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Macmillan Childrens Publishing Group

Sinusitis Relief

Harvey Plasse, M.D., and Shelagh Ryan Masline

Holt Paperbacks

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Sinusitis Relief

CHAPTER 1
What Is Sinusitis?
If you're reading this book, you probably picked it up because you or someone you know suffers from sinus problems ... and you're looking for some answers. Sinusitis, which afflicts more than 30 million people in this country, is one of the most common health problems facing Americans today. Perhaps even more surprising, people who have this disease report more pain, depression, and fatigue in their lives than even those who have heart disease or chronic back pain. Yet because sinusitis is so poorly understood, people often suffer in silence, failing to receive proper diagnosis and treatment.
WHAT IS SINUSITIS?
Sinusitis is the term used to describe sinus disease.
• Because sinus and nasal disease are so closely linked, you may also hear your doctor refer to the two jointly as rhinosinusitis. The prefix "rhino," from the Greek, means "nose."

SINUSITIS: A PRIMER
The suffix "itis" means inflammation, and sinusitis is an inflammation of the mucous membranes lining one or more of the hollow sinuscavities in the skull. Sinusitis has grown increasingly common over the course of the last decade or so. Although no one knows exactly why, experts speculate that forces such as increased environmental pollution and immune impairment are at work. But whatever the explanation turns out to be, sinus sufferers in this country are making more than 10 million visits to the doctor each year. As a result, physicians write over 13 million antibiotic prescriptions--adding up to a staggering annual tab of more than $3 billion, and literally millions of days lost yearly from work and school. Still more cases of sinusitis go undiagnosed. People mistakenly believe that their symptoms are due to recurrent allergies or colds when, in fact, they have a common condition that responds extremely well to appropriate treatment.
KEY FACTS ABOUT SINUSITIS
• Sinusitis develops in more than 30 million Americans annually.
• Each year an average of four days of work per person is lost because of acute sinusitis.
• Although chronic sinusitis is not as common as acute sinusitis, it is the most common chronic disease in the United States today, affecting 14 percent of the population.
• Most cases of sinusitis are preceded by a cold.
• Sinusitis is on the rise.

AN OVERLOOKED AND MISUNDERSTOOD DISEASE
While in some cases it is just a minor nuisance, often sinusitis can make life miserable. Particularly frustrating is the fact that because the chronic variety usually presents no obvious symptoms--no fever, no rash--little credibility is given to its sufferers. Consequently, people cope with symptoms such as headaches, nasal congestion, a reduced sense of smell, and facial pain for years, sometimes decades, without finding a solution. The fact is, sinusitis is more than just a runny nose or a stuffed-up head. Chronic or recurrent cases carry a significant risk of complications that can be dangerous and, particularly in people with compromised immune systems, even fatal. Though rare, these complications include blindness and infections of the brain. But even when serious complications do not develop,sinusitis can have a severely negative impact on one's overall quality of life. (Read more about sinusitis and quality-of-life issues later in this chapter.)
Overall, sinusitis is shaping up to be one of the most common and yet, simultaneously, one of the most misunderstood diseases of our era. It is misdiagnosed, overdiagnosed, and underdiagnosed, subject alike to both over- and undertreatment. Even when medical attention is sought, not all doctors know how to make the right diagnosis or appropriately treat sinusitis. Some people undergo unnecessary surgical procedures, while others can't seem to obtain the simple prescription that would rid them of painful symptoms. But once you arm yourself with the proper information about sinusitis--the warning signs to watch for, the right people to turn to, the treatment to expect, and more--you can successfully prevent or control the many serious consequences of this disease.
WHAT CAUSES SINUSITIS?
Infection and inflammation that block the sinus openings (ostia) are the direct causes of sinusitis. Given these circumstances, it comes as no surprise that sinus infection most often follows a common cold. But the chances of developing sinus problems are greatly enhanced by a whole host of other factors, including allergies, immune system problems, polyps, and swollen adenoids. An overall rise in immune impairment is a major contributing factor to the epidemic of sinusitis in recent years, as is the increase in urban air pollution. It is now generally accepted that diseases that are related to or increase the risk for sinusitis are on the rise worldwide and are associated with increased pollution. Another aspect that scientists are focusing on is the role of fungi, which appear to be nearly ubiquitous in the sinuses. Your chances of developing sinus disease may also be greater if you are a smoker, or even if you are exposed to secondhand smoke. Changes in ambient pressure--as during air travel or scuba diving--also contribute to the problem. Some of these factors can be avoided while others are inevitable, for the anatomy of the nasal passages and sinuses themselves plays an occasional role in sinusitis. To further complicate matters, explanations for sinus infection and pain can usually be attributed to a combination of some or all of these elements. (Read more about the causes of sinusitis in chapters 3 and 4.)
THE ANATOMY OF A SINUS INFECTION
Not everyone who has a cold or an allergic reaction develops sinusitis. You are most likely to develop sinusitis when the following three factors are all present:
• You have sinus blockage. This can be the result of inflammation, or of mechanical obstruction such as enlarged adenoids or nasal polyps.
• You are experiencing some kind of immune system impairment.
• Infection-causing microorganisms are present.
Ostial Obstruction
When you experience an inflammatory problem such as an upper respiratory infection or allergic reaction, the diameter of a sinus opening shrinks. Doctors refer to this condition as ostial obstruction. The osteomeatal unit, or OMU, is considered the seat of sinus disease, since the majority of the sinuses drain into this area around the nose. Sinusitis is usually initiated with obstruction of this final common pathway.


