Sinusitis

In Denver and Lone Tree, Colorado

Sinusitis Symptoms and Treatment

Many people suffer from chronic sinusitisSome common symptoms are: runny nosenasal congestionloss of smelland headachesUnfortunatelyafter multiple attempts of prescription and non-prescription drugsthere are many who just can’t seem to get better.

In September 1999the Mayo Clinic published an article stating that 93% of all chronic sinusitis is caused by mold – not as an allergic reactionbut rather as an immune system response to fungus.

Sinusitis develops by breathing in air particlesmold in most casesthat enter the sinuses and lungsThis causes an allergic reactionSmall pits form in the sinus mucosal surfacetrapping mucous so that it cannot drainThe stagnant mucous gets infected which causes nasal polyps and thickening of the lining of the sinusesobstructing the outflow of mucousThe polyps cause more infection and the infection causes more polypsresulting in a self-perpetuating cycle.

How would one stop this vicious cycle?

  • Control the air fungi (mold) in your nose and in the air you breathe.
  • Normal saline nasal irrigation.
  • Antifungal and antibiotic Nasal Sprays.
  • Appropriate use of oral antibiotics antihistamine/decongestants.
  • Endoscopic sinus surgery.

Fungal Sinusitis Fungi are plant-like organisms that lack chlorophyllSince they do not have chlorophyllfungi must absorb food from dead organic matterFungi share with bacteria the important ability to break down complex organic substances of almost every type (cellulose) and are essential to the recycling of carbon and other elements in the cycle of lifeFungi are supposed to “eat” only dead thingsbut sometimes they start eating when the organism is still aliveThis is the cause of fungal infectionsthe treatment selected has to eradicate the fungus to be effective.

In the past 30 yearsthere has been a significant increase in the number of recorded fungal infectionsThis can be attributed to increased public awarenessnew immunosuppressive therapies (medications such as cyclosporine that “fool” the body’s immune system to prevent organ rejection)and overuse of antibiotics (anti-infectives).

When the body’s immune system is suppressedfungi find an opportunity to invade the body and a number of side effects occurBecause these organisms do not require light for food productionthey can live in a damp and dark environmentThe sinusesconsisting of moistdark cavitiesare a natural home to the invading fungiWhen this occursfungal sinusitis results.

Types Of Fungal Sinusitis

Mycetoma Fungal Sinusitis produces clumps of sporesa “fungal ball,” within a sinus cavitymost frequently the maxillary sinusesThe patient usually maintains an effective immune systembut may have experienced trauma or injury to the affected sinus(es)Generallythe fungus does not cause a significant inflammatory responsebut sinus discomfort occursThe noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinusAn anti-fungal therapy is generally not prescribed.

Allergic Fungal Sinusitis (AFS) is now believed to be an allergic reaction to environmental fungi that is finely dispersed into the airThis condition usually occurs in patients with an immunocompetent host (possessing the ability to mount a normal immune response)Patients diagnosed with AFS have a history of allergic rhinitisand the onset of AFS development is difficult to determineThick fungal debris and mucin (a secretion containing carbohydrate-rich glycoproteins) are developed in the sinus cavities and must be surgically removed so that the inciting allergen is no longer presentRecurrence is not uncommon once the disease is removedAnti-inflammatory medical therapy and immunotherapy are typically prescribed to prevent AFS recurrence.

Note: A 1999 study published in the Mayo Clinic Proceedings asserts that allergic fungal sinusitis is present in a significant majority of patients diagnosed with chronic rhinosinusitisThe study found 96 percent of the study subjects with chronic rhinosinusitis to have a fungus in cultures of their nasal secretionsIn sensitive individualsthe presence of fungus results in a disease process in which the body’s immune system sends eosinophils (white blood cells distinguished by their lobulated nuclei and the presence of large granules that attract the reddish-orange eosin stain) to attack fungiand the eosinophils irritate the membranes in the noseAs long as fungi remainso will the irritation.

Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in patients without an identifiable immune deficiencyThis form is generally found outside the USmost commonly in the Sudan and northern IndiaThe disease progresses from months to years and presents symptoms that include chronic headache and progressive facial swelling that can cause visual impairmentMicroscopicallychronic indolent sinusitis is characterized by a granulomatous inflammatory infiltrate (nodular shaped inflammatory lesions)A decreased immune system can place patients at risk for this invasive disease.

Fulminant Sinusitis is usually seen in the immunocompromised patient (an individual whose immunologic mechanism is deficient either because of an immunodeficiency disorder or because it has been rendered so by immunosuppressive agents)The disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain.

The recommended therapies for both chronic indolent and fulminant sinusitis are aggressive surgical removal of the fungal material and intravenous anti-fungal therapy.

Pediatric Sinusitis

Your child’s sinuses are not fully developed until late in the teen yearsAlthough smallthe maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birthUnlike in adultspediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problemssuch as viral illness and allergy.

Sinusitis Symptoms in Children

The following symptoms may indicate a sinus infection in your child:

  • A “cold” lasting more than 10 to 14 dayssometimes with a low-grade fever.
  • Thick yellow-green nasal drainage.
  • Post-nasal dripsometimes leading to or exhibited as sore throatcoughbad breathnausea and/or vomiting.
  • Headacheusually in children age six or older.
  • Irritability or fatigue.
  • Swelling around the eyes.

Young children are more prone to infections of the nosesinusand earsespecially in the first several years of lifeThese are most frequently caused by viral infections (colds) and they may be aggravated by allergiesHoweverif your child remains ill beyond the usual week to ten daysa sinus infection may be the cause.

You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smokereducing his/her time at day careand treating stomach acid reflux disease.

Sinusitis Treatment for Children

Acute sinusitis: Most children respond very well to antibiotic therapyNasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffinessNasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane functionOver-the-counter decongestants and antihistamines are not generally effective for viral upper respiratory infections in children and the role of such medications for treatment of sinusitis is not well definedSuch medications should not be given to children younger than two years old.

If your child has acute sinusitissymptoms should improve within the first few days of treatmentEven if your child improves dramatically within the first week of treatmentit is important that you complete the antibiotic therapyOne of our physicians may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis: If your child suffers from one or more symptoms of sinusitis for at least 12 weekshe or she may have chronic sinusitisChronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek an ENT specialistWe may recommend medical or surgical treatment of the sinuses.

Diagnosis of sinusitis: One of our doctors will examine his/her earsnoseand throatA thorough history and examination usually leads to the correct diagnosisOccasionallyspecial instruments will be used to look into the nose during the office visitAn x-ray called a CT scan may help to determine how completely your child’s sinuses are developedwhere any blockage has occurredand confirm the diagnosis of sinusitisThe doctor may look for factors that make your child more likely to get sinus infectionsincluding structural changesallergiesand problems with the immune system.

When is surgery for children necessary for sinusitis?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapyUsing an instrument called an endoscopeone of our surgeons opens the natural drainage pathways of your child’s sinuses and makes the narrow passages widerThis also allows for culturing so that antibiotics can be directed specifically against your child’s sinus infectionOpening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infectionsYour doctor may also advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis.

Although the adenoid tissue does not directly block the sinusesinfection of the adenoid tissuecalled adenoiditis (obstruction of the back of the nose)can cause many symptoms that are similar to sinusitis namelyrunny nosestuffy nosepost-nasal dripbad breathcoughand headache.

Sinusitis in Children Summary

Sinusitis in children is different than sinusitis in adultsChildren more often demonstrate a coughbad breathcrankinesslow energyand swelling around the eyes along with a thick yellow-green nasal or post-nasal dripOnce the diagnosis of sinusitis has been madein most caseschildren are successfully treated with antibiotic therapyIn the rare childwhere medical therapy failssurgical therapy can be used as a safe and effective method of treating sinus disease in children.

