Sinusitis: Only The Nose Knows
by Teri L. Gehring
December 19, 2009
In Biblical literature, the curse of Adam and Eve eating Garden of Eden’s “Forbidden Apple” has plagued humankind for centuries, including diseases. Bacteria and viruses are only two major components inflicting millions of people around the world, as both Influenza A and B viruses prominently seize at least 36,000 lives each year in the United States. Although heart disease is the number one killer of Americans annually, I have decided to direct this assignment to my own suffering ailment, which is none other than sinusitis. I was age five when I first noticed that my sinus infections would forever become a suffering way of life. As the years passed, my sinusitis only worsened; especially, when weather is cold, damp, and considerably humid. Sinusitis continues to baffle scientists, as it is a swelling of the inner lining of the sinus cavities.
Since community health workers cannot “diagnose” diseases, I shall pretend like I am a physician named “Dr. Teresa Gehring” and my patient is “Mrs. Cindy Sinus.” Cindy is a 35-year-old married woman living in Cincinnati, OH and she has chronically suffered from sinus infections for many years. Little does Cindy realize that there is no real “cure” for sinusitis, as only relieving techniques can help alleviate her pain temporarily, or longer term. Indeed, Western medicine treats only the symptoms, but never the true cause of one’s ailments, which by the way, I do not plan to damper my patient’s hopes of at least finite moments of relief. The nurse has just shown Cindy to my office, as I greet her with, “Good morning, Mrs. Sinus. I’m Dr. Gehring. What can I do for you today?” Cindy answers, “Hi, Doctor. My sinus infections continue getting worse and I don’t know what to do for it. It’s hard to breathe at times when my nose is constantly stuffed up and I cannot afford to move to a drier climate like Arizona. Please tell me what I can do, since my nose is constantly stuffed up and I get some terrible sinus headaches. My husband tells me I snore loudly at night, so do you think my sinus infections are causing this?”
Sad to say, I cannot offer Cindy a real cure for her sinusitis, since there currently is none. What I can offer my patient are ways she can help relief her sinus complications, as I explain to her what the sinuses are and how they can become infected. I go on to explain to Cindy, “Welcome to ‘Sinus Valley,’ Cindy, since Cincinnati, OH is considered one of the worst areas for sinus infections. The sinuses are the spaces between the bones in the face where air passes and a fluid called “mucus” drains into the nose. In sinusitis, the swelling blocks the openings in the sinuses through which mucus drains into the nose. When mucus cannot drain properly, the pressure of the blocked fluid inside the sinuses can be painful. There are numerous causes of particular allergens affecting different segments of the population, as it could be fungus; ragweed; pollen; dust; or any number of things. In your case, Cindy, I would recommend some tests to see which allergens, if any, are causing your sinus infections and even prescribe some antibiotics to you for the time being. If you are snoring at night, sinus congestion would definitely help cause this effect, as I bet you wake up tired in the morning. Correct?” At this point in conversation, Cindy is astonished, as she replies, “Yes, Doctor. How did you know I was tired all the time?”
Once my patient seemed to understand my assessment of her sinusitis condition, I said, “I know all about how miserable sinusitis can be, since I, myself, have this condition. Since there is a lack of oxygen in the body from nasal obstruction, I know the feeling of constant fatigue when my sinuses are congested. I am also going to check your nose today, in order to see if you have a deviated septum and the colored mucus contents . With a deviated septum, surgery may be warranted and the color of your mucus can help determine if you have chronic sinusitis, rhinitis, or a mixture of both alternating conditions. Today, Cindy, I am going to go over all options with you.”
Assuming Cindy has adequate health insurance, I proceed to look into her nose and explain different sinus relief methods to her. If Cindy was uninsured, chances are she would join over 47 million uninsured Americans in delaying medical care and choosing just to tolerate her ailment. For this assignment, my patient’s worries are far from having health insurance or affording a doctor’s visit. After I physically observe the interior of Cindy’s nose, I notice she has thick, greenish-yellow mucus, which indicates a painful sinus infection, along with her forehead being slightly hotter and redder than normal. At this moment in time, I further explain to my patient, “You definitely have sinusitis. There are over 37 Americans, who have sinus infections and it is quite common. It feels much like a head cold, with a stuffy or runny nose, along with a headache. For most people, sinusitis is a temporary condition that goes away with simple treatment. If the symptoms do not clear up easily, medication can help. In rare cases, surgery may bring permanent relief.” Cindy then replies, “What causes my horrible sinus infections?” In answer to my patient’s question, I went on to say, “The sinuses are the spaces between the bones of the face. Air passes in and out of these spaces, and mucus drains through them and out of the nose. The sinuses also reduce the weight of the skull and give our voices a nicer sound. There are four main pairs of sinus openings in the face, sometimes called “sinus cavities,” which are: Maxillary – in the cheekbones; Ethmoid – between the eye sockets; Frontal – in the forehead and above the eyebrows; and Sphenoid – deep in the head at the back of the nose. Each of these pairs of sinus openings has a channel that leads to the nose. These channels are quite narrow and can be easily blocked when the lining becomes swollen. This lining is called the ‘mucous membrane.’ This same mucous membrane forms the inner lining of the nose.”
