In Denver and Lone Tree, Colorado
Sinusitis Symptoms and Treatment
Many people suffer from chronic sinusitis. Some common symptoms are: runny nose, nasal congestion, loss of smell, and headaches. Unfortunately, after multiple attempts of prescription and non-prescription drugs, there are many who just can’t seem to get better.
In September 1999, the Mayo Clinic published an article stating that 93% of all chronic sinusitis is caused by mold – not as an allergic reaction, but rather as an immune system response to fungus.
Sinusitis develops by breathing in air particles, mold in most cases, that enter the sinuses and lungs. This causes an allergic reaction. Small pits form in the sinus mucosal surface, trapping mucous so that it cannot drain. The stagnant mucous gets infected which causes nasal polyps and thickening of the lining of the sinuses, obstructing the outflow of mucous. The polyps cause more infection and the infection causes more polyps, resulting 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 chlorophyll. Since they do not have chlorophyll, fungi must absorb food from dead organic matter. Fungi 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 life. Fungi are supposed to “eat” only dead things, but sometimes they start eating when the organism is still alive. This is the cause of fungal infections; the treatment selected has to eradicate the fungus to be effective.
In the past 30 years, there has been a significant increase in the number of recorded fungal infections. This can be attributed to increased public awareness, new 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 suppressed, fungi find an opportunity to invade the body and a number of side effects occur. Because these organisms do not require light for food production, they can live in a damp and dark environment. The sinuses, consisting of moist, dark cavities, are a natural home to the invading fungi. When this occurs, fungal sinusitis results.
Types Of Fungal Sinusitis
Mycetoma Fungal Sinusitis produces clumps of spores, a “fungal ball,” within a sinus cavity, most frequently the maxillary sinuses. The patient usually maintains an effective immune system, but may have experienced trauma or injury to the affected sinus(es). Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An 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 air. This 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 rhinitis, and the onset of AFS development is difficult to determine. Thick 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 present. Recurrence is not uncommon once the disease is removed. Anti-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 rhinosinusitis. The study found 96 percent of the study subjects with chronic rhinosinusitis to have a fungus in cultures of their nasal secretions. In sensitive individuals, the 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 fungi, and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation.
Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in patients without an identifiable immune deficiency. This form is generally found outside the US, most commonly in the Sudan and northern India. The disease progresses from months to years and presents symptoms that include chronic headache and progressive facial swelling that can cause visual impairment. Microscopically, chronic 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.
Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such 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 days, sometimes with a low-grade fever.
- Thick yellow-green nasal drainage.
- Post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting.
- Headache, usually in children age six or older.
- Irritability or fatigue.
- Swelling around the eyes.
Young children are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds) and they may be aggravated by allergies. However, if your child remains ill beyond the usual week to ten days, a 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 smoke, reducing his/her time at day care, and treating stomach acid reflux disease.
Sinusitis Treatment for Children
Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. Over-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 defined. Such medications should not be given to children younger than two years old.
If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. One 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 weeks, he or she may have chronic sinusitis. Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek an ENT specialist. We may recommend medical or surgical treatment of the sinuses.
Diagnosis of sinusitis: One of our doctors will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how completely your child’s sinuses are developed, where any blockage has occurred, and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infections, including structural changes, allergies, and 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 therapy. Using an instrument called an endoscope, one of our surgeons opens the natural drainage pathways of your child’s sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child’s sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections. Your 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 sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.
Sinusitis in Children Summary
Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, in most cases, children are successfully treated with antibiotic therapy. In the rare child, where medical therapy fails, surgical 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.S. residents will be 65 or older in 2030. Of all Americans 65 and older, 14.1 percent report that they suffer from chronic sinusitis; for those 75 years and older, the 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 part, sinusitis symptoms, diagnosis, and treatment are the same for the elderly as other adult age groups. However, there are special considerations for older patients.
Changing Physiology: With aging, the physiology and function of the nose changes; the nose lengthens and the nasal tip begins to droop due to weakening of the supporting cartilage. This in turn causes a restriction of nasal airflow, particularly at the nasal valve region (where the upper and lower lateral cartilages meet). Narrowing in this area results in the complaint of nasal obstruction, often referred to as geriatric rhinitis.
Patients with geriatric rhinitis typically complain of constant “sinus drainage”, a chronic need to clear the throat or “hawk” mucus, and a sense of nasal obstruction, most often when they lie down. Other 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.
However, it is a mistake to blame all upper respiratory problems on the aging process. Elderly patients with symptoms such as repeated sneezing; watery eyes; nasal obstruction with clear profuse watery runny nose; and soft, pale turbinates (top-shaped bones in the nose) may have allergic rhinitis. Patients 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 obstruction, headaches, and facial pressure. These patients usually have pus drainage and nasal redness. In contrast, the geriatric rhinitis patient usually has a dry, irritated nose. The diagnosis of chronic sinusitis can be confirmed with a computed tomography scan (CT scan) of the sinuses.
Sinusitis vs Rhinosinusitis
In recent studies, ENT surgeons have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Symptoms associated with rhinosinusitis include nasal obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial pressure and pain, alteration in the sense of smell, cough, fever, halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache. Patients 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 Americans, 15 to 20 million of whom are women over 45 years of age. Because of the concerns regarding prolonged estrogen use in postmenopausal women, a nasal calcitonin spray is sometimes prescribed to prevent bone loss. The 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 effects. The majority (80 to 85 percent) of the nation’s elderly have chronic diseases and take multiple drugs including over-the-counter medications, Placing them at higher risk for drug interactions than other patients.
Surgery For Geriatric Rhinitis: Nasal and sinus surgery is occasionally advised for older patients. Patients with structural abnormalities, such as a deviated septum or nasal valve collapse causing severe nasal problems, should be seen by one of our ENT specialists for evaluation and possible surgical management.
Sources For Aging Patients: Administration on Aging (AoA), U.S. Department of Health and Human Services; Geriatrics.