Question: What about immune deficiencies?
Answer: Researchers have recognized that immune deficiencies can be important to a pre-disposition to sinusitis. One notable immune deficiency is called secretory IGA deficiency. It is notable that IGA deficiency is always associated with an IGG subtype deficiency which may be reversed by the monthly administration of an intravenous immunoglobulin. This problem is more likely to be found in elderly patients who have failed to respond to adequate medical and surgical management. These patients should also receive the care of an infectious disease specialist.

Question: I thought sinusitis was an infection?
Answer: Infection is only one of many causes of inflammation of the sinuses. Signs of infection include fever, green and foul-smelling nasal drainage, and facial pain. Infection should be treated with antibiotics.

Is Sinusitis Common?

Question: Is sinusitis common?
Answer: Sinusitis is one of the most common health care complaints in the United States. Approximately one in eight people in the United States will have sinusitis at one time in their lives. The National Center for Disease Statistics reports that sinusitis is now the number one chronic illness for all age groups in the United States. The 1993 National Health Interview Survey found that sinusitis was the most commonly reported chronic disease, affecting approximately 14% of the United States population.

Sinus disease affects roughly 31 million people annually. Between 1990 and 1992, reports indicate that sinusitis sufferers had approximately 73 million days of restricted activity - a 50% increase from 4 years earlier! Sinusitis accounted for nearly 25 million physician office visits in the United States in 1993 and 1994. (Of course, many more cases are unreported and many patients suffer without seeing a physician, so the true incidence of sinusitis is unknown.)

Until recently, sinusitis has been an undertreated disease. Its drastic negative effect on quality of life has been generally unappreciated and unrecognized. Recent studies show that patients score the effects of chronic sinus disease in areas such as bodily pain and social functioning as more debilitating than diseases such as angina, congestive heart failure, emphysema, chronic bronchitis, and lower back pain, to name a few.

It is estimated that 2.2 billion dollars is spent yearly on prescription and non-prescription medication. Overall health expenditures for sinusitis in 1996 were estimated at approximately 5.8 billion dollars, with 1.8 billion of that being spent on children 12 years and younger.

Question: Is sinusitis getting the attention it deserves?
Answer: In the past, many patients were told they would just have to "live with it." Since the introduction of endoscopic techniques for diagnosis of sinus disease in the United States in 1985, increased attention has been directed to this problem.

Medical therapy may be recommended in the face of nasal symptoms and mucosal disease. Typical medications used in the treatment of mucosal disease include oral antibiotics, mucolytics, nasal steroid spray, nasal saline spray, oral decongestants, oral antihistamines, and steroids. The selection of appropriate medications is tailored to each patient (See Medical Treatment.

Question: Is sinusitis on the rise?
Answer: Perhaps because the air we breathe is becoming increasingly more polluted, sinusitis is on the rise.

Question: What are some of the factors that are important in causing the rise in sinusitis?
Answer: A number of factors are felt to be important in the increasing incidence in sinusitis. Irritated air pollutants and inhaled allergens are bad for the sinuses and are increasing. Global warming and the related increases in air pollution have also affected the sinuses. Cigarette smoke is also detrimental to the sinuses -- not only for the smokers, but also due to second-hand smoke.

Question: Is there any good news?
Answer: While the incidence of sinusitis is on the rise, there have also been enormous improvements during the past 15 years in the ability to diagnose and treat this problem. This is largely because of technological advances in nasal endoscopy and x-ray imaging, and the development of newer, more powerful medications.

Question: How does sinusitis develop? (In other words, why me?!)
Answer: In many people with sinusitis, the lining of the nose and sinuses is overly sensitive to a variety of factors. This is a problem to which a patient may be genetically predisposed. Factors to which the nose may react include environmental pollution and allergies, temperature changes, and possibly also stress and certain foods.