The Inflammatory Response
Inflammation is most commonly due to viral infection or allergies. The resulting redness, swelling, heat, and pain are local tissue reactions to an abnormal stimulus (such as infection, allergy, injury, or irritation). The inflammatory response is actually a protective move on the part of your body to isolate the affected area and rush in blood packed with disease-fighting antibodies to neutralize any hostile invaders. Yet inflammation leads to acute rhinitis: a sudden swelling of the mucous membrane that lines the nose. As the swelling extends to the sinus membranes, it increasingly interferes with airflow and normal mucous drainage, eventually narrowing the ostia or even closing them altogether.


The Role of Colds and Allergies
Colds and allergies are the most common culprits responsible for inflammation and obstructed drainage. If these are ruled out, your physician will examine your nose and sinuses for signs of anatomic or mechanical obstruction. For example, small grapelike growths callednasal polyps can interfere with the normal drainage of your sinuses. Other possible causes of obstruction include unusually small drainage openings, a significantly deviated septum, and tumors. Adequate mucociliary clearance--the sweeping of mucus through sinus chambers by microscopic hairs called cilia--is also essential to proper drainage and the normal functioning of the sinuses. Finally, a change in the nature or amount of secretions within the nasal cavities may lead to inadequate drainage. Sinusitis develops when inflammation is strong enough to impair local immune defenses as well as contribute to ostial obstruction.
Immune Impairment
The immune system is the body's natural defense against infection. In the nose and sinuses--indeed, throughout the respiratory system--mucous secretions are rich in substances that destroy or inhibit disease-causing microorganisms. Among the most important of these are proteins known as immunoglobulins. These vital antibodies work to eradicate infectious organisms that play a significant role in sinusitis. Other protective substances in mucus are T cells, which are best known for their ability to combat HIV infection. In addition, there are enzymes that attack Candida and other fungi and kill bacteria by invading and digesting their walls. Current research supports a greater emphasis on the role of weakened immune defenses in chronic sinusitis, shifting away somewhat from the traditional focus on infection. It may be that the presence of disease-causing organisms is less significant than the weakened immune system that makes a person susceptible to them.


