Roughly 37 million people will suffer from a sinus infection this year — but it’s important to know that every sinus infection is not created equal. Sinus problems arise from a spectrum of issues, and that’s why they range in severity.
Acute sinusitis (lasting less than four weeks) is most commonly caused by viral or bacterial infections, and even allergens or environmental irritants. Viruses usually cause the majority of acute sinus infections in the general population and can be associated with an upper respiratory infection. In cases of chronic sinusitis (lasting 12 weeks or more), the causes are more complex and can commonly be an interaction of recurrent acute sinusitis, asthma, allergic rhinitis, immune disorders or structural abnormalities like a deviated septum or nasal polyps.
Sinuses are more than a source of congestion. They lighten the weight of the skull, they help shape the sound of our voice and above all, they have an impact on our breathing. Our sinuses are one of our body’s first points of contact with the environment around us. When you breathe air in, the nasal passages warm and filter the air, preparing it for the lower respiratory tract.
[See: 7 Lifestyle Tips to Manage Your Asthma.]
When the Sinuses Don’t Play Nice
Most people don’t ever think about their sinuses until they get sick. The symptoms of nasal congestion, facial pain, pressure and nasal discharge can drastically decrease a person’s quality of life and have economic impacts (such as decreased productivity and missed work days) costing an estimated $12.8 billion per year.
Sinuses are more than just the hollow spaces housed by bones behind the face. There are four pairs of named sinuses that are connected to the nasal passages. The two larger pairs lay behind the forehead and cheekbones, while the smaller pairs are behind the nose and between the eyes, below the brain.
As an otolaryngologist who specializes in rhinology and head and neck surgery at The Ohio State University Wexner Medical Center, I like to tell my patients that the sinuses are like rooms in your head. These surface of the rooms are lined with carpet, called cilia. The cilia push debris and mucus out towards the doors of the sinus and out to the hallway known as the nasal passageway. Now when the doors of the sinuses swell shut or the cilia don’t work, or a combination of the two occurs, a sinus infection can take place.
Viruses cause the majority of acute sinusitis cases (they also cause many common colds). The virus is breathed in through the nose and can infect the sinuses. When this occurs, it causes an inflammatory reaction; as the immune response begins, the sinuses and nasal passageway swell and become inflamed. This is because white blood cells rush to this area to fight the virus. Acute sinusitis caused by viruses is typically short-lived and ends as soon as the cold is gone. Chronic sinusitis may develop from recurrent acute sinusitis that damages the function of the cilia or mucus clearance, or as a result of scarring from chronic inflammation.
In patients with chronic sinusitis, the situation is slightly more complex, as an interplay of many different factors can summate to produce this disease. These patients tend to have allergies, and instead of reacting to an antigen or foreign substance in the typical immune response, some patients have a tendency to elicit an allergic response, which has a marked increase in inflammation. This marked increase in inflammation can decrease the ability of the cilia to function properly and or swell the doors of the sinuses shut. Chronic sinusitis is a spectrum disease when looking at the general population, and a lot of this can not only be the interaction of people’s immune system with their environment, but also the interaction of the host with the different colonization of bacteria in the sinonasal cavity. For unknown reasons, these biodomes, or collection of bacterial flora, can turn pathogenic. Thus it’s important to understand the underlying pathological disease process and design an individualized treatment plan using several different clinical instruments. For some, that would include a tailored medical regimen including allergy testing and therapy when appropriate. For others, this treatment plan may be augmented to include surgery.
If you breathe in an allergen, virus, toxin or debris, the cilia are naturally going to try to push it out toward the doors to get it out of the sinuses. Occasionally, these allergens or toxins may overwhelm the sinuses, causing the doors to swell shut. In other words, the allergen or toxin causes an inflammatory reaction. The immune response causes release of inflammatory mediators such as histamine and leukotrienes, which can cause the secretion of mucus. Additionally, the blood vessels in the area dilate in preparation to fight the bacteria. White blood cells are also sent to the area where the bacteria and sinuses swell — which can lead to more blockage because there’s more room for mucus to build up. These circumstances are what typically leads to a sinus infection, also called sinusitis.
[See: How to Survive Ragweed Allergy Season.]
It Happens to (Almost) Everyone
Since we don’t live in a sterile world and are constantly breathing in irritating materials, almost all of us are going to get a sinus infection at some point. Everyone has a range of different traits that can add up to produce sinusitis, making treatment and diagnosis unique to the individual.
[See: Old-School Cold Remedies That Really Work.]
When the Swelling Never Stops
Chronic sinusitis occurs when symptoms persist. Someone with chronic sinusitis is constantly getting sinus infections, upwards of four or five per year. Although some patients may respond to antibiotics initially, the disease process can become resistant to antibiotics alone and will ultimately require surgery.
Treatment must be individually tailored and completely depends on the type of sinusitis the patient has, individual anatomic variations, medical comorbidities including asthma and allergic responses to antigens.
The primary reason people may need sinus surgery is because they’ve gotten into a cycle where medicines no longer work. For these patients, if their sinus swelling persists and keeps those doors shut, they could eventually scar shut.
The point of sinus surgery is to help reestablish normal function of the sinuses. The surgery is not going to completely cure the patient of sinus infections, but it will decrease the number of sinus infections they get and will make their sinuses more receptive to medications in the future.
Sinus surgery is tailored to each patient and depends on what parts of the sinuses are inflamed. They are in a very important area of the body — near the brain and eyes — so you have to be very accurate during surgery, within a fraction of a millimeter. Thus, there can be complications associated with aggressive surgical treatment.
To try and perfect this precise surgery, my team at The Ohio State University Wexner Medical Center is using 3-D technology to design customized models that can map out airflow patterns before we ever pick up a scalpel. We create these maps using fluid dynamics to simulate airflow through the sinuses. We liken the mapping technology to playing a videogame because it allows us to try multiple variations until we get the airflow we want. If we have the ability to better define airflow problems ahead of surgery, we can prevent patients from having complications later in a select subset of patients suffering from nasal obstruction.
For acute sinusitis, the problem usually improves on its own or with the help of antibiotics. Nasal irrigation can also help clear the sinuses. Chronic sinusitis can be treated in a variety of ways depending on the cause: viral, bacterial, fungal or polyps. Accurate diagnosis and at times antibiotics are typically recommended to treat acute infection. But often, many people can also develop chronic sinusitis because they have become resistant to antibiotics. For those with chronic sinusitis caused by allergies, antihistamines and immunotherapy may be treatment options to control the problems during allergy season. Nasal corticosteroid spray is suggested and is especially helpful for those with chronic sinusitis or allergic rhinitis.
If the patient is unresponsive to nonsurgical options, he or she be a candidate for surgery. Conventional surgical options include endoscopic sinus surgery or a balloon-catheter sinuplasty. I would caution patients, as balloon-catheter sinuplasty is only appropriate for a very small set of patients and the current surgical gold standard is functional endoscopic sinus surgery. This has been shown to most effectively open sinuses in an attempt to restore normal sinus function.
If you think you suffer from chronic sinusitis, speak with your primary care physician to get referred to an otolaryngologist. Don’t assume it’s just a minor nuisance — if your sinuses are having an impact on your quality of life, you deserve a solution.
Dr. Alexander Farag is an otolaryngologist who specializes in rhinology and skull base surgery at The Ohio State University Wexner Medical Center.
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Suffering from Sinus Infections? One Treatment Size Does Not Fit All originally appeared on usnews.com
