Allergies and Hay Fever
Antihistamines, Decongestants, and Cold Remedies
Continuous Positive Airway Pressure (CPAP)
Facial Sports Injuries
20 Questions About Your Sinuses
Allergic Rhinitis (Hay Fever)
Allergic Rhinitis, Sinusitis, and Rhinosinusitis
Antibiotics and Sinusitis
Deviated Septum
Do I Have Sinusitis?
How Allergies Affect your Child's Ears, Nose, and Throat
Injection Snoreplasty
Sinus Headaches
Sinus Pain: Can Over-the-Counter Medications Help?
Sinus Surgery

Allergies and Hay Fever

Insight into causes, treatment, and prevention

• Why does the body develop allergies?
• What allergens should be avoided?
• When should a doctor be consulted?
• and more…

Millions of Americans suffer from nasal allergies, commonly known as hay fever. Often fragrant flowers are blamed for the uncomfortable symptoms, yet they are rarely the cause; their pollens are too heavy to be airborne. An ear, nose, and throat specialist can help determine the substances causing your discomfort and develop a management plan that will help make life more enjoyable.

Why does the body develop allergies?

Allergy symptoms appear when the immune system reacts to an allergic substance that has entered the body as though it was an unwelcomed invader. The immune system will produce special antibodies capable of recognizing the same allergic substance if it enters the body at a later time.

When an allergen reenters the body, the immune system rapidly recognizes it causing a series of reactions. These reactions often involve tissue destruction, blood vessel dilation, and production of many inflammatory substances including histamine. Histamine produces common allergy symptoms such as itchy, watery eyes, nasal and sinus congestion, headaches, sneezing, scratchy throat, hives, shortness of breath, etc. Other less common symptoms are balance disturbances, skin irritations such as eczema, and even respiratory problems like asthma.

What allergens should be avoided?

Many common substances can be allergens. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs such as penicillin, and environmental pollutants commonly cause many to suffer allergic reactions.

Pollens

One of the most significant causes of allergic rhinitis in the United States is ragweed. It begins pollinating in late August and continues until the first frost. Late springtime pollens come from the grasses, i.e., timothy, orchard, red top, sweet vernal, Bermuda, Johnson, and some bluegrasses. Early springtime hay fever is most often caused by pollens of trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood, and alder. Colorful or fragrant flowering plants rarely cause allergy symptoms because their pollens are too heavy to be airborne.

Household allergens

Certain allergens are present all year long. These include house dust, pet danders, some foods and chemicals. Symptoms from these are frequently worse in the winter when the house is closed up and where there is poor ventilation.

Mold

Mold spores can also cause allergy problems. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Mold is also common in foods, such as cheese and fermented beverages.

How can allergies be managed?

Allergies are rarely life threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the quality of life. Considering the millions spent on antiallergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

For some allergy sufferers symptoms may be seasonal, but for others it is a year-round discomfort. Allergy symptom control is most successful when multiple management approaches are used simultaneously. They may include minimizing exposure to allergens, desensitization with allergy shots, and medications.

If used properly, medications, including antihistamines, nasal decongestant sprays, steroid sprays, saline sprays, and cortisone-type preparations, can be helpful. Even over-the-counter drugs can be beneficial, but some may cause drowsiness.

When should a doctor be consulted?

The most appropriate person to evaluate allergy problems is an otolaryngologist (ear, nose, and throat specialist). Aside from gathering a detailed history and completing a thorough examination of the ears, nose, throat, head, and neck, the doctor will offer advice on proper environmental control and evaluate the sinuses to determine if infection or structural abnormality (deviated septum, polyps) is contributing to the symptoms.

In addition, the doctor may advise testing to determine the specific allergen that is causing discomfort. In some cases immunotherapy or allergy shots may be recommended. Immunotherapy is a unique treatment because it induces the build up of protective antibodies to specific allergens.