A Greater Susceptibility to Disease
When your immune system is functioning at peak efficiency, disease-fighting substances band together to help keep you healthy. But if your body no longer produces an adequate number of antibodies, you become more susceptible to a whole panoply of disorders--and featuring prominently among these is sinusitis. Immune impairment can have any number of different causes. For example, if you are undergoing aggressive chemotherapy for cancer or are taking cortisone for a chronic condition such as colitis, your immune system is weakened. This makes you more likely to come down with a cold or flu that can be a precursor to sinusitis. Sinus disease is also especially common in people with weakened immunesystems due to HIV infection. In recent years, the overuse of broad-spectrum antibiotics has contributed to impaired immunity by encouraging the emergence of drug-resistant strains of bacteria. Along with the increases in air pollution and the corresponding increase in allergic rhinitis, this practice is believed to be a major contributing factor to the soaring incidence of sinusitis.
The Overuse of Antibiotics
Over the course of the last decade or two, there has been an explosion of so-called supergerms or superbugs, bacteria that cause infections that are difficult and sometimes impossible to treat with the antibiotics we have available today. Supergerms are a direct consequence of the overuse of antibiotics. To set the record straight, antibiotics are only effective in curing bacterial infections; they have no effect whatsoever on viruses. Nevertheless, patients frequently ask for and doctors often continue to prescribe these drugs for viral infections such as colds and flu. Incredibly, the Centers for Disease Control and Prevention (CDC) estimate that one-third of the 150 million outpatient prescriptions written for antibiotics in the United States each year is unnecessary. To further complicate matters, livestock on farms are routinely fed antibiotics to prevent infection and promote growth. Scientists are concerned that this practice will eventually lead to drug-resistant bacteria that can reach us through the food chain.
Inside your body, bacteria adapt to the onslaught of repeated antibiotic attacks by morphing into ever newer, tougher, and harderto-treat strains. Antibiotics may also destroy the friendly bacteria that normally reside in your digestive tract, thus opening the door to the growth of the more destructive Candida fungus. The irony is that treatment with the same antibiotics that miraculously cure many dangerous bacterial infections can also lead to the generation of virulent supergerms. Indeed, these are often the very bacteria responsible for serious and persistent cases of chronic sinusitis that fail to respond to regular antibiotic treatment. The answer? According to organizations such as the CDC and the American Medical Association (AMA), it lies in reducing the number of unnecessary antibiotic prescriptions and educating the public about the differences between viral and bacterial infections. As an individual, you can protect yourself and your family by talking to your own physician and making certain that he or she prescribes antibiotics only when absolutely necessary. Even though they are more expensive, you might also consider buying freerange, antibiotic-free chicken and beef.
Bacteria and Other Disease-Causing Microorganisms
The third critical element in the initiation of sinusitis is the presence of bacteria or other disease-causing microorganisms. Sinusitis is an infection, frequently brought on by a virus such as a cold or flu, but usually perpetuated by bacteria, and occasionally by a fungus. Bacteria are opportunistic invaders that take advantage of other weakened conditions of the body--in this case, sinus obstruction and immune impairment. Most often, inflammation due to viral infection or allergy is a key component in this process; blocking the ostia, it leads to poor sinus drainage. But whether blockage is due to inflammation or mechanical problems (such as polyps or adenoids), once the sinuses can no longer drain properly, pus, mucus, and other secretions begin to accumulate in cavities. This creates a fertile breeding ground for infectious microorganisms such as bacteria and fungi. The vicious cycle of sinusitis is thus begun, as inflammation that blocks airflow and drainage opens the door to infection, which in turn causes further inflammation and blockage, and so on until the cycle is finally broken by the body's own immune defenses or through medical intervention.
BACTERIAL CAUSES OF SINUSITIS
A major difference between acute and chronic sinus disease lies in the types of organisms involved. Three out of four cases of acute disease are caused by Streptococcus pneumoniae or Hemophilus influenzae bacteria. Anaerobes--stubborn bacteria that live and grow in the absence of oxygen--are commonly found in chronic sinusitis, although it is uncertain whether this is a cause or effect of the disease. Multiple organisms are also more likely to be involved in chronic infections.

