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Sinusitis a Seasonal Downer
Excerpt By Nancy A. Melville, HealthScoutNews

For most of us, autumn means carving pumpkins and raking colorful leaves, but for family doctors and allergists, it means another annual ritual of treating sinus infections.

According to the American Academy of Asthma, Allergy and Immunology (AAAAI), more than 18 million sinusitis sufferers participate in that "'ritual," showing up at doctors' offices each year with excessively runny noses, sinus headaches and other symptoms.

And those are just the people with serious enough symptoms to feel they require treatment. All told, the AAAAI estimates, 31 million Americans suffer a bout of sinusitis each year.

Sinusitis specifically involves an inflammation of the lining of the nasal sinuses, which are hollow cavities that lie behind the nose, around the eyes and even within the cheekbones. The inflammation is usually caused by a bacterial or viral infection.

For some, the infection is fleeting enough to be mistaken for an allergy or common cold. And in fact, the AAAAI reports, 60 to 70 percent of sinus infections do go away on their own.

But for many, the lingering symptoms may prompt the need for antibiotics before they'll subside.

Dr. John Costa, the medical director of Clinical Allergy at Boston's Brigham & Women's Hospital, says there are a number of symptoms that indicate a real case of sinusitis, and not just a cold.

"With a sinus infection, you might have pain in the cheekbones, forehead or bridge of the nose, and there is tenderness, headache, sometimes fever, and even sometimes aching of teeth and upper jaw," he explains.

"In fact, many patients will come to the doctor having been to the dentist first, only to have had them say, 'Your teeth are fine, but I can see on your X-ray that your sinuses have fluid,' " he adds.

That fluid, or mucus coming from the nose, is perhaps the most tell-tale evidence of a sinus infection. Unlike allergies, which cause a clear mucus, sinus infections produce a thick yellow or greenish nasal drainage -- and plenty of it.

Another reason it's sometimes hard to distinguish a sinus infection from a cold is because in most cases it's the cold that prompts the sinus infection in the first place, by swelling up the nasal passages that keep the sinuses clear, explains Costa.

"When an upper respiratory tract infection (or common cold) causes the tissue in the nose and sinuses to become swollen, you have an accumulation of mucus up in the sinuses. When that's unable to drain, it serves as a beautiful place to grow bacteria."

And voila! -- you've got a sinus infection.

Keeping those passages clear is a crucial factor in fending off, as well as treating, sinus infections, Costa says.

"If someone appears to have a sinus infection, it will be treated with an antibiotic," he adds. "But just as important is the use of something to help make sure that the nose opens so the sinuses can drain, because the point is to help make sure the sinus drainage pathways are open so that the actual infected material has a way to get out."

Regular decongestants can do that, but Costa warns that nasal sprays can quickly become addictive in the sense that after just a few days of usage, the spray can become necessary to decongest the nose. He advises taking decongestants like Sudafed in pill form instead, which doesn't have the addictive effect.

Also potentially impeding the treatment of many a sinus infection is the prescribed antibiotic treatment itself, adds Dr. Charles Feldman, a member of the AAAAI public education committee.

"There's a problem in doctors often not prescribing an antibiotic for a long-enough period to end the infection," he says.

"A family doctor might put a patient on something for seven days, and when the patient shows up and says, 'I'm no better,' the doctor tries another antibiotic for another seven days. And they might do this three times and still not have the right treatment. Meanwhile, the patient is suffering needlessly," he adds.

Effective treatment with an antibiotic usually requires taking the drug over a course of 14 to 20 days, Feldman says, along with the decongestant that's necessary to keep the nasal passages clear.

As if one or two sinus infections annually aren't bad enough, some people endure chronic sinus infections, suffering through them multiple times per year.

Costa says in those cases, saline cleansing kits sold at many drug stores can work wonders against infection.

"The simple act of doing a saline cleansing on a daily basis can dramatically reduce the incidence of sinus infection, because you're cleansing away the debris that accumulates and you're keeping the drainage pathways clear."

"As long as you keep those passages open, you have a good chance of clearing the infection without needing the antibiotics," he adds.

What to Do: Read more about sinusitis at the American Academy of Asthma, Allergy and Immunology.

Many sinus infections accompany the flu. For more information about prevention and control of the flu, visit the Centers for Disease Control and Prevention.


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