Tips for reducing the exposure to common allergens

• Wear a pollen mask when mowing grass or house cleaning (most drugstores sell them).
• Change the air filters regularly in heating and air conditioning systems, and/or install an air purifier.
• Keep windows and doors closed during heavy pollen seasons.
• Rid the home of sources of mildew.
• Don’t allow dander-producing animals (i.e., cats, dogs, etc.) into the home and bedroom.
• Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic materials.
• Enclose mattress, box springs, and pillows in plastic barrier cloth.
• Use antihistamines and decongestants as necessary and as tolerated.
• Sleep with the head of the bed tilted upward. Elevating the head of the bed helps relieve nasal congestion.
• Observe general good health practices: exercise daily, do not smoke, avoid air pollutants, eat a balanced diet, and supplement diet with vitamins, especially C.
• Use a humidifier in the winter. Be sure to clean the humidifier regularly to avoid mold build-up.
• Discuss hay fever and allergy symptoms with a physician when experiencing an allergic reaction.

Antihistamines, Decongestants, and Cold Remedies

Insight into recommended use and side effects

• What are the side effects of antihistamines?
• Who should not use decongestants?
• What are combination remedies?
• and more…

Drugs for stuffy nose, sinus trouble, congestion and drainage, and the common cold constitute a large segment of the over-the-counter market for America’s pharmaceutical industry. Even though they do not cure allergies, sinusitis, colds, or the flu, they provide welcome relief for at least some of the discomforts of seasonal allergies and upper respiratory infections. However, it’s essential for consumers to read the ingredient labels, evaluate their symptoms, and choose the most appropriate remedy.

What are antihistamines?

Histamine is an important body chemical that is responsible for the congestion, sneezing, and runny nose and itching that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing these symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established, but they can also be very effective if taken after the onset of symptoms.

What are the side effects of antihistamines?

Most of the older over-the-counter antihistamines produce drowsiness, and are therefore not recommended for anyone who may be driving an automobile or operating equipment that could be dangerous. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome. Some of the newer over-the-counter and prescription antihistamines do not produce drowsiness.

Typical antihistamines include Benadryl®*, Chlor-Trimetron®*, Claritin®, Dimetane®*, Hismanal®, Nolahist®*, PBZ®*, Polaramine®, Seldane®, Tavist®*, Teldrin®, Zyrtec®, Allegra®, and Allavert®.

What are decongestants?

Congestion in the nose, sinuses, and chest is due to swollen, expanded, or dilated blood vessels in the membranes of the nose and air passages. These membranes, with a great capacity for expansion, have an abundant supply of blood vessels. Once the membranes swell, one becomes congested.

Decongestants help to shrink the blood vessels in the nasal membranes and allow the air passages to open up. Decongestants are chemically related to adrenaline, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants taken as a pill or liquid is a jittery or nervous feeling causing difficulty in going to sleep and elevating blood pressure and pulse rate.

Who should not use decongestants?

Decongestants should not be used by a patient who has an irregular heart rhythm, high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants in pill or liquid form are Dura-Vent®, Exgest®, Entex®, Propagest®, Novafed®*, and Sudafed®*.

* May be available over the counter without a prescription. Read labels carefully, and use only as directed.

Decongestants are also available over the counter in nasal spray form. This method of medication delivery brings immediate relief to the nasal mucous membranes without the usual side effects that accompany pills or liquids that are swallowed. Over-the-counter decongestant nose sprays should be reserved for urgent, emergency and short term use. Because repetitive use can lead to lack of effectiveness and return of the congestion, and thus lead to the urge to use more sprays more frequently, these medications often carry a warning label, “Do not use this product for more than three days.” This problem will only improve once the use of the nasal drops or spray is discontinued.

What are combination remedies?

Theoretically, if the side effects could be properly balanced, the sleepiness caused by antihistamines could be cancelled by the stimulation of decongestants. For instance, one might take the antihistamine only at night and take the decongestant alone in the daytime. Alternatively, one could take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use. Since no one reacts exactly the same as another to drug side effects, a consumer may wish to adjust the time of day the medications are taken until finding the combination that works best.

Antihistamines/decongestants: Many pharmaceutical companies have combined antihistamines and decongestants together in one pill.

Typical combinations of antihistamines with decongestants are: Actifed®*, A.R.M.®*, Chlor-Trimeton D®*, Claritin D®, Contac®*, CoPyronil 2®*, Deconamine®, Demazin®*, Dimetapp®*, Drixoral®*, Isoclor®*, Nolamine®, Novafed A®, Ornade®, Sudafed Plus®, Tavist D®*, Triaminic®*, and Trinalin®.