THE DIFFERENT TYPES OF SINUSITIS
To clarify some of the confusion and misperceptions that persist concerning sinusitis, doctors make careful distinctions among the different types of this disease. Specifically, they categorize sinusitis according to which cavities are affected and how long symptoms last. There are four pairs of sinuses: the maxillary, frontal, ethmoid, andsphenoid. (Read more about the anatomy of the sinuses in chapter 2.) The location of sinus pain and swelling depends upon which sinuses are affected. For example, if you have a maxillary infection, your teeth and upper jaw may ache. In contrast, an infection of the frontal sinuses in the forehead causes pain when this area is touched.
Perhaps even more important, physicians make a careful distinction between two major categories of sinusitis: acute and chronic. Both forms of sinusitis can be confusing to diagnose and treat. Acute sinusitis most commonly occurs as a complication of a common cold, but may also be linked with allergies, anatomic abnormalities, or even dental infection. Because they are similar and often overlap, acute sinusitis is often confused with a cold, and thus can be neglected by affected individuals or incorrectly treated by doctors. When this happens, the result can be chronic sinusitis, the symptoms of which are far more subtle and even trickier to diagnose.
By definition, acute sinusitis lasts up to four weeks. Within that time, there is a complete resolution of symptoms such as congestion, postnasal drip, and headache. However, if symptoms linger longer than this, you may have or be at risk of developing chronic sinusitis. In the long run, chronic disease exacts a much deadlier toll on the sinuses. Chronic sinusitis occurs when symptoms persist for twelve weeks or longer. People who suffer from chronic sinusitis may never feel completely right. They always have what seems like a slight cold or nasal congestion, which occasionally flares up into full-blown sinus infection.
There are also two further subdivisions of sinusitis. Subacute sinusitis occurs when symptoms last longer than four but less than twelve weeks. It is especially important to correctly diagnose and treat this type of problem, before it becomes chronic and causes permanent scarring and narrowing of the sinuses. Recurrent acute sinusitis consists of four or more acute episodes in one year. Between these attacks, there are no symptoms. Although sinusitis--no matter what type--is most commonly due to bacterial infection, it may also be caused by a fungus or virus. In the case of recurrent sinusitis, you may be infected by different microorganisms at different times.
ACUTE SINUSITIS
Most cases of sinus disease are acute sinusitis. That is, they either respond to treatment or clear up on their own within four weeks. Say
THE FOUR TYPES OF SINUSITIS
• Acute sinusitis lasts up to four weeks, during which time there is a complete resolution of symptoms.
• Subacute sinusitis lasts longer than four weeks, but less than twelve weeks.
• Recurrent acute sinusitis consists of four or more acute episodes within one year.
• Chronic sinusitis lasts twelve weeks or longer.

you've developed a cold that lasts longer than usual. You have trouble breathing through your nose, and at night a persistent cough disturbs your sleep. To make matters even worse, your sinuses are achy and tender to the touch. In fact, the problem may not be a cold at all--you probably have acute sinusitis.
Sinusitis and the Common Cold
Acute sinusitis is most commonly preceded by a common cold, which physicians refer to as viral rhinitis. Only a small percentage of people with colds go on to develop acute sinusitis. However, because cold and flu viruses are so prevalent, especially in the winter months, millions of Americans develop sinusitis each year.
Normal mucous production, intact mucous membranes, good mucociliary clearance, and open ostia are all essential to proper sinus drainage. But nearly nine out of ten people experience sinus cavity abnormalities when they have a cold. As we mentioned earlier, the most common problem is blockage of the osteomeatal unit (OMU), the area around the nose into which the majority of the sinuses drain. Blockage of the OMU accompanies almost all upper respiratory infections and sets off the chain of events that initiates sinusitis. When this inflammatory pathway is activated, a number of different things take place. Blood vessels in the nasal turbinates become swollen and engorged; plasma leaks into the nose and sinuses; mucociliary clearance becomes impaired; mucosal gas metabolism changes; goblet cells and seromucous glands produce excess mucus; secretions thicken and stagnate; and pain nerves and/or sneeze and cough reflexes are stimulated. In other words, ostial blockage and other factors lead to infection in one or more cavities, and you develop acute sinusitis. (Read about the role of upper respiratory infections in greater detail in chapter 3.)
REQUIREMENTS FOR NORMAL SINUS DRAINAGE
• Normal mucous production
• Intact mucous membranes
• Proper mucociliary clearance
• Open, unblocked ostia

