthy and happy!