What should I look for in a “cold” remedy?

Decongestants and/or antihistamines are the principal ingredients in “cold” remedies, but drying agents, aspirin (or aspirin substitutes), and cough suppressants may also be added. Therefore, consumers should choose remedies with ingredients best suited to combat their own symptoms. If the label does not clearly state the ingredients and their functions, the consumer should ask the pharmacist to explain them.

Which medicine do I need?

The chart below makes it simple for you to determine which type of medicine is right for you based on the symptoms that each treats.

MEDICINE	SYMPTOMS RELIEVED	SIDE EFFECTS
Antihistamines	Sneezing Runny nose Stuffy nose Itchy eyes Congestion	Drowsiness Dry mouth & nose
Decongestants	Stuffy nose Congestion	Stimulation Insomnia Rapid heart beat
Combination of above	All of above	Any of above (more or less)

Continuous Positive Airway Pressure (CPAP)

Snoring Problems

Forty­-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons and it usually grows worse with age. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.

Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP), and jaw adjustment techniques.

What Is Continuous Positive Airway Pressure (CPAP)?

Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea.

If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.

Before the invention of the nasal CPAP, a recommended course of action for a patient with sleep apnea or habitual snoring was a tracheostomy, or creating a temporary opening in the windpipe. The CPAP treatment has been found to be nearly 100 percent effective in eliminating sleep apnea and snoring when used correctly and will eliminate the necessity of a surgical procedure.

With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not cure the problem. However, studies have shown that long­term compliance in wearing the nasal CPAP is about 70 percent. Some people have found the device to be claustrophobic or have difficulty using it when traveling. If you find that you cannot wear a nasal CPAP each night, a surgical solution might be necessary. Your otolaryngologist will advise you of the best course of action.

If you have significant sleep apnea, you may be a prime for CPAP. Your otolaryngologist will evaluate you and ask the following questions:

• Do you snore loudly and disturb your family and friends?
• Do you have daytime sleepiness?
• Do you wake up frequently in the middle of the night?
• Do you have frequent episodes of obstructed breathing during sleep?
• Do you have morning headaches or tiredness?

Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway.

Before receiving the nasal mask, you would need to have the proper CPAP pressure set during a "sleep study." This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

Facial Sports Injuries

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it's your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

What First Aid Supplies Should You Have on Hand in Case of An Emergency?

• sterile cloth or pads
• scissors
• ice pack
• tape
• sterile bandages
• cotton tipped swabs
• hydrogen peroxide
• nose drops
• antibiotic ointment
• eye pads
• cotton balls
• butterfly bandages

• Ask "Are you all right?" Determine whether the injured person is breathing and knows who and where they are.

• Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.

• Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.

• Look at the eyes to make sure they move in the same direction and that both pupils are the same size.

• If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

• Call for medical assistance (911).

• Do not move the victim, or remove helmets or protective gear.

• Do not give food, drink or medication until the extent of the injury has been determined.

• Remember HIV...be very careful around body fluids. In an emergency protect your hands with plastic bags.

• Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.

• Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.

• Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

• swelling and bruising, such as a black eye

• pain or numbness in the face, cheeks or lips

• double or blurred vision

• nosebleeds

• changes in teeth structure or ability to close mouth properly

It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.

If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

• deep skin cuts

• obvious deformity or fracture

• loss of facial movement

• persistent bleeding

• change in vision

• problems breathing and/or swallowing

• alterations in consciousness or facial movement

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

• breathing difficulties

• deformity of the nose

• persistent bleeding

• cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist-head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist -- head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention Of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

• Be sure the playing areas are large enough that players will not run into walls or other obstructions.

• Cover unremoveable goal posts and other structures with thick, protective padding.

• Carefully check equipment to be sure it is functioning properly.

• Require protective equipment - such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.

• Prepare athletes with warm-up exercises before engaging in intense team activity.

• In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes - check the path of travel, making sure there are no obstructing fences, wires or other obstacles.

• Enlist adequate adult supervision for all children's competitive sports.

20 Questions About Your Sinuses

Q. How common is sinusitis?

A. More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.

Q. What is sinusitis?

A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Q. What are the signs and symptoms of acute sinusitis?

