- The Washington Times - Monday, December 1, 2003

Breathing isn’t easy for Sheila Norman of Arlington. Since she was diagnosed with a serious lung condition about seven years ago, she has had major sinus problems, which have caused significant facial and jaw pain.

Despite four operations on her sinuses in four years, Ms. Norman, 46, must work continually to maintain healthy nasal passages. Once a week, her physician uses a machine to suck the mucus from her head, and she uses a modified water pick to perform a daily nasal wash.

Although she needs to maintain this routine indefinitely, Ms. Norman is glad she found the help she needed. Otherwise, she might have been put on a respirator because of her illness, Churg-Strauss syndrome.

“If you think you have sinus problems, you should have someone look at it,” she says. “You’d be very surprised how involved your sinuses are in respiratory health. There’s quite a bit doctors can do about your sinuses. They can do things you can’t imagine. It could be very simple to fix.”

Sinusitis, an inflammation of the hollow cavities within the cheekbones around the eyes and behind the nose, is a common sinus problem in the fall and winter. In fact, it affects more than 31 million Americans every year, according to the American Academy of Allergy, Asthma and Immunology in Milwaukee.

The condition can be caused by colds, allergies, problems in the immune system or structural problems in the nasal cavity, says Dr. Suzette Mikula, an otolaryngologist at Georgetown University Hospital in Northwest.

Both acute sinusitis and chronic sinusitis produce swelling in the sinus cavity, which causes mucus to stagnate and may trigger an infection. Acute sinusitis usually starts as a bacterial infection. If it doesn’t resolve in five to seven days, the patient probably needs antibiotics, Dr. Mikula says.

“If it lingers on and on without being treated with an antibiotic, it can change the nasal lining permanently,” Dr. Mikula says. “Then it won’t function as well. There may be chronic inflammation causing chronic sinus infections.”

As a recurring condition, chronic sinusitis, which appears at least two or three times a year, may be caused by a bacterial infection. It also may be caused by other triggers, such as narrow nasal cavities, allergies or weather changes.

“If you walked around with a clip on your nose and couldn’t breathe at all through the day, that’s what the problem [feels like],” she says. “Not only do they have nasal obstruction, they are having post-nasal drainage. It’s like walking around with a cold, with symptoms that never go away.”

The procedure that objectively distinguishes sinusitis from other ailments, such as a common cold, is a CAT scan, says Dr. Ziad Elias Deeb, chairman of the department of otorhinolaryngology at Washington Hospital Center in Northwest. However, he says the scan must be performed when the patient is healthy.

“If someone has a common cold and you take a CAT scan of the sinuses, you may show evidence of changes in the sinuses,” he says. “When the cold resolves, you repeat the scan, and the changes will disappear.”

Once someone is diagnosed with sinusitis, several treatment options are available. Although antibiotics are the best-known possibility, allergy medication, allergy shots, immunotherapy, nasal irrigation and nasal sprays can be used effectively under the supervision of a physician, Dr. Deeb says.

In extreme cases, surgery is performed on the inside of the nose. It causes no scaring on the outside of the face. The patient is put to sleep under general anesthesia. The sinuses are opened, and the inflamed tissue is removed to promote drainage and ventilation. If there are anatomical problems, such as an enlarged nasal bone, they will be corrected.

After surgery, the patient is followed until the sinus cavity heals. The patient receives routine checkups and cleanings and may continue with nasal irrigation and sprays until the sinuses are functioning normally. Unfortunately, many patients who have the operation have relief for a period of time, but their problems return eventually.

“Most problems can be resolved medically before resorting to surgery,” Dr. Deeb says. “At the same time, the nasal cavity is a target organ for many systemic problems, including ones that manifest themselves first with nasal symptoms. One of the first signs of HIV can be nasal congestion. In the past, one of the major signs of syphilis was nasal congestion.”

Further, pregnant women often suffer from nasal congestion during the third trimester, he says. If a pregnant woman gets a cold, she might not shake it until she delivers her child, because of elevated levels of hormones such as estrogen. Because nasal sprays can become addictive, he cautions women not to use them too heavily but to expect relief to come after giving birth.

Also, taking a dip in a swimming pool is not a good idea for a person with nasal congestion, Dr. Deeb says. Because the sinuses are close to the brain, if someone with acute sinusitis dives into a pool, bacteria in the water could cause an infection that travels to the eye or the brain.

“Chlorine in the water cannot sterilize it,” he says. “Even when you have a common cold, don’t put your head under. Don’t jump into the pool.”

People without sinusitis cannot imagine the misery the condition brings, says Dr. Brian A. Smart, fellow of the American Academy of Allergy, Asthma and Immunology. He is vice chairman of the organization’s sinusitis committee.

Figuring out the root of the problem can bring better treatment, he says. However, the natural remedy of nasal irrigation seems to relieve almost all patients. Lukewarm water with a small amount of salt and vinegar is poured through one nostril with the head tilted. The liquid should come out the other nostril, bringing mucus and scabbing.

“Many patients return and tell me they are surprised that they feel so much better,” he says. “The key for those people who are willing to do nasal saline is that they should do it two times plus per day.”

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