After I explained how the sinuses operate, Cindy then asked, “Why did God ever create sinuses? All they do is cause nothing but pain and agony.” Having no real answer as to why God created sinus misery, I subtly answered Cindy’s question by saying, ” I would say that God made the mucous membrane in the nose and sinuses for our own personal air filter system, as they warm, moisten, and clean the air entering our bodies. The mucous membrane creates a clear, wet, slightly sticky mucus that gathers any dust, smoke, bacteria, or virus particles that may be floating in the air. Tiny hairs along the membrane called ‘cilia’ act as miniature oars, moving the mucus along, much like a conveyor belt through the sinuses and out the nose. When the mucus containing unwanted particles causes the sinus openings to become blocked and somehow reaches the nose and throat, our bodies prompt us to swallow, spit, sneeze, or cough them out of the body; but, at that point, cilia can no longer move the mucus through.”
My patient continued having her doubts about God’s sinus plan,’ as she asked, “I understand that God wanted our respiratory systems clean and free of germs and debris. Why does it have to be so miserable, like running nose, pain, and headaches, you know, the whole nine yards?” As a doctor, I am used to scrutinizing questioning, so I further explain, “The mucous membrane is also one of the body’s front-line defense systems. It releases chemicals that help destroy bacteria and viruses before they can attack. Rhinitis results in a basic runny nose, sometimes accompanied by facial pain and a headache. It is caused by a swelling of the nose’s mucous membrane only, rather than the mucous membrane of the sinuses. Rhinitis is much more common than sinusitis and is more frequently caused by allergies than by a bacteria or virus. Many people, especially children, experience rhinitis during the winter months as a reaction to the cold air. Most cases of sinusitis are actually a combination of rhinitis and sinusitis, meaning that the mucous membranes of both the nose and sinuses are swollen. This condition is sometimes called ‘rhinosinusitis.’ If your mucus is clear, but your nose experiences sinusitis symptoms, then this would be classified as rhinitis; however, since you told me your mucus is greenish-yellow, then indicates a sinus infection. From my own diagnosis, you have rhinosinusitis, which is are alternating bouts of rhinitis, like when air is extremely humid, damp, and cold, such as on a rainy or snowy day when you get a runny nose from going outside; yet, after you have recently been sick with a cold or flu, then this infection causes sinusitis.”
Cindy seemed surprised about my explanation pertaining to sinusitis and rhinitis, as she said, “You know, Doctor, I just got over the flu last week. I usually have clear, running mucus from my nose, as I heard that different mucus colors determines if a person has sinusitis or rhinitis. It seems like people call it ‘sinus infections,’ as I often times refer to my congested nose as having sinus problems. I just always assumed that I had constant sinus troubles, rather than calling it ‘rhinitis.’ I do notice that when weather is cold, damp, and either rainy or snowy, my sinus infections are ten times worse. When I was vacationing in New Mexico, I began having lots of sinus relief in the hotter, drier climate. My nose did not keep on running, nor did I have lots of aggravating pain in my face and nose when I was in New Mexico.” I then went on to confirm my patient’s own recorded analysis of herself by saying, “Almost everyone experiences rhinitis at some point in their lives, and the majority of people will also experience sinusitis. Sometimes, a simple head cold will turn into sinusitis if the body has difficulty fighting off the bacteria or virus that caused the cold. This is the case when body aches and fatigue from a cold go away, but the runny nose and postnasal drip symptoms continue to worsen. Like I said earlier, each year, sinusitis affects about 37 million Americans. It is the most frequently reported chronic condition in the United States and the fifth most common reason for taking an antibiotic . It accounts for more than 13 million doctor visits per year in the United States alone.”
