Alamo Asthma & Allergy Associates
Drs. Michael and Adrianne Vaughn

115 Gallery Circle
Suite 200
San Antonio, TX 78258
(Stone Oak MRI/Urgent Care Bldg.)
Tel: 210.499.0033
Fax: 210.404.0926

Sinusitis

The Nasal sinuses are hollow cavities found within the skull and located behind the eyes, the nose and the cheek bones. The primary function of these sinuses is to warm, moisten and filter the air passing through the nasal cavity. The sinuses also play a role in our ability to vocalize certain sounds.Sinusitis is an infection of the sinuses, and is most common in the winter months.  Sinusitis may last for months or even years (if inadequately treated), and sinusitis is often misdiagnosed as nasal allergies. This is especially true for young children who are often thought to be suffering with allergies during a sinus infection because their nasal drainage is observed to be “mostly clear” or because they have only nasal congestion. Nasal drainage, when present during sinusitis, can be either colored or clear. The accurate diagnosis of true nasal allergy can only be made by documenting the presence of allergic antibodies (IgE); either by skin testing or blood testing (RAST). Sinusitis can produce symptoms in the nose, eyes, throat, middle ear and even the lungs. Sinusitis may cause very noticeable symptoms such as facial pain, headache, thick nasal drainage or “post-nasal drip” (which may result in a productive cough). Conversely, sinusitis may cause only mild symptoms such as throat clearing, nasal congestion (with or without drainage), a non-productive “dry” cough, toothache (upper teeth), ear pain, balance problems, fatigue, or even concentration difficulties. Sinusitis is also a very common trigger of asthma symptoms in asthmatics. Only very rarely does a sinus infections cause a fever.

   There are two types of sinusitis: acute and chronic. Acute sinusitis is typically caused by a bacterial infection. It often develops as a late complication following a viral respiratory infection (“the common cold”). Sinusitis should be suspected whenever nasal symptoms last for more than 2 weeks. Acute sinusitis usually causes more prominent or noticeable symptoms than chronic sinusitis. Chronic sinusitis is also usually caused by bacterial infections however; this diagnosis requires that nasal symptoms be present for more than 6 weeks. When laboratory cultures are performed on chronically infected sinuses, multiple strains of bacteria are often found to co-exist. Each bacterial strain has its own unique antibiotic sensitivity profile and a single course of antibiotics will frequently fail to kill all the strains present in a chronically infected sinus.

     Although viral “colds” are the most common preceding cause of acute sinusitis, people who suffer with nasal allergies (allergic rhinitis) or environmental irritant sensitivity (non-allergic rhinitis) are also at risk for developing frequent sinusitis. These nasal problems cause swelling of the mucous membranes lining the sinuses. If the small opening of a normally hollow sinus cavity becomes blocked, mucous accumulation can occur. The inability to clear mucous from the sinuses allows for bacterial growth, which then leads to further mucous membrane inflammation and prolonged sinus obstruction.

   Most patients with recurring sinusitis have more than one problem that predisposes them to infection. Addressing all potentially relevant factors is key to successfully breaking this pattern. Persons with sinus problems should avoid environmental irritants such as tobacco smoke, and any other triggers which have been noted in the past to worsen their nasal symptoms. Environmental irritant sensitivity (Non-Allergic Rhinitis) causes symptoms that are nearly identical to those of true allergy (Allergic Rhinitis). Among persons suffering from allergic rhinitis, about 70% also suffer from non-allergic rhinitis. Unfortunately, some of the medications commonly used to treat Allergic Rhinitis (i.e. Claritin / Allegra / Zyrtec), have no significant effect on controlling the symptoms of Non-Allergic Rhinitis. Treatment of nasal inflammation with the appropriate medication(s) can often control nasal obstruction, thereby reducing the risk for developing recurrent infections. Making the correct diagnosis concerning the cause of the nasal symptoms is the most important factor in choosing the medication(s), which will most likely be effective for each individual.