A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough.

Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Q. How is acute sinusitis treated?

A. Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Q. What are the signs and symptoms of chronic sinusitis?

A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.

Q. What measures can be taken at home to relieve sinus pain?

A. Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.

Q. How effective are non-prescription nose drops or sprays?

A. Use of nonprescription drops or sprays might help control symptoms. However, extended use of non-prescription decongestant nasal sprays could aggravate symptoms and should not be used beyond their label recommendation. Saline nasal sprays or drops are safe for continuous use.

Q. How does a physician determine the best treatment for acute or chronic sinusitis?

A. To obtain the best treatment option, the physician needs to properly assess the patient' s history and symptoms and then progress through a structured physical examination.

Q. What should one expect during the physical examination for sinusitis?

A. At a specialist' s office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exist. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.

Q. What other diagnostic procedures might be taken?

A. Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

Q. What is nasal endoscopy?

A. An endoscope is a special fiber optic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas.

Q. Why does an ear, nose, and throat specialist perform nasal endoscopy?

A. Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient' s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that may cause recurrent sinusitis.

Q. What course of treatment will the physician recommend?

A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.

Q. Will any changes in lifestyle be suggested during treatment?

A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.

Q. When is sinus surgery necessary?

A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

Q. What does the surgical procedure entail?

A. The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.

Q. What does sinus surgery accomplish?

A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist--head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Q. What are the consequences of not treating infected sinuses?

A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Q. Where should sinus pain sufferers seek treatment?

A. If you suffer from severe sinus pain, you should seek treatment from an otolaryngologist--head and neck surgeon, a specialist who can treat your condition with medical and/or surgical remedies.

Allergic Rhinitis (Hay Fever)

Allergic rhinitis (hay fever) is an especially common chronic nasal problem in adolescents and young adults. Allergies to inhalants like pollen, dust, and animal dander begin to cause sinus and nasal symptoms in early childhood. Infants and young children are especially susceptible to allergic sensitivity to foods and indoor allergens.

What causes allergic rhinitis?

Allergic rhinitis typically results from two conditions: family history/genetic predisposition to allergic disease and exposure to allergens. Allergens are substances that produce an allergic response.

Children are not born with allergies but develop symptoms upon repeated exposure to environmental allergens. The earliest exposure is through food—and infants may develop eczema, nasal congestion, nasal discharge, and wheezing caused by one or more allergens (milk protein is the most common). Allergies can also contribute to repeated ear infections in children. In early childhood, indoor exposure to dust mites, animal dander, and mold spores may cause an allergic reaction, often lasting throughout the year. Outdoor allergens including pollen from trees, grasses, and weeds primarily cause seasonal symptoms.

The number of patients with allergic rhinitis has increased in the past decade, especially in urban areas. Before adolescence, twice as many boys as girls are affected; however, after adolescence, females are slightly more affected than males. Researchers have found that children born to a large family with several older siblings and day care attendance seem to have less likelihood of developing allergic disease later in life.

What are allergic rhinitis symptoms?

Symptoms can vary with the season and type of allergen and include sneezing, runny nose, nasal congestion, and itchy eyes and nose. A year-long exposure usually produces nasal congestion (chronic stuffy nose).

In children, allergen exposure and subsequent inflammation in the upper respiratory system cause nasal obstruction. This obstruction becomes worse with the gradual enlargement of the adenoid tissue and the tonsils inherent with age. Consequently, the young patient may have mouth-breathing, snoring, and sleep-disordered breathing such as obstructive sleep apnea. Sleep problems such as insomnia, bed-wetting, and sleepwalking may accompany these symptoms along with behavioral changes including short attention span, irritability, poor school performance, and excessive daytime sleepiness.

In these patients, upper respiratory infections such as colds and ear infections are more frequent and last longer. A child’s symptoms after exposure to pollutants such as tobacco smoke are usually amplified in the presence of ongoing allergic inflammation.

When should my child see a doctor?

If your child’s cold-like symptoms (sneezing and runny nose) persist for more than two weeks, it is appropriate to contact a physician.

Emergency treatment is rarely necessary except for upper airway obstruction causing severe sleep apnea or an anaphylactic reaction caused by exposure to a food allergen. Treatment of anaphylactic shock should be immediate and requires continued observation and care.