After I further explained the differences between sinusitis and rhinitis, Cindy exclaims, “Wow! I never knew so many people had sinus problems! I guess I am one of many, who suffers from having a constantly stuffed up nose and headaches all the time. Kind of hard to figure out, huh? Where do I go from here?” Since I am only a primary care physician, I give my patient a referral to a highly respected ENT (Ear, Nose, and Throat) specialist named, “Dr. Fred Snorkeldorf” (“Snorkeldorf” is one of small Freakies figurines that children in 1960’s-1970’s enjoyed as boxed cereal prizes) as I reply, “I have an ENT specialist that I am going to refer you to, since he can analyze your sinus problems a lot better than I can. An ENT specialist can give you some x-rays and possibly surgery, if needed, and the one I highly recommend is Dr. Snorkeldorf. From what I can see, your septum is greatly deviated; therefore, Dr. Snorkeldorf may recommend surgery. In the meantime, using warm salt water to administer up your nose, and afterward, allowing water to drain out will temporarily clear any mucus congestions and give you relief. Have you ever heard of a ‘Neti pot?’ “
It did not take long for Cindy to glance at me in a bewildered manner, as she asked, “No, I never heard of a ‘Neti pot.’ What is it?” It was then that I went on to explain, “A ‘Neti pot’ has been used for centuries in India, as it looks like a tea kettle with a long spout. You can just fill up the Neti pot with warm water, then add salt, but not too much salt. All you do is go to your bathroom sink, tip your head back a bit, then pour salt water from the Neti pot into your nostrils. Just give it a few seconds and allow warm salt water to wash through your sinus cavities; afterward, bend your head down towards sink and spit out, in order to let water run out of your nose. The salt water will irrigate your congested sinus mucus for awhile, giving you better relief. Don’t forget to keep a Kleenex on hand each time you do this.”
Not surprisingly, Cindy asks, “Where can I find a Neti pot?” I had to think a few minutes before I replied, Walmart, K-Marts, or any department store should have Neti pots, or items like them. You can look in kitchen or lawn and garden supplies inside the store. You can use a long-spouted plant watering pot, or simply use a nose dropper from nasal drops, where you can pour warm salt water into another container and then use nasal dropper for your regime. As I discussed earlier, there is endoscopic surgery that is performed completely through the nostrils and helps wash out excessive mucus. For now, until you see an ENT specialist, I highly recommend that you make your own warm salt water solution at home to help irrigate any annoying sinus infections you have. There is also endoscopic sinus surgery to irrigate condensed mucus, as it entails not cutting the skin and can be done through the nasal passages. In addition to irrigating your sinuses with warm salt water, garlic tablets have been known to sharply curtail sinus suffering, as you can also find them in stores mentioned, or your local health food store. With everything said, is there anything else I can help you with, before you go today?”
“Time sure flies when you’re having fun,” as one would say! Indeed, my session with Cindy has lasted over half an hour, as she seemed more relaxed and confident, afterward. In answer to my polite question, Cindy replied, “I think you pretty well covered everything today, Doctor. Thanks a lot. Oh, by the way, I get my prescription medicine at Walgreens.” I did not hesitate to hand my patient some informative pamphlets and other information about sinusitis and rhinitis, in order for her to better educate herself on her painful ailments. As my patient was about to make her exit, I then recorded all the information needed and proceeded to phone Cindy’s pharmacy in reference to Penicillin medication I prescribed. I also handed Cindy her prescription note and said, “If there is anything else I can do for you, please don’t hesitate to call me. In the meantime, have a wonderful day.” It was then that Cindy thanked me and walked out the door towards reception area, as she has been my patient for over 10 years.
For more information about sinusitis suffering, please visit http://www.youtube.com/watch?=BdKdwd88xQE , as Cindy, herself, stars in this video called Pasha Snoring and Sinus Center Patient Stories: Cindy.
Nosing Through Sinusitis Pamphlets
In pamphlets distributed to my patient and many others, there is some of information that can be quite helpful in dealing with miserable sinus congestion symptoms. Today, there are over 37 million Americans suffering with sinus problems, as this is quite common. Medical costs for treatment of sinusitis in the United States are estimated at $2 billion per year. This does not include the few cases requiring more costly x-rays and surgery. Modern-day pollution has increased number of people suffering from allergies, resulting in sinusitis on the rise. Symptoms of sinusitis vary from person to person. While one person may have all of the symptoms, someone else may have only one or two of them. Acute sinusitis is usually painful, while chronic sinusitis is generally more uncomfortable. The most common symptoms are:
– Stuffy or runny nose.
