Your Health: Acute sinusitis: A painful inflammation

Sinuses are air pockets found in the bones of the skull. There are seven sinuses which are located on both sides of the nose, in between the eyes, and one deep behind the nose. Their true function is not well understood, but some have suggested that sinuses serve to lighten the weight of the skull, to humidify the air we breathe and to create resonance in our voices.
Acute sinusitis is an inflammation of the sinuses. This in turn causes the lining of the sinuses to become swollen. The swelling interferes with drainage of sinus fluid, thus filling up the space, which causes the typical pain. It is usually triggered by the common cold virus and less often by seasonal allergies (hay fever).
Sinus infections affect more than 30 million adults in the U.S. every year and cost the health care system about $3 billion to diagnose and treat.
Those who experience hay fever or any allergic condition that affects the sinuses are more at risk for sinusitis. Risk factors also include exposure to pollutants, such as cigarette smoke, and nasal passage abnormalities, such as a deviated septum or nasal polyps.
Common symptoms of a sinus infection are:
* Nasal obstruction with drainage of thick yellow or green mucus
* Pain, tenderness, swelling and pressure around the eyes or aching in the upper teeth
* Reduced sense of smell and taste
* A cough, often worse at night
If the above symptoms are combined with a fever greater than 100.5 degrees Fahrenheit, unbearable facial pain, or swelling and redness around the eyes and nose, that’s a reason to see a doctor immediately for a possible sinus infection.
Recommendations for treatment to relieve the symptoms include:
* Saline nasal irrigation: Over the past few years, since I have become familiar with this treatment, I have seen countless patients with sinus infections that might have needed antibiotics cure their infections with saline irrigation. “Neil Med” sells a rinsing system for less than $15 and can be found at all pharmacies.
* Decongestants: This includes over-the-counter medication, such as Sudafed. (Have the pharmacy tech help you find the generic alternative with the ingredient “pseudoephedrine.”) There are also nasal sprays, such as Neo-Synephrine or Afrin, either of which should be used for no more than one week. Remember to always read the labels on medications before using them.
* Nasal steroids:. These medications, which can be obtained with a doctor’s prescription, include Flonase and Nasonex, among others, and are used to prevent and treat nasal inflammation.
Because sinusitis is usually caused by a virus, my advice for those who have symptoms of a sinus infection is to treat the symptoms as outlined above for a week or two. Then, if symptoms worsen or do not improve, see a doctor.
When you do so, don’t expect or ask to be prescribed antibiotics. Just tell the doctor your symptoms and let him or her examine you and offer the treatment he or she feels is in your best interest. This might or might not include antibiotics. Trust your doctor’s advice.
 Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. A doctor with 36 years’ experience, he invites readers to view his previous columns at his website, http://valleydoctor.wordpress.com. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.