What happens during a physician visit?

The doctor will first obtain an extensive history about the child, the home environment, possible exposures, and progression of symptoms. Family history of atopic/allergic disease and the presence of other disorders such as eczema and asthma strongly support the diagnosis of allergic rhinitis. The physician will seek a link between the symptoms and exposure to certain allergens.

The physician will examine the skin, eyes, face and facial structures, ears, nose, and throat. In some cases, a nasal endoscopy may be performed. If the history and the physical exam suggest allergic rhinitis, a screening allergy test is ordered. This can be a blood test or a skin prick test. In most children it is easier to obtain a blood test known as the RadioAllergoSorbent Test or RAST. This test measures the amount of specific Immunoglobulin E antibodies (IgE) in the blood responding to various environmental and food allergens.

The skin test results, often immediately available, may be affected by the recent use of antihistamines and other medications, dermatologic conditions, and age of the patient. The blood test is not affected by medication, and results are usually available in several days.

How is allergic rhinitis treated?

The most common treatment recommendation is to have the child avoid the allergens causing the allergic sensitivity. The physician will work with caregivers to develop an avoidance strategy based on the nature of the allergen, exposure, and availability of avoidance measures.

Cost and lifestyle are important factors to consider. For mild, seasonal allergies, avoidance could be the most effective course of action. If pet dander is the offender, consideration should be given to removing the pet from the child’s environment.

Severe symptoms, multiple allergens, year-long exposure, and limited resources for environmental control may call for additional treatment measures. Nasal saline irrigations, nasal steroid sprays, and non-sedating antihistamines are indicated for symptom control. Nasal steroids are the most effective in reducing nasal symptoms of allergic rhinitis. A short burst of oral steroids may be appropriate for some patients with severe symptoms or to gain control during acute attacks.

If symptoms are severe and due to multiple allergens, the child is symptomatic more than six months in a year, and if all other measures fail, then immunotherapy (IT) (or desensitization) may be suggested. IT is delivered by injections of the allergen in doses that are increased incrementally to a maximum that is tolerated without a reaction. Maintenance injections can be delivered at increasing intervals starting from weekly to bi-weekly to monthly injections for up to three to five years. Children with pollen sensitivities benefit most from this treatment. IT is also effective in reducing the onset of pollen-induced asthma.

Allergic Rhinitis, Sinusitis, and Rhinosinusitis

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis.

Allergic Rhinitis occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result.

Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves.

Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

Non-Allergic Rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis

Recent studies by otolaryngologist–head and neck surgeons have better defined the association between rhinitis and sinusitis. They have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Most importantly, computed tomography (CT scan) findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages). Otolaryngologists, acknowledging the inter-relationship between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis.

The catalyst relating the two disorders is thought to involve nasal sinus overflow obstruction, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis. Likewise, chronic inflammation due to allergies can lead to obstruction and subsequent sinusitis.

Other medical research has supported the close relationship between allergic rhinitis and sinusitis. In a retrospective study on sinus abnormalities in 1,120 patients (from two to 87 years of age), thickening of the sinus mucosa was more commonly found in sinusitis patients during July, August, September, and December, months in which pollen, mold, and viral epidemics are prominent. A review of patients (four to 83 years of age) who had surgery to treat their chronic sinus conditions revealed that those with seasonal allergy and nasal polyps are more likely to experience a recurrence of their sinusitis.

Antibiotics and Sinusitis

An antibiotic is a soluble substance derived from a mold or bacterium that inhibits the growth of other microorganisms.

The first antibiotic was Penicillin, discovered by Alexander Fleming in 1929, but it was not until World War II that the effectiveness of antibiotics was acknowledged, and large-scale fermentation processes were developed for their production.

Acute sinusitis is one of many medical disorders that can be caused by a bacterial infection. However, it is important to remember that colds, allergies, and environmental irritants, which are more common than bacterial sinusitis, can also cause sinus problems. Antibiotics are effective only against sinus problems caused by a bacterial infection.

The following symptoms may indicate the presence of a bacterial infection in your sinuses:

• Pain in your cheeks or upper back teeth
• A lot of bright yellow or green drainage from your nose for more than 10 days
• No relief from decongestants, and/or
• Symptoms that get worse instead of better after your cold is gone.