– Clear, thin discharge from the nose (as in chronic sinusitis), or thick yellow or green discharge
from the nose, sometimes tinged with blood (as in acute sinusitis).
– Sneezing and/or coughing.
– Pain over the bridge of nose.
– Postnasal drip from nose into the throat.
– Headache that is worse in morning, when bending forward, or when riding an elevator.
– Frequent throat clearing.
– Itchy eyes and nose.
– Reduced sense of smell and/or taste.
– Bad breath.
– Fever and chills.
– Pain in roof of mouth or teeth.
– Face and eye pain.
If there is facial or eye pain, the condition is acute, and therefore, it is easy to tell which sinus openings are blocked. If blowing the nose does not bring forth enough mucus, a gentle massaging of the areas of facial pain can sometimes help reduce blockage. Less common symptoms, which may or may not be ccompanied by a stuffy nose, are: Earache; feeling of fullness in the ear; swelling and tenderness behind the ear; and/or ear popping due to mucus in the ear’s Eustachian tube, besides the following:
– Sore throat and hoarse voice caused by infected postnasal drip.
– Swelling of eye area due to spread of infection from sinuses to the eye.
– Severe headache with vomiting, which is a very rare symptom indicating possibility of meningitis caused
by infection spread to the brain.
The symptoms of sinusitis are very similar to those of the common cold. More prevalent in children, the symptoms may mimic a cold and only a doctor’s examination can determine the true cause. If the symptoms do not subside within 10 days, or if there is any fever, a doctor should be consulted. Like a head cold that moves into the chest, sinusitis and chest congestion often occur together. This is because the respiratory system of the chest and sinuses are connected to one another. Chest congestion and sinusitis also have similar causes.
Infections of the sinuses can become severe if not treated early and an infection of the chest can lead to pneumonia without early medical attention; therefore, people with conditions causing chest conditions, such as asthma or bronchitis, are especially prone to rhinitis and sinusitis. On a frequent basis, treating sinusitis can bring relief when all other courses of treatment have failed to improve breathing. Sinus relief is especially effective when polyps are present, or when a deviated septum prevents adequate passage of
air through the nose. While it is quite uncommon, sinusitis can become serious, especially in children. If left untreated, an infection that has spread to the eye can cause blindness. Spread of the infection into the brain can result in serious diseases, such as meningitis. Fortunately, with modern antibiotic treatments available, such spread of infection is very rare.
A doctor will not recommend surgery, unless symptoms have been chronic and frequent over a long period
of time, and either have not responded to medication or are especially severe. Sinus surgery can correct the following:
– Swelling and blockages caused by chronic sinusitis.
– Swelling and blockages caused by repeated attacks of acute sinusitis.
– Deviated septum.
– Polyps.
– Tumors.
While there are several different types of sinus surgery that may be recommended, endoscopic sinus surgery is rapidly becoming the preferred surgery of choice for more doctors. Endoscopic sinus surgery utilizes a thin, lighted instrument called an “endoscope.” The endoscope looks like a wide-angle camera lens, as the it is inserted into the nostrils, while the doctor looks inside the sinuses through an eyepiece. The endoscope beams a light into different parts of the nose and sinuses, allowing the doctor to see what is causing blockages. Surgical instruments can then be used next to the endoscope to remove the blockages and improve breathing. Unlike most traditional surgeries, endoscopic sinus surgery does not involve cutting through the skin, as it is performed entirely through the nostrils; therefore, most people can go home the very same day. Additionally, endoscopic sinus surgery leaves no visible scars and causes less pain and discomfort. Depending upon the extent of the surgery, a local anesthetic or general anesthetic may be used.
A sinus washout is a minor operation, which one of the maxillary sinuses, the pair closest to the cheekbones, is punctured with a small needle passed through the nose The excess mucus is then washed out of the sinus cavities. When the sinuses are clear and any infection or pus has been washed out, the swelling eventually goes down. The mucus membrane and cilia are then able to return to normal functioning. Sinus washouts are rarely painful and are usually performed under a local anesthetic, which means the person is awake, but cannot feel any pain in the area of the operation; however, the procedure can be uncomfortable, as the needle can create a crunching feeling and the washing of mucus can feel quite strange.
A general anesthetic, which puts the person completely to sleep, is preferred with children. Some adults may also feel more comfortable under general anesthesia. A doctor will usually diagnose sinusitis based on the symptoms reported and diagnose the ones he/she observes upon examination. Unfortunately, x-rays and magnetic resonance imaging (MRI) do not give an accurate picture of sinusitis; however, some doctors find an accurate picture of the sinuses through an x-ray of the head called a “CT scan” to be useful. The first thing the doctor will do is ask a patient about his/her symptoms, such as headaches, facial, or mouth pain; mucus drainage that is yellow or green; swelling around the eyes; and fever.