The Signs and Symptoms of Acute Sinusitis
If you have a cold that persists for ten days or longer, chances are you have an acute sinus infection. Common symptoms include congestion, nasal discharge, postnasal drip, and a reduced or absent sense of smell (hyposmia or anosmia). Nasal discharge may remain clear, or become yellow or green. Sometimes the discharge is tinged with blood due to the drying out of delicate mucous membranes or overzealous nose blowing. Postnasal drip may cause hoarseness, a sore throat, and cough. Because mucus trickles down your windpipe and bronchial tubes while you sleep, your cough will probably be worse at night and early in the morning. In some cases, postnasal drip is so severe that it causes gagging and vomiting in the morning. Many people also suffer from low-grade fever, chills, night sweats, and fatigue. Bad breath (halitosis) is a minor but inconvenient problem for some. Of course, complicating diagnosis is the fact that many of these same signs and symptoms also occur in colds.
Headache and Facial Pain
Most people with acute sinus disease suffer from headache or facial pain. In fact, these hallmark symptoms often help physicians distinguish cases of sinusitis from simple colds and flu, especially when pain regularly occurs at certain times of the day. Sinus headaches cause deep, dull pain that ranges from mild to moderate intensity. Pain may be due to inflammation, or pressure within the sinuses brought on by trapped air, or an accumulation of undrained fluid. Air may also be blocked from entering a sinus, creating a vacuum. People with vacuum-type sinus headaches are sensitive to pressure changes such as those that occur in low-pressure weather systems or when descending in an airplane. They may also experience sensations of ear pain, pressure, or fullness.
The Location of Sinus Pain
The location of pain depends on which sinuses are infected. When the frontals are involved, pain is in the forehead and over the eyes. Maxillary pain frequently occurs between the cheek and nose, but may also affect the upper teeth. Many people who have a maxillary infection believe toothache is the problem, and they initially consult a dentist rather than a doctor. Maxillary pain may also be referred to the ear or back of the head. Ethmoid infection often accompanies maxillary as well as other types of sinusitis. Infected ethmoid sinuses produce pain between and behind the eyes. Since the ethmoids are located near the tear ducts in the corners of the eyes, there may also be swelling of the eyelids and surrounding tissues. The eyes themselves may ache and water. Sphenoid sinuses, which are located deep within the skull, can cause pain just about anywhere on the head. (Note: The symptoms of sinusitis often differ for children. For instance, headaches are uncommon in youngsters--especially those under age six. Turn to chapter 8 to read about sinusitis in children.)
WHERE DOES IT HURT?
• Acute frontal sinusitis causes a severe frontal headache and tenderness of the involved sinus in the forehead.
• Acute maxillary sinusitis causes pain, pressure, and tenderness over the cheekbone. There may also be toothache and temporal headache.
• Acute ethmoid sinusitis causes a persistent headache around the eyes or in the forehead.
• Acute sphenoid sinusitis causes diffuse headache pain around the skull and is often accompanied by a fever.

Diagnosing Acute Sinusitis
Physicians make a diagnosis of acute sinusitis when you have:
• Two or more major factors
• One major and two minor factors
• Nasal purulence on examination
A diagnosis of acute sinusitis is suggested when you have:
• One major sign or symptom
• Two or more minor signs or symptoms
Major Factors:
• Facial pain or pressure
• Facial congestion or fullness
• Nasal obstruction and congestion
• Nasal discharge, which can be purulent, discolored postnasal drainage
• Reduced or absent sense of smell (hyposmia or anosmia).
• Fever
• Purulence in nasal cavity on examination
Minor Factors:
• Headache
• Fatigue
• Bad breath (halitosis)
• Dental pain
• Cough
• Ear pain, pressure, or fullness