Most patients with a clinical diagnosis of acute sinusitis caused by a bacterial infection improve without antibiotic treatment. The specialist will initially offer appropriate doses of analgesics (pain-relievers), antipyretics (fever reducers), and decongestants. However if symptoms persist, a treatment consisting of antibiotics may be recommended.

Antibiotic Treatment For Sinusitis

Antibiotics are labeled as narrow-spectrum drugs when they work against only a few types of bacteria. On the other hand, broad-spectrum antibiotics are more effective by attacking a wide range of bacteria, but are more likely to promote antibiotic resistance. For that reason, your ear, nose, and throat specialist will most likely prescribe narrow-spectrum antibiotics, which often cost less. He/she may recommend broad-spectrum antibiotics for infections that do not respond to treatment with narrow-spectrum drugs.

Acute Sinusitis

In most cases, antibiotics are prescribed for patients with specific findings of persistent purulent nasal discharge and facial pain or tenderness who are not improving after seven days or those with severe symptoms of rhinosinusitis, regardless of duration. On the basis of clinical trials, amoxicillin, doxycycline, or trimethoprim–sulfamethoxazole are preferred antibiotics.

Chronic Sinusitis

Even with a long regimen of antibiotics, chronic sinusitis symptoms can be difficult to treat. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis. When antibiotic treatment fails, allergy testing, desensitization, and/or surgery may be recommended as the most effective means for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.

Pediatric Sinusitis

Antibiotics that are unlikely to be effective in children who do not improve with amoxicillin include trimethoprim-sulfamethoxazole (Bactrim) and erythromycin-sulfisoxazole (Pediazole), because many bacteria are resistant to these older antibiotics. For children who do not respond to two courses of traditional antibiotics, the dose and length of antibiotic treatment is often expanded, or treatment with intravenous cefotaxime or ceftriaxone and/or a referral to an ENT specialist is recommended.

Deviated Septum

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A "deviated septum" occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.

A deviated septum may cause one or more of the following:

• Blockage of one or both nostrils
• Nasal congestion, sometimes one-sided
• Frequent nosebleeds
• Frequent sinus infections
• At times, facial pain, headaches, postnasal drip
• Noisy breathing during sleep (in infants and young children)

In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a "cold" (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the "cold" resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.

Diagnosis Of A Deviated Septum:

Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

Your First Visit:

After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.

Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty:

Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

Do I Have Sinusitis?

Sinusitis is inflammation of the lining membrane of any sinus. Take the following quiz to see if you have sinusitis.

Choose "yes" if you have any of the following symptoms for ten days or longer; otherwise, choose "no."

1. Facial pressure/pain?

     yes         no


2. Headache pain?

     yes         no


3. Congestion or stuffy nose?

     yes         no


4. Thick, yellow-green nasal discharge?

     yes         no


5. Low fever (99-100°)?

     yes         no


6. Bad breath?

     yes         no


7. Pain in the upper teeth?

     yes         no

If you answered "Yes" to three or more of the symptoms listed above, you may have a sinus infection resulting from allergies, bacteria, or a response to fungi. An examination by an ear, nose, and throat specialist may be warranted.

How Allergies Affect your Child's Ears, Nose, and Throat

Your child has been diagnosed with allergic rhinitis, a physiological response to specific allergens such as pet dander or ragweed. The symptoms are fairly simple -- a runny nose (rhinitis), watery eyes, and some periodic sneezing. The best solution is to administer over-the-counter antihistamine, and the problem will resolve on its own ….right?

Not really – the interrelated structures of the ears, nose, and throat can cause certain medical problems which trigger additional disorders – all with the possibility of serious consequences.

Simple hay fever can lead to long term problems in swallowing, sleeping, hearing, and breathing. Let’s see what else can happen to a child with a case of hay fever.

Ear infections:

One of children’s most common medical problems is otitis media, or middle ear infection. These infections are especially common in early childhood. They are even more common when children suffer from allergic rhinitis (hay fever) as well. Allergic inflammation can cause swelling in the nose and around the opening of the Eustachian tube (ear canal). This swelling has the potential to interfere with drainage of the middle ear. When bacteria laden discharge clogs the tube, infection is more likely.

