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Seniors and Asthma
What you need to know about sinusitis Sinusitis is a very common problem, which can cause a great deal of misery. It is defined as inflammation of the lining of the nasal sinuses, which are hollow cavities behind the forehead, eyes and nose. Most sinusitis is caused by infections, which may be viral, bacterial, or, occasionally, fungal. An individual may have sinusitis if some of the following symptoms are present: cold symptoms for more than seven days, fatigue, cough, low-grade fever, sinus headache, toothache, facial pain, colored nasal discharge (especially green), or foul-tasting post-nasal drip. Sinusitis may also be present (and may have been present for a long time) if an individual has symptoms such as loss of sense of smell and taste, bad breath and chronic nasal and sinus congestion. Sinusitis often occurs in situations in which mucus cannot drain normally from the sinuses into the back of the nose and throat. Usually this happens when there is an obstruction of some kind, such as polyps, enlarged air cells within the inner folds of the nose, or, very often, thickening of the lining of the sinuses. The pores through which the sinuses drain are very tiny so thickening of the lining around the pores may lead to obstruction. A common cause of this thickening of the sinus lining is allergies. The management of sinusitis that has been present for a short period of time (acute sinusitis) is generally antibiotics and observation, whereas the management of sinusitis that has been present for a long time (chronic sinusitis) is often much more complicated. The management of chronic sinusitis may involve medications, such as antibiotics, antihistamines, decongestants, mucus thinning medications and anti-inflammatory nasal sprays. This more complex management plan has to do with the recent discovery that chronic sinusitis is usually caused by inflammation, not infection. The inflamed sinus lining, however, becomes an ideal environment for bacteria to move in. Therefore, infection does play a role in chronic sinusitis, but is usually not the initial cause of this condition. The management plan may also need to include further evaluation, such as a sinus x-ray or CT scan, to better define the extent of the sinusitis and to look for evidence of blockage. Allergy testing may also be useful in the evaluation of chronic sinusitis since allergies may predispose an individual to sinusitis. In fact, in at least 50% of people with chronic sinusitis, an allergy is involved. Allergists are trained in the evaluation and management of sinusitis whether allergies are present or not. If allergies are present, however, allergist/immunologists have additional tools, such as teaching about environmental controls, allergy medications and allergy immunotherapy (allergy shots) that may go a long way toward improving chronic sinusitis. Many people suffer from sinusitis symptoms and choose to "live through it." Sometimes, they get lucky and the sinusitis resolves. More often, the symptoms, such as facial pain and post-nasal drip, come and go for many months or years. An allergist/immunologist may be helpful in evaluating and treating this problem so that sinusitis sufferers may live more comfortable lives. Brian A. Smart, MD, FAAAAI, is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI) and a practicing allergist/immunologist at DuPage Medical Group in Glen Ellyn, IL. |
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