Sinusitis: Special Considerations for Aging Patients

More than 20 percent of U.Sresidents will be 65 or older in 2030Of all Americans 65 and older14.1 percent report that they suffer from chronic sinusitisfor those 75 years and olderthe rate declines to 13.5 percent.

Geriatric rhinitis complaints are:

  • Constant need to clear the throat.
  • A sense of nasal obstruction.
  • Nasal crusting.
  • Vague facial pressure.
  • Decreased sense of smell and taste.

For the most partsinusitis symptomsdiagnosisand treatment are the same for the elderly as other adult age groupsHoweverthere are special considerations for older patients.

Changing Physiology: With agingthe physiology and function of the nose changesthe nose lengthens and the nasal tip begins to droop due to weakening of the supporting cartilageThis in turn causes a restriction of nasal airflowparticularly at the nasal valve region (where the upper and lower lateral cartilages meet)Narrowing in this area results in the complaint of nasal obstructionoften referred to as geriatric rhinitis.

Patients with geriatric rhinitis typically complain of constant “sinus drainage”a chronic need to clear the throat or “hawk” mucusand a sense of nasal obstructionmost often when they lie downOther features include nasal crusting (especially in the winter and in patients taking diuretics)vague facial pressure (attributed to “sinus trouble”)and a decreased sense of smell and taste.

Howeverit is a mistake to blame all upper respiratory problems on the aging processElderly patients with symptoms such as repeated sneezingwatery eyesnasal obstruction with clear profuse watery runny noseand softpale turbinates (top-shaped bones in the nose) may have allergic rhinitisPatients with this diagnosis will benefit from consultation with an otolaryngic allergist.

Patients with chronic sinusitis will have a long history of thick drainage that is often foul smelling and tasting and is associated with nasal obstructionheadachesand facial pressureThese patients usually have pus drainage and nasal rednessIn contrastthe geriatric rhinitis patient usually has a dryirritated noseThe diagnosis of chronic sinusitis can be confirmed with a computed tomography scan (CT scan) of the sinuses.

Sinusitis vs Rhinosinusitis

In recent studiesENT surgeons have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitisThe symptomsnasal obstruction/discharge and loss of smelloccur in both disordersSymptoms associated with rhinosinusitis include nasal obstructionnasal congestionnasal dischargenasal purulencepostnasal dripfacial pressure and painalteration in the sense of smellcoughfeverhalitosisfatiguedental painpharyngitisotologic symptoms (e.g., ear fullness and clicking)and headachePatients with documented chronic sinusitis unresponsive to medications should see one of our ENT specialists.

Osteoporosis: Osteoporosis is a significant health problem in the United States affecting approximately 24 million Americans15 to 20 million of whom are women over 45 years of ageBecause of the concerns regarding prolonged estrogen use in postmenopausal womena nasal calcitonin spray is sometimes prescribed to prevent bone lossThe most common side effect reported with nasal calcitonin spray is a runny nose.

Other symptoms that may occur include: nasal crust, dryness, redness, irritation, sinusitis, nosebleeds, and headache. Sinusitis sufferers using a nasal calcitonin spray should inform their physicians.

Medications For Geriatric Rhinitis: Treatment for this age group needs to be more individualized to meet the patient’s slower metabolism and the increasing potential for side effectsThe majority (80 to 85 percent) of the nation’s elderly have chronic diseases and take multiple drugs including over-the-counter medicationsPlacing them at higher risk for drug interactions than other patients.

Surgery For Geriatric Rhinitis: Nasal and sinus surgery is occasionally advised for older patientsPatients with structural abnormalitiessuch as a deviated septum or nasal valve collapse causing severe nasal problemsshould be seen by one of our ENT specialists for evaluation and possible surgical management.

Sources For Aging Patients: Administration on Aging (AoA)U.SDepartment of Health and Human ServicesGeriatrics.