SUBACUTE AND RECURRENT ACUTE SINUSITIS
Keep in mind that there are also two important subcategories of acute sinusitis: subacute and recurrent acute. If symptoms persist for longer than four but less than twelve weeks, you have what is known as subacute sinusitis. Again, it is essential to stop subacute disease dead in its tracks--otherwise, it can progress to the chronic stage, which is associated with permanent scarring and narrowing of the sinuses.
Subacute follows acute sinusitis, and its symptoms are more subtle. You may no longer be in severe discomfort, but neither are you back to your normal, healthy self. Symptoms generally include intermittent nasal congestion and a cloudy discharge, which may (unlike the acute variety) affect only one side of the nose or head. Many people also experience a mild headache or sore throat, especially in the morning, as a result of nighttime postnasal drip. If you find yourself with symptoms like these following an acute episode of sinusitis, see your doctor. Vigorous treatment with antibiotics can prevent more serious future damage.
When you experience four or more acute attacks within one year (without any symptoms in between), you have recurrent acute sinusitis. Some people are more prone to periodic sinus attacks than others. For example, if you have a form of immune impairment (such as HIV) or sinus dysfunction (such as narrowed sinus openings due to scarring), you may often develop an acute flare-up following a cold or flu. Of course, no two cases of sinusitis are exactly alike, and the causes of acute attacks vary from person to person. Potential triggers include anxiety, depression, stress, sleep disturbances, hormonal changes associated with pregnancy or PMS, drinking too much alcohol, smoking cigarettes, and breathing in irritating secondhand smoke, dust, or paint. Susceptible individuals may also develop sinusitis from changes in ambient pressure, as when flying or scuba diving. Variations in temperature and weather can also play a role, as when you get chilled or overheated, are caught in the rain, or sleep in a draft. Molds or fungi that flourish in damp basements are yet another cause. Flare-ups of recurrent acute sinusitis generally last only a week or two, but may require antibiotic treatment.
CHRONIC SINUSITIS
In recent years, there has been a significant change in the understanding of chronic sinus disease. Whereas not too long ago it was seen primarily as an infectious problem, today researchers are focusing more attention on the immunological aspects. Although far less prevalent than acute disease, chronic sinusitis is the most common chronic illness in the United States today. Moreover, due to factors such as the increase in air pollutants and the corresponding rise in allergic rhinitis, the overuse of antibiotics, and the overall increase in immune impairment, the incidence of chronic sinusitis is rapidly increasing to epidemic proportions. Of particular concern are serious complications--especially those that affect the eyes and brain--that are most frequently associated with chronic disease.
The Signs and Symptoms of Chronic Sinusitis
In chronic sinusitis, signs and symptoms by definition last for twelve weeks or longer. They commonly include chronic mild to moderate discomfort, nasal congestion, postnasal drip, a decrease or loss of the sense of smell, and a low-grade fever. Some people also experience asore throat, cough, bad breath, or extreme fatigue. But even though these signs and symptoms are roughly the same as those describing acute sinusitis, in the chronic variety they are less dramatic and more subtle. This poses a unique set of problems for chronic sinusitis sufferers. Even though you may feel sluggish and ill, your spouse or employer or teacher may not take your disease seriously. Indeed, some regular medical practitioners find it challenging to recognize the understated signs and symptoms of chronic sinusitis. Nevertheless, it is essential to accurately diagnose and treat sinus disease that lasts for a prolonged period of time--otherwise, it can cause permanent damage and destruction of sinus tissues. In diagnosis, doctors must carefully distinguish chronic sinusitis from other ailments with similar signs and symptoms, such as colds, allergies, and bronchitis. (Turn to chapter 3 to learn more about the links among sinusitis, respiratory infections, allergies, and asthma.)
WHY IS ALLERGIC RHINITIS ON THE RISE?
There are several theories about the recent rise in allergic rhinitis:
• Many experts believe that it is due to the increase in diesel fuel in the air. They point out that both allergic rhinitis and asthma are more common in the industrialized societies of the United States and Europe. These problems are relatively rare in the non-Western world, especially among children.
• Another theory associates the increase in allergic rhinitis--along with atopic allergy and asthma--with the decrease in childhood infections. Over the years, vaccinations, smaller family size, and antibiotics have combined to reduce the frequency of common childhood diseases ranging from mumps and measles to colds and flu. But infections are thought to stimulate a nonatopic type of immune system. In their absence, children develop immune systems that are more prone to allergic rhinitis and asthma.

Diagnosing Chronic Sinusitis
The signs and symptoms of chronic sinusitis are more or less the same as those of the acute illness. However, they are more subtle and tend to drag on and on. A diagnosis of chronic sinusitis is made when you have two or more major factors, or one major and two minor factors, or purulence on nasal examination.
Major Factors:
• Facial pain or pressure
• Nasal obstruction and congestion
• Nasal discharge and purulence, discolored postnasal discharge
• Facial congestion or fullness
• Reduced or absent sense of smell (hyposmia or anosmia)
• Purulence in nasal cavity on examination
Minor Factors:
• Headache
• Fever
• Fatigue
• Dental pain
• Ear pain, pressure, or fullness
• Bad breath (halitosis)
• Cough

