Sinusitis

What is Sinusitis?

Sinusitis, also called rhinosinusitis, is defined as inflammation, swollen irritated tissue, of the nasal and sinus cavity linings. Both areas are typically involved in sinusitis because the sinus linings can be described as an extension of the nasal lining, a “deeper” area of the upper respiratory tract. Rhinitis occurs commonly without sinusitis but it is uncommon for sinusitis to occur without rhinitis. The Board Certified Allergist is an expert in upper and lower respiratory tract allergy, evaluation and treatment. This includes patients with rhinosinusitis whether allergy is the primary or contributing cause or not.

The sinus cavities are primarily found within the cheek bones, around the eyes and behind the nose. The main function of these sinuses is to moisten and filter the air as an extension of the nasal cavity’s function. There is also a role in voice quality.

Inflammation of the nasal and sinus linings may be caused by allergy to inhalants such as pollens, mold spores, pet dander and house dust components, infections, tobacco smoke or other airborne irritants. Symptoms of sinusitis include mucus drainage, head congestion, fullness, pressure or headaches over the sinus cavities, cough, toothache and occasionally fever. However, also runny nose, mucus drainage, and irritated throat associated with nasal and sinus area headaches can be a common presentation of allergic rhinitis. Many people with “sinus” headaches actually have migraine or other types of headaches; therefore not all headaches localized to the sinuses are due to sinusitis.

Types of Sinusitis

There are two types of sinusitis, acute and chronic. Acute sinusitis is short in duration, typically days to a couple of weeks with symptoms completely resolving. The most common cause of acute sinusitis is a viral infection (e.g. common cold). A bacterial infection is suspected when symptoms persist beyond 10-14 days. Since most acute sinusitis episodes are not related to bacteria, antibiotics are usually not required. Symptomatic treatment may include decongestants, nasal saline irrigation or warm moist inhalation or a mild cough suppressant. If mucus is thick and colored, mucus thinning agents may be administered. If despite these therapies symptoms do not improve, an antibiotic may be considered.

Chronic sinusitis occurs when symptoms are on and off or continual for months and is potentially more serious. A more aggressive diagnostic and therapeutic approach is essential to improve the condition or if symptoms worsen or complications occur. These include progressively worse sinus disease or infection spreading to adjacent tissues and other areas of the respiratory tract. While chronic sinusitis may be related to bacterial infections, non-infectious causes of chronic sinusitis are common.

What is Hyperplastic Sinusitis?

Hyperplastic sinusitis involves inflamed sinus linings and may be seen in association with several conditions including asthma or nasal polyp disease. Individuals with frequent sinus infections may need to be evaluated for other conditions including allergic rhinitis, a structural abnormality such as an obstructing nasal septal deviation, or in some cases immunodeficiency. In addition, various environmental exposures may need to be evaluated. Also, regular or frequent use of decongestant nasal sprays, available without a prescription, can cause rhinosinusitis. The Board Certified Allergist can evaluate all of these areas. Evaluation may include allergy testing, sinus imaging (e.g. CT scan), immune function tests, analysis of nasal secretions or lining, and a flexible fiberoptic scope to more directly visualize the upper respiratory tract. Information from various tests are useful to develop an appropriate treatment plan c. A referral to an Otorhinolaryngologist, also known as Ear, Nose and Throat Surgeon may be needed if the condition cannot be controlled medically and an evaluation for surgical intervention is indicated.

Beware of frequent antibiotic use every time possible sinus symptoms arise as antibiotic resistance and allergy to antibiotics occur. Also, frequent use of oral and/or injected cortisone or steroids can create major permanent medical problems.

Lastly, “sinus headaches” may actually be a nasal related headache, migraine or another type. The Board Certified Allergist is skilled in evaluation and differentiation in these areas and can skillfully develop a more focused treatment plan.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

Sinus Headaches

Headaches can range from a nuisance to just plain miserable. In some circumstances, headaches can be a sign of a various serious medical problem. When they are sudden and extremely severe, you should seek immediate medical attention.

Chronic or recurring headaches are a common misery. They can keep you from enjoying your life. There are many potential causes to that pain in your head. Most people have heard of migraine headaches for example. Within the migraine family, there are numerous different types (common, classic, atypical, ocular, etc.). There are many different families in the headache area. You may be familiar with some of these as well. For example you may have heard of muscular headaches, tension headaches, stress headaches, cluster headaches, etc. Sinus headaches are another type of head pain that you may suffer with.

Sinus headaches may present as pain in your forehead, between your eyes, in your check bones or even what seems to be pain from your upper teeth. Sinus headaches can be caused from inflammation or swelling of the tissue that lines the sinus cavities (hollow places in the bones of your face and head). This swelling or inflammation may be due to allergies, infection, or irritating particles in the air. Sinus headaches can result from misaligned bones (such as a deviated septum or a bone spur on the septum). This could begin after an automobile accident or other trauma to your nose or face. Polyps (grape like extra growths of tissue) may also be involved in sinus headaches.

Sinus headaches are often responsive to medications that block the inflammation or swelling of the sinus tissue. Decongestants are also often helpful in sinus headaches (but are not safe for all to take, so check with your doctor). Sometimes saline nasal irrigation (washing the nose out with salt water) can alleviate a sinus headache.

If you think your headaches are sinus related, you should discuss this with your doctor. A board certified allergist will have the expertise you need to investigate a possible sinus origin to your headaches.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

Pollen Counts Over Texas

The Texas Allergy, Asthma and Immunology is proud to have several members who are affiliated with the National Allergy Bureau. These are allergists who take time to analyze air samples for what is currently in the air that could be affecting their patients. They then report their findings to the National Allergy Bureau website that you can access through www.aaaai.org/nab.

Pollens can vary in their occurrence depending on the time of year. In general, you can expect to have problems from these pollens if you are allergic to them. In Texas, the amount of pollen you may be exposed to may vary a great deal. For instance, people who live in Austin have a terrible time from Cedar starting in late December whereas those who live in El Paso may suffer from high mulberry counts later in the Spring. Grass generally pollinates from March through July and then also in September and October. Finally, Ragweed tends to be a problem for most allergic patients in September and October.

A board-certified or board –eligible allergist can help define for you what may be bothering you and thus help you make your plans for your season. Staying indoors with the doors and windows closed is the easiest but often the most inconvenient. Your allergist can make other recommendations to improve your quality of life. For more information about allergists in your area, look us up on the web at www.taais.org.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.