Sore throats:

The hay fever allergens may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to "post-nasal drip." It can lead to cough, sore throats, and husky voice. Although more common in older people and in dry inland climates, thick, dry mucus can also irritate the throat and be hard to clear. Air conditioning, winter heating, and dehydration can aggravate the condition. Paradoxically, antihistamines will do so as well. Some newer antihistamines do not produce dryness.

Snoring:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis (hay fever) and perennial (year-round) allergic rhinitis. This allergic condition may have a debilitating effect on the nasal turbinates, the small, shelf-like, bony structures covered by mucous membranes (mucosa). The turbinates protrude into the nasal airway and help to warm, humidify, and cleanse air before it reaches the lungs. When exposed to allergens, the mucosa can become inflamed. The blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose. This inflammation, or rhinitis, can cause chronic nasal obstruction that affects individuals during the day and night.

Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, because the nasal airway is the normal breathing route during sleep. Once turbinate enlargement becomes chronic, it is irreversible except with surgical intervention.

Pediatric sinusitis:

Allergic rhinitis can cause enough inflammation to obstruct the openings to the sinuses. Consequently, a bacterial sinus infection occurs. The disease is similar for children and adults. Children may or may not complain of pain. However, in acute sinusitis, they will often have pain and typically have fever and a purulent nasal discharge. In chronic sinusitis, pain and fever are not evident. Some children may have mood or behavior changes. Most will have a purulent, runny nose and nasal congestion even to the point where they must mouth breathe. The infected sinus drains around the Eustachian tube, and therefore many of the children will also have a middle ear infection.

Seasonal allergic rhinitis may resolve after a short period. Administration of the proper over-the-counter antihistamines may alleviate the symptoms. However, if your child suffers from perennial (year round) allergic rhinitis, an examination by specialist will assist in preventing other ear, nose, and throat problems from occurring. 

Injection Snoreplasty

What Is Injection Snoreplasty?

Injection snoreplasty is a nonsurgical treatment for snoring that involves the injection of a hardening agent into the upper palate. Army researchers from Walter Reed Army Medical Center introduced this procedure at the 2000 Annual Meeting of the American Academy of Otolaryngology – Head and Neck Surgery Foundation.Their early findings indicate that this treatment may reduce the loudness and incidence of primary snoring (snoring without apnea, or cessation of breath).The Academy neither endorses nor discourages the use of injection snoreplasty for the treatment of snoring.

Those seeking injection snoreplasty to reduce snoring should first be screened for obstructive sleep apnea or OSA (frequent cessation of breathing due to upper airway obstruction) by undergoing a sleep test. If sleep apnea is confirmed, other treatment may be recommended.

Sinus Headaches

Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity.

Symptoms Of Sinusitis

Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:

• Pain and pressure around the eyes, across the cheeks and the forehead
• Achy feeling in the upper teeth
• Fever and chills
• Facial swelling
• Nasal stuffiness
• Yellow or green discharge

However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful. 

Treatment For A Sinus Headache

Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region – the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses.

There are several at-home steps that help prevent sinus headache or alleviate its pain. They include:

• Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower.
  
• Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day.
  
• Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution.
  
• Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you.
  
• Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended.
  
• Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed.

If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.

Sinus Pain: Can Over-the-Counter Medications Help?

Why Do We Suffer From Nasal And Sinus Discomfort?

The body's nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain, and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What Is The Role Of OTC Medication For Sinus Pain?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal Saline Sprays: Non-Medicated Nasal Sprays Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming "addicted" to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or "getting hooked on nasal sprays." The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as "non-drowsy" due to a side effect of stimulation of the nervous system.

Decongestant-Combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil Cold and Sinus® exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer non-sedating antihistamines are available.

Antihistamine-Decongestant Combination Products Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them "non-drowsy." The combined allergy product then relieves congestion and a runny nose.

Sinus Surgery

The ear, nose, and throat specialist will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.

A recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications.

A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.

Sinus Surgical Options Include:

Functional endoscopic sinus surgery (FESS): Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.

FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting.

Image guided surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult.

Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the United States armed forces to guide bombs to their target.

Caldwell Luc operation: Another option is the Caldwell-Luc operation, which relieves chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A “window” is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.