   In addition to causing nasal inflammation as an irritant (non-allergic rhinitis), tobacco smoke exposure also adversely affects nasal cilia. Cilia are microscopic hair-like projections from the surface of the cells lining the respiratory system (mucous membranes).

Cilia beat in a coordinated fashion to move mucous and bacteria down and out of the sinuses and up and out of the lungs toward the back of the throat where they are normally swallowed. Smoke exposure causes the cilia to beat in an uncoordinated manner decreasing the normal clearance of mucous and bacterial. This is why children of smokers have a higher incidence of ear infections and why smokers have more bronchitis and sinusitis episodes than non-smokers. (See www.AlamoAsthma.com for “scientific studies” concerning tobacco smoke)

   Some people (both adults and children) who suffer from recurrent sinusitis have poor immunity to a bacterial organism that cause the majority of sinus infections: Streptococcus pneumonia. If there are low levels of protective antibodies (IgG) to these organisms in the blood, a person may get the same type of bacterial infection over and over again. Frequent nasal and ear infections occur even among normal healthy children under the age of two. Under normal circumstances, each new infection triggers the immune system into creating a long lasting protective IgG antibody response and over time, the frequency of these childhood infections normally decreases. We have noted that persons with poor immunity to these organisms often never seem to “out-grow” their frequent infection period. Children who have failed to develop protective antibody levels following their infancy immunizations with the pneumococcal (7 strain) vaccine are especially at risk for frequent infections. These immune system problems are easily diagnosed by blood testing and if present, are usually correctable by administering the appropriate booster vaccination(s). After age 2, if needed, children (and adults) can be immunized with a vaccine called “Pneumovax” containing 23 different varieties of Streptococcus pneumonia.

   Finally, structural problems inside the nose that narrow the air passages such as polyps, a deviated nasal septum (the bone and cartilage structure that separates the left and right sides of the nose), or enlarged adenoids may also contribute to the risk for recurrent sinusitis. Surgery is sometimes needed to correct these issues. Even if symptoms seem to be coming from the sinuses, the sinuses are not always infected. To make a correct diagnosis, a physician will need to take a history and perform a physical examination. The physician may also order testing to help determine the factors contributing to recurrent infection. These tests may include: allergy testing, immune system testing, or a CAT scan (which shows very precise images of the sinus cavities). In addition, it may be necessary to collect samples of the nasal secretions for evaluation or culture.

Treatment

 Sinus infections generally require treatment with a combination of therapies. Antibiotics may be given for 2 or more weeks and frequently more than one course of antibiotics may be required. Medications to reduce nasal blockage or control allergies may also be prescribed. These medicines may include: decongestants, mucus-thinning medicines, oral steroids, antihistamines, and/or topical nasal steroid sprays. For persons with year-round allergies or irritant sensitivity (non-allergic rhinitis), long-term daily anti-inflammatory treatment is often necessary to reduce the risk for recurrent infections. At times, effective treatment of “true” nasal allergies (allergic rhinitis) may require immunotherapy (also called "allergy shots"). Allergy shots are typically recommended only when available medications fail to adequately control allergic symptoms. Allergy shots do not improve symptoms of non-allergic rhinitis. In addition, the use of a saline sinus rinse solution, especially during an active sinus infection or after an allergen / irritant exposure, may also help to improve nasal symptoms. Occasionally, a sinusitis may be due to a fungal infection. If your physician suspects this, treatment with the anti-fungal medication Amphotericin B may be added to the saline sinus rinse.

   In cases of persistently obstructed sinus passages due to structural or anatomic problems, evaluation by an Otorhinolaryngologist (ENT), a medical specialist trained in the surgical correction of ear-nose-and throat problems, may be required.




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Asthma & Allergy Associates
115 Gallery Circle
Suite 200
San Antonio, TX 78258
(Stone Oak MRI/Urgent Care Bldg.)
Tel: 210.499.0033
Fax: 210.404.0926
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