Environmental pollutants in the air can cause increased irritation of the nasal and sinus passages, particularly in people with hypersensitive nasal lining (mucosa). We are also becoming more aware of the effects of both general outdoor and indoor pollution. Chemicals used in the manufacturing of carpets, furniture, or buildings may also be a problem for sensitive individuals.

If you have allergies, your nose may react to allergy-inducing substances in the air, such as dust or mold. Allergic nasal and sinus swelling may in turn lead to sinusitis. Food allergies (or sensitivities) can also be an unrecognized cause of nasal congestion and swelling. Lastly, certain conditions that exist within your own body can increase your susceptibility to sinus infections. For example, periods of emotional stress can result in swelling of the nasal lining. Many female patients develop nasal swelling during pregnancy.

In patients with this type of hypersensitivity, these factors may cause more marked irritation and swelling, secondary sinus obstruction, and poor clearance of mucus. Should secondary chronic infection develop subsequently, the problem is typically made worse and the hyper-reactivity then further increases. Treatment of the infection, even when it is low-grade, may, over time, result in a significant improvement in the symptoms of hyper-reactivity.

Sinus Symptoms

Question: What causes the SYMPTOMS of sinusitis? In other words, why does the swelling of the sinuses make me feel bad? Why is it a problem?
Answer: You feel SYMPTOMS of sinusitis when the inflammation causes blockage of the small openings of the sinuses.

Question: What are the symptoms of sinusitis?
Answer: The symptoms of sinusitis include nasal blockage (the #1 symptom), facial pressure or pain, snoring, postnasal drainage, bad breath, fatigue, recurrent infections, tooth pain, loss of sense of smell, and others.

Question: What can I do about nasal blockage?
Answer: Nasal blockage has many causes. It is convenient to divide them into causes that are treated medically and causes that require surgical treatment.

Medical causes include the common cold (viral infection -- a temporary cause), bacterial sinusitis, allergy, sensitivity to dust, smoke, pollution and other irritants.

Surgical causes include anatomic abnormalities such as a deviated septum, nasal polyps, obstructed sinuses that do not improve with medication, over-enlarged turbinates, obstructing adenoids, and other causes. Sometimes, scarring from trauma or prior nasal surgery can cause nasal obstruction.

Chronic nasal obstruction must be evaluated by a specialist.

Question: What can I do about snoring?
Answer: There are many causes of snoring. One of them is nasal obstruction. Nasal obstruction causes you to breathe through your mouth; this causes greater vibration of the tissue in the back of your mouth and throat when you are sleeping and may lead to snoring or increased snoring. If you snore, you should check with a specialist to find out the cause. Maybe it is because of nasal blockage, in which case a simple nasal treatment may fix your problem!

Question: What can I do about postnasal drainage?
Answer: Postnasal drainage is a symptom that can be a result of rhinitis or sinusitis: Abnormal swelling of the nasal and sinus membranes causes them to produce thick abnormal mucus. This thick mucus can drain into the back of your throat and cause cough, sore throat, nasal blockage, and so forth.

Treatment of postnasal drainage includes treating the cause of the postnasal drainage. (See Medical Treatment of sinusitis).

Question: What can I do about bad breath?
Answer: A common cause of bad breath is thick postnasal drip. This thick mucus can be white, yellow or even green. If you have sinusitis, it is stagnant in your sinuses and becomes foul-smelling, then it drips back into your throat to give you bad breath. No mouthwash will take this bad breath away! You need to see a sinus specialist.

Question: What can I do about fatigue?
Answer: Chronic sinusitis - like any chronic illness - can take a lot out of you. It can decrease your energy and make you less productive. If you have fatigue, you should see your primary doctor to evaluate other causes, but if you have sinusitis, you should realize that this can be a contributing factor.

Question: What can I do about recurrent infections?
Answer: We must find out why you get recurrent infections and treat this problem! Some causes are unavoidable. For instance, if you have small children in elementary school who bring home cold after cold, you will have to wait until they grow older! (Actually, even in this situation we can often help you with preventive medical treatment).

