Q: I am a 48-year-old female and otherwise healthy, but I often get sinusitis. That happens mostly after a cold, but I can get it at other times as well. Do you have any suggestions how to stop this? I get such bad headaches with it that I have to take time off work.
A: Sinusitis is an inflammation or infection of the sinus cavities, mostly in the upper face at the sides of the nose. It can be caused by a viral infection, such as a cold or flu, or a bacterial infection. Fungal infection is also possible, but rare. Allergies can also lead to chronic or recurring sinusitis.
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Sinus problems are diagnosed as being recurrent if there are four or more episodes a year that last for 10 days or more, and you are clear of symptoms in between. They are labelled chronic if the symptoms last for 12 weeks or more with or without treatment.
Bacterial sinusitis usually starts with an upper respiratory tract infection that does not improve after two weeks or starts to get worse after five days. There is usually a stuffy nose accompanied by a yellowish green discharge. Facial pain, headache and even toothache are present accompanied by a fever. The facial pain typically gets worse if you lean forward and feels better if you lie on your back.
Other symptoms are bad breath, cough, earache and a reduced sense of smell. The face can be puffy, especially around the eyes, resulting in them appearing smaller than usual.
As many as 60 percent of cases of acute sinusitis get better without treatment, but the other 40 percent require antibiotics.
In your case, I would first try to rule out allergies by seeing if the sinusitis responds to antihistamines, or by avoiding the allergen. If this doesn’t help, I would assume you have a chronic or recurring infection. You may require a prolonged course of antibiotics with a drug such as Clavulin or Clindomycin that can handle the more resistant strains of bacteria. Putting salt water up your nose regularly can also be helpful and you may also need to use a topical nasal spray containing a steroid such as Nasocort.
Your doctor should recommend a visit to an ear, nose and throat specialist. Sometimes there is an anatomical anomaly that makes the sinus opening into the back of the nose too small, so that mucous cannot drain enough. Nasal polyps or a deviated nasal septum can also cause this. Surgery may be needed to make these openings larger.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