THE COMPLICATIONS OF SINUSITIS
Although physicians have made great strides in controlling sinus disease, serious complications still can and do occur. Of course, hands down, acute sinusitis that progresses to chronic disease is the most common complication and one that you must make every effort to avoid. It is also possible for painful, fluid-filled cysts to develop and become infected. In some cases, a maxillary sinus infection extends to the upper teeth. Rare complications include the spread of infection into the pituitary gland or even into the blood (bacteremia). The sinus complications that are of greatest concern to physicians are those that occur when infection extends beyond the bony walls of the sinuses into the nearby vital structures of the eyes and brain. (Turn to chapter 7 to learn more about eye and brain complications.) But even if you don't develop serious complications, sinusitis can have a dramatic negative impact on your quality of life.
SINUSITIS AND QUALITY OF LIFE
Whenever you suffer from sinusitis--or related colds or allergies--symptoms such as a runny nose, congestion, cough, and fatigue can make you feel downright miserable. But what many people fail torealize is that these conditions can also impair your overall quality of life. Sinusitis impacts not only the physical but also the emotional functioning of affected individuals. Over time, physical discomforts may come to have an effect on your relationships at home and work. If you feel lousy and can't sleep at night, you may find yourself being irritable and impatient with family members. Things that you used to let go may now make you lash out in anger. At work, you may not be able to think as clearly as usual or be as productive. And if you break into a sneezing fit, or can't keep your eyes open during an important meeting, the embarrassment can be considerable. If this happens on a consistent basis and is accompanied by multiple absences--as is often the case with chronic sinusitis--you may be at risk of losing your job. Affected children frequently miss school, leading to academic and social difficulties. Even when they attend classes, discomfort and exhaustion may make it hard to concentrate on math or reading--and a child suffering from chronic sinusitis may not be up to participating in gym class at all. Further complicating matters is the fact that medications you take to control symptoms can actually add to the problem, alternately causing side effects such as drowsiness and lethargy or nervousness and insomnia. Over time, these sorts of experiences can lead to a diminished self-image and depression.


The Impact of Chronic Sinusitis
Of the various sinus and nasal problems, long-lasting chronic sinusitis has the greatest negative impact on physical and emotional functioning. Indeed, studies have shown that its effects are comparable to those of other serious health problems, including congestive heart failure and recent heart attacks. Most people with chronic sinusitis always feel a little under the weather--they are worn out and tired and usually congested. A few experience nearly constant headaches and sinus pain. Yet because these symptoms are more subtle and less dramatic than those of a bad cold or acute sinusitis or an allergy attack, family members, employers, and teachers are not always sympathetic and understanding--which can be extremely frustrating.
People with chronic sinusitis also get sick more often than other people. When you already have a weakened immune system from fighting off disease, you are more susceptible to coming down with a cold or succumbing to an allergic reaction. Even worse, a minor cold or allergic reaction is more likely to explode into a case of full-blown sinusitis. Consequently, chronic sinusitis sufferers miss more days ofwork or school and are usually compelled to make frequent visits to the doctor.
Chronic sinusitis is also more apt to cause disturbing alterations in the senses of smell and taste. Changes in smell may include a decreased (or even absent) sense of smell and the sensation of phantom odors. As a result, some people feel anxiety about safety issues, such as detecting fire or gas leaks, or eating spoiled food; others express self-conscious concern about their breath and body odor. Changes in smell are often accompanied by changes in taste--such as an altered taste for food, less enjoyment from eating, and a sudden preference for spicier foods. Not surprisingly, all these effects often add up to a reduced enjoyment of life. In studies, chronic sinusitis sufferers typically report less satisfaction with their lives than healthy individuals.
HOW COLDS, ALLERGIES, AND SINUSITIS MAY AFFECT YOUR LIFE
• Sleep disturbances
• Diminished sense of smell and taste
• Cognitive impairment
• Lost productivity
• Absences from work or school
• Inability to fully participate in sports and other physical activities
• Diminished self-image

UNDERSTANDING SINUSITIS
Clearly, sinusitis can have a major impact on every aspect of your life. As a result, it is essential to understand more about this troubling disease, so you know what to do if you or a loved one experiences its symptoms. Now that you've learned the basics about the disease itself, in the next chapter we'll take a closer look at the anatomy of the sinuses.

Copyright © 2002 by Harvey Plasse, M.D., and Shelagh Ryan Masline