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Understanding Chronic Sinus Problems

By Rob O’Bert, MD, Otolaryngologist On staff at Missouri Baptist Medical Center and a member of BJC Medical Group of Missouri | Posted: June 2011

Anything that obstructs sinus flow may cause a buildup of mucus in the sinuses, infection and inflammation. Sinuses are air-filled cavities within the facial skeleton. There are four sinuses on each side. Their precise purpose is unknown, but they do help filter and humidify the air we breathe, lighten the weight of the skull and provide a “crumple zone,” protecting the brain and eyes in case of severe facial trauma. Sinuses are covered with a mucus layer and cells that contain little hairs on their surfaces called cilia. These help trap and push out bacteria and pollutants. Each sinus has an opening (about the diameter of a straw) that allows mucus to drain. This drainage is essential to keeping you healthy and your sinuses working well. 

A sinus infection generally occurs when the openings of the sinus cavities become swollen shut for too long (10 to 14 days). Swelling usually results from a viral illness or allergy flare-up.  Symptoms include nasal drainage, congestion, decreased smell and taste, headache, facial and upper teeth pain, and fatigue.

Many patients ask me how they can tell the difference between a sinus infection and a cold.  Symptoms are similar. With an infection symptoms don’t go away. If your symptoms persist for more than 10 days, you may have a sinus infec­tion and should see your primary care physician. A sinus infection less than a few weeks duration is considered acute sinusitis. 

If these symptoms persist beyond six weeks, you may have chronic sinusitis. Chronic sinusitis affects more than seven million people annually.  While anti­biotics may have killed the infection, chronic inflammation caused by the infection continues to produce many of the same symptoms. Some patients with chronic sinusitis also have polyps, which are grape-like growths of inflammatory tissue that block the sinus openings and may be related to allergies.

Acute sinus infections are typically treated with a combination of medications. A nasal decongestant, such as Afrin®, used for four days, will help open up the sinus allowing better drainage (do not use longer than four days, as it can worsen sinus problems). Saline sinus irrigations also are very beneficial, especially the squeeze bottle varieties. Antibiotics and/or a nasal steroid spray are also prescribed, depending upon symptoms. 

Surgery may be beneficial for those patients with chronic sinusitis who do not respond to traditional medical thera­pies. The goal of surgery is to enlarge the natural openings of the sinuses, and remove infected or inflamed membranes. One of the benefits of surgery is decreasing the likelihood of developing chronic sinusitis in the future because the sinus openings are larger and unlikely to swell shut with future colds or allergy flare-ups.

Techniques of sinus surgery have evolved significantly over the last several years. Some patients are even candidates for an extremely minimally invasive approach known as balloon sinuplasty. With this technique the sinus openings are dilated with a balloon without removing any tissue, allowing for less postoperative pain and a quicker recovery.   Hopefully, having this knowledge helps you breathe more easily.

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