ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, December 10, 1996 TAG: 9612100061
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: Jane Brody
Is that cold you caught two weeks ago still hanging on? Chances are it is no longer a cold but a sinus infection, and chances are it will not go away on its own.
In fact, failing to get prompt and proper medical treatment could result in serious complications or a chronic sinus problem that requires prolonged therapy and even surgery to correct.
Each year 35 million Americans develop sinus infections, the most common reason to see a doctor. Proper treatment of sinusitis requires an antibiotic because at least half the infections are bacterial and not self-curing.
But a new survey of 1,002 people who reported having had a cold, allergy or sinus infection during the previous year showed that three-fourths of those who had sinusitis treated themselves with over-the-counter medications, and 39 percent never saw a doctor about their problem.
The survey, conducted by Yankelovich Partners for the American Academy of Otolaryngology-Head and Neck Surgery, also found that most people were ignorant of the signs and symptoms of sinusitis and could not tell the difference between it and a cold or allergy.
What do you have?
Winter is prime time for sinusitis, which most often occurs as the aftermath of a cold. Any cold that persists or worsens after 7 to 10 days is most likely a sinus infection.
Other precipitating causes include nasal allergies and exposure to toxic fumes or air pollutants like tobacco smoke, both of which cause nasal tissues to swell, and obstructions resulting from a crooked nose, deviated septum, polyp, foreign body, tumor or even scar tissue from a previous sinus infection.
Sometimes an infection in an upper tooth can extend into the sinuses. People with immune deficiency diseases like AIDS and patients on immune-suppressing drugs are especially susceptible to sinusitis.
Normally, mucus that collects in the sinus cavities surrounding the eyes and nose is swept out into the nasal passages by millions of tiny hairs called cilia that cover the lining of the cavities and keep them sterile. But when the narrow passageways from the sinuses to the nose are blocked by swollen tissues from a cold or allergy or by physical obstructions, mucus collects in the sinuses and becomes a breeding ground for infectious organisms.
Increased pressure in blocked sinuses typically causes pain in the forehead, between and behind the eyes, or in the cheeks and upper teeth, depending upon which sinus cavities are involved.
Suspect an acute sinus infection if you have three or more of the following symptoms: facial pain or pressure; headache; congestion or stuffy nose; postnasal drip; thick, yellow-green nasal mucus; ``cold'' symptoms for more than 10 days; low-grade fever, bad breath or pain in your top teeth.
If what you have is ``just a cold,'' the nasal discharge will be thin and watery or thick and whitish, you are unlikely to have tooth pain or bad breath, and you should feel better within 10 days.
If your problem is an allergy, the nasal discharge will be thin, clear and watery, you will have no fever, tooth pain or bad breath, and symptoms will last from hours to weeks or months, depending on the cause of your allergy.
Untreated or inadequately treated sinus infections that persist for extended periods can develop into chronic sinusitis, in which the lining of the sinus cavities no longer can function properly. Headaches, facial pain and fever are less common in chronic sinusitis, but nasal congestion and unpleasant nasal secretions usually persist.
Infected mucus that drips from sinus cavities into the lower respiratory tract can cause or aggravate bronchitis, chronic cough and asthma. In rare cases, a sinus infection can spread to the eye or brain, a life-threatening complication that causes a severe headache and warrants immediate medical attention.
Prevention and treatment
You can reduce the likelihood of sinusitis by practicing good nasal hygiene.
If you develop a cold or allergy, use an oral or nasal spray decongestant for a few days (no longer than a week); take care when you blow your nose to block one nostril at a time and blow gently through the other; drink plenty of fluids to keep nasal secretions thin and watery; avoid air travel, or, if you must fly, use a long-acting nasal spray decongestant before takeoff, and control allergy attacks through avoidance of the cause (if possible), use of antihistamines when exposure is unavoidable or, if necessary, desensitization shots to increase your tolerance to the troublesome allergens.
The treatment of sinus infections has become an increasing challenge as more and more bacteria develop resistance to commonly used antibiotics. It takes a while for antibiotics to reach therapeutic levels in the sinus cavities, and failure to treat each infection with the full 10 or 14 days of the prescribed medication is a common cause of antibiotic resistance. Patients typically feel better after four or five days and nearly half stop taking the medication soon after.
Surviving bacteria may cause a recurrent acute infection or a low-grade chronic sinusitis. Furthermore, these surviving bacteria may evolve into ``superbugs'' that are difficult to treat.
Your doctor will choose an antibiotic that is likely to kill off the most common causes of sinusitis. Be sure to tell the doctor if you have a known or suspected allergy to penicillin. If you do not experience significant relief within five days, report that to the doctor, since a different medication may be needed.
Be sure to take every dose of the medication for the full length of the prescription. If the usual treatments fail to clear up the problem, ask to be referred to an otolaryngologist, who may have to extract a sample of sinus mucus to determine the precise cause of your infection and its sensitivity to different antibiotics.
You can speed your recovery and increase your comfort by taking measures that reduce swelling in the nose and sinuses and improve drainage. For several days use an oral or nasal spray decongestant (but be sure it is not combined with an antihistamine, which will dry and thicken secretions); inhale heated mist from a facial sauna device, steam bath, hot shower or by breathing through a hot, moist towel, and use saline nose drops. You can also use an over-the-counter painkiller like aspirin, acetaminophen or ibuprofen.
Chronic sinusitis requires a month of treatment: three weeks of antibiotics plus a month of steam inhalation and use of a steroid nasal spray and saline nose drops.
If this fails to clear up the problem, see an otolaryngologist for tests that may reveal a hidden cause. You may need surgery to clear away damaged sinus tissue and allow healthy tissue to grow back. Sinus surgery can now be done under local anesthesia on an outpatient basis by means of a scope inserted through the nose.
For more information
The American Academy of Otolaryngology-Head and Neck Surgery has produced a new educational pamphlet, ``Is It More Than Just a Cold or Allergy?'' a guide to identifying and treating sinusitis. To obtain a free copy call (800) 546-9493.
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