However, if you have sinus blockage predisposing you to infections, medical and/or surgical therapy can help.

Question: What can I do about cough?
Answer: Two of the most common causes of cough are post-nasal drip and acid reflux. If you have a chronic cough, and especially if you smoke, it is critical that a specialist examine your larynx. You might also need a chest x-ray. Treatment of the cause -- postnasal drainage, acid reflux, or both -- should improve it or resolve your cough.

Question: What if my cough persists despite treatment?
Answer: Sometimes a cough can persist even after the cause has been treated. This might be a cough reflex. Often, the cough cycle must be broken by a cough suppressant prescribed by your doctor.

Also, re-examination for other causes is important when a cough persists.

Question: Any other general suggestions about treatment?
Answer: An important part of treatment of any of these various conditions is to avoid, whenever possible, the causative factor. If you smoke cigarettes, you should quit promptly. If you recognize a substance you are allergic to, you should avoid it as much as possible and consider treatment by a specialist. If you have any underlying medical condition or illness, you should be under the care of an appropriate physician.

Your general state of health and nutrition affects every part of your body, including your sinuses. For this reason, we advocate maintaining a healthy diet, including taking vitamin supplements, and getting regular exercise.

Facial Pain

Question: What can I do about facial pain/headache?
Answer: Facial pain and headaches have many causes. Tension headache, migraine headache, stress headache, cluster headaches, reflex sympathetic dystrophy, and more exist. Sinusitis does contribute to facial pressure and pain, and it can reduce your resistance to other kinds of headaches -- that is, sinusitis can lower your threshold or make you more disposed to another type of headache.

The complete and thorough evaluation of headache includes evaluation by a neurologist and often an ENT specialist. If you feel that your pain is probably more sinus-related, start with the sinus specialist. He/she will examine you thoroughly and search out all of the MANY causes of facial pain that can be treated. If nothing definitive is found, do not lose hope. Your specialist(s) may still be able to offer you effective treatment.

In a rare patient, ENT and neurologic exam finds no cause for the headache. In these cases, a Pain Management Specialist is enlisted to your team, with frequent positive results that are usually a surprise to the patient!

Question: Can sinus problems make my migraines worse?
Answer: YES. Sinusitis can lower your threshold for migraine headaches. In other words, it can cause you to have migraines more easily. It is commonly thought that sinusitis can act in some cases as a "trigger" for migraine headaches. Treatment of sinusitis may in some cases decrease the incidence of migraine headaches.

Tooth Pain

Question: What role do my teeth play in sinusitis?
Answer: Proper care of the maxillary teeth and gums can be a major factor in the prevention of maxillary sinusitis, because the molar teeth are just beneath the sinus floor. Also, sinusitis can irritate the tooth roots and cause tooth pain. In these cases, treating the sinusitis often causes relief from the tooth pain.

Sense of Smell and Taste

Question: Do sinus problems affect my sense of smell?
Answer: Smell and taste sensation go hand-in-hand. If you lose your sense of smell, then you probably also find that food is bland or tasteless. Also, this can be a more serious problem because you cannot tell if food is spoiled; and if something in the house is burning you would not be able to smell it.

The nerves for smell are located in a very small area high in the nasal cavity. Even a small amount of blockage in this location can cause you to lose sense of smell. (That's why you lose sense of smell when you have a cold, for instance). However, there are a number of other problems that can cause a loss of sense of smell, including tumors, and this MUST be evaluated by a specialist.

The Common Cold

Question: Is it true that the common cold can lead to a bacterial sinus infection?
Answer: A cold is a viral infection that typically goes away in a few days. Many episodes of acute sinusitis follow the common cold. When fluid taken from the sinuses of patients with acute bacterial sinusitis have been studied, cold viruses have invariably been found.