Sometimes, the doctor will simply massage or tap the areas of the face to determine which sinus openings are tender to the touch. Some doctors use tests to determine breathing capacity and swelling ability to make an accurate diagnosis. A specialist may choose to use an endoscope, which is a thin, lighted instrument inserted into the nostrils to view sinus blockages. Antibiotics typically clear up an infection within two weeks; however, in the case of chronic sinusitis, antibiotics may need to be taken for up to 28 days.
Treatments for sinusitis include:
– Antihistamines are somet mes used to block allergic reactions and dry mucus; but, they should be
used with caution, since they can cause severe drying of the mucus membranes.
– Decongestant nasal sprays are used short-term to reduce mucous membrane swelling; however,
long-term use of these sprays can cause other problems .
– Steroid nasal sprays also reduce swelling and are especially useful for treatment of sinusitis caused by a fungi.
– Saline nasal sprays or rinses, which consist of a salt solution, can be made at home or bought without
a prescription. Saline cleanses the nose and adds moisture to thin the mucus.
– “Cromolyn sodium” is a nasal spray under the brand name of Nasalcrom that can be used for short-
term relief of symptoms. Different antihistamines, decongestants, and steroids are best used only
when symptoms are at their worst, since it can cause side effects.
– Allergy shots on a regular basis for a selected period of time can be helpful when sinusitis is caused by
certain allergens.
Surgery can bring permanent relief when sinusitis symptoms do not respond to medications over time, or are the result of a nasal obstruction, such as polyps. Antihistamines should not be taken for more than a few days, as the main side effect is severe dryness of the mucous membrane and they prevent drainage necessary for healing. There are some new antihistamines called “histamine type 1 blockers,” which claim to cause less drying of the mucous membrane.
Decongestant nasal sprays should not be used for more than three days without instructions from a doctor. Long-term use of decongestant nasal sprays can cause a “rebound” condition that makes nasal congestion worse, as the swollen membrane becomes dependent upon the spray; therefore, decongestant nasal sprays are actually addictive. After three days of use, wait at least a week before using a decongestant, again. People who consistently use these sprays risk high blood pressure, as well as damage to the mucous membranes and heart. Low-dose steroid nasal sprays, on the other hand, have been found to be safe for a period of time, depending upon type of steroid prescribed.
To prevent attacks of sinusitis:
– Adopt a healthy lifestyle that includes exercise and a balanced diet.
– Keep air filtration systems in your home or workplace to keep air clean.
– Use nose plugs when swimming or diving in a pool, in order to prevent chlorine from irritating the sinuses.
– Drink plenty of fluids to maintain adequate moisture in the body.
– Use a humidifier if air is dry, especially during winter months when artificial heat intensifies air’s dryness.
– Avoid allergens whenever possible.
– Use coffee, tea, alcohol, and dairy products in moderation.
– Do not smoke and avoid secondhand smoke.
– Avoid stress as much as possible.
– Take vitamin supplements to maintain a healthy immune system.
– There is some evidence that garlic tablets (available at pharmacies and health food stores) can
help strengthen the immune system.
According to U.S. researchers, an identified protein causes nasal and sinus polyps in 15% to 30% of people, who suffer from chronic sinusitis. Consequently, overgrowths of sinus tissue called “polyps” can block sinus passages and make breathing difficult, or impossible to breathe through the nose, which leads to pain, swelling, and infections. Directions for future research are underway to target sinusitis sufferers by offering a possible nasal spray with an anti-VEGF agent, in order to help combat overgrowth of cell tissues producing painful polyps. For now, oral steroids will continue to temporarily relieve sinusitis problems, along with mandated surgery in more severe cases. There is more information about current research study in December 1, 2009 issue of American Journal of Respiratory and Critical Care Medicine.
There should be more to life than gagging on mucus and experiencing painful confrontations of sinus infections, as I sincerely hope my own personal experiences with this suffering dilemma helps Cindy and many other sinusitis victims. I am glad Cindy came to my office, since there are treatments to help alleviate many sinusitis symptoms. In the meantime, only a sinus sufferer’s “nose knows” the true congested misery. Eventually, over-the-counter Mucinex Spray’s “Mr. Mucus” and his snotty friends will become evicted from millions of people’s inflamed nostrils.
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