Viral infections destroy the cilia of the mucous membranes, and approximately six weeks are required for regeneration. Many doctors therefore believe that this is a predisposing factor for a bacterial sinusitis super-infection, since these patients have decreased mucus flow, thick abnormal mucus, and osteomeatal complex blockage.

In addition to problems such as the common cold, allergens and non-allergic pollutants are significant triggers to sinusitis. Irritants such as cigarette smoke, perfume, toxic chemicals, and other pollutants remain a problem for many patients.

Anatomic abnormalities can also predispose to acute sinusitis. These problems are typically easy to recognize and may be corrected surgically.

Question: Are some people more predisposed than others to colds, and also to sinusitis?
Answer: YES. If your nasal and sinus anatomy is particularly narrow, you are less able to tolerate the swelling of the nasal membrane lining that is caused by nasal irritants. Also, the nasal lining of some people is simply more sensitive than in others. For example, some people are very sensitive to cigarette smoke; their noses seem to "swell shut" almost immediately. Also, some people have severe allergies while others do not. These are two obvious examples, but the point is that the way each person's nose reacts to the world around them is unique, and based on genetic factors. Depending upon your anatomy, and depending upon how your nose reacts to the world around you, you may be more or less susceptible to sinusitis.

Smoking, Stress & Other Factors

Question: Does smoking affect my sinuses?
Answer: YES. Environmental pollutants in the air, such as cigarette smoke, can cause increased irritation of the nasal and sinus passages, particularly in people with hypersensitive nasal lining (mucosa). We are also becoming more aware of the effects of both general outdoor and indoor pollution. Chemicals used in the manufacturing of carpets, furniture, or buildings may also be a problem for sensitive individuals.

If you smoke, you should quit promptly. Smoking causes so many health problems besides sinusitis that are not the subject of this discussion. Just read the warning on the cigarette package, and talk to your family doctor. Please stop smoking!

Many surgeons feel that cigarette smoking is a contraindication to sinus surgery. In other words, it is unlikely that the sinus surgery will have much positive effect if you continue to damage your sinus linings with cigarette smoke.

Question: What else can be making my sinus problems worse?
Answer: Certain conditions that exist within your own body can increase your susceptibility to sinus infections. For example, periods of emotional stress can result in swelling of the nasal lining. Many female patients develop nasal swelling during pregnancy. Certain medications used to treat high blood pressure can also cause swelling of the nasal lining. Or, if you have diabetes, high blood sugar can make you more prone to infections in general. Certain relatively rare disorders such as Lupus, Cystic fibrosis, Wegener's disease, Sarcoidosis, and others are associated with difficult sinus problems. Be sure to inform your physician if you have, or suspect, any medical problems.

If you have any underlying medical condition or illness, you should be under the care of an appropriate physician.

Plane Travel

Question: If I have a sinus infection, can I travel by airplane?
Answer: Nasal congestion secondary to sinusitis and other conditions is a relative contraindication to air travel. This means that you should only travel by plane if you have first consulted with your physician. Your physician may determine that it is not safe for you to fly, or he or she may feel that you can fly with proper pre-treatment.

The risks of flying with nasal congestion include severe facial pain, damage to the eardrums including bleeding and perforation, dizziness or vertigo, sinus bleeding, and other even more serious conditions.

It is recommended that patients with nasal congestion take a systemic decongestant and also spray the nasal passages with a topical long-acting nasal decongestant before the flight and before the descent. You should check with your doctor to make sure that you can take these medications -- for instance, patients with high blood pressure may want to avoid these medications.

Patients with allergies may also take an antihistamine, under a doctor's supervision. In some cases, a doctor may wish to prescribe other medications such as oral prednisone a few days prior to travel. Medical care should be available at the patient's destination in case sinusitis develops.

Air travelers with sinusitis are also advised to chew gum, swallow frequently, and learn how to perform the Valsalva maneuver to clear their ears. One way to perform this maneuver is to hold the nose and gently generate pressure against the closed mouth and glottis every 30 seconds.