QUESTION: I have had a stuffed up head that makes it hard for me hear and feels like I have bags under my eyes. Others I have talked to say they are also experiencing the same sinus problems. This seems unusual for this time of the year. I have tried taking an antihistamine to help open my sinuses and help me hear, but my wife says I shouldn’t do that. What should I do? — Albert, Lima
Thank you for your question and I will try and answer it from an ENT surgeon’s standpoint.
As for possible reasons for sinusitis, the most common factors are allergies (seasonal and perennial), infections (usually viruses), anatomical blockage (deviated septum, polyp), acid reflux, environmental issues (children in daycare), irritants (cigarette smoke, workplace fumes/dust), certain medications, rare conditions like cystic fibrosis and immune deficiency to name a few. Tumors are rare in the sinuses, though still occur.
The symptoms may include itching, sneezing, runny nose and nasal congestion that may point to allergy. Additional symptoms like pus like drainage including postnasal drip, headaches, ear infections/fullness, worsening of asthma, nasal obstruction (polyps), nosebleeds may occur with progression of the condition.
When you see your doctor, your history will be very helpful, including social history like smoking and work history, pets at home, type of heating in your home etc. As most of the sinus related examination needs specialized equipment to visualize the small spaces in the nose, ears and less so with throat examination, a good amount of information will be through obtaining additional tests, that may include, blood tests for allergy, cultures from nose, sometimes CT scans, before starting you on medications.
The majority of the sinus symptoms resolve with medical treatment. Medical treatment starts with addressing the social issues, encouraging hand washing, encouraging alcohol hand gel, reducing time spent in day care for kids or small class sizes for kids. Simple saline nasal rinses (several OTC brands available), managing acid reflux, lifestyle changes (quitting smoking) usually help. Antihistamines, corticosteroid sprays will help and those with positive allergy tests through blood or skin tests, may need allergy shots. Majority of patients don’t need antibiotics but with persistence of symptoms for more than 4 weeks, or with complications, antibiotics for 2 to 4 weeks may be needed.
Special situations like immune suppression from long term steroid therapy, malignancy, uncontrolled asthmatics etc., may need preventive courses of antibiotics in winter especially.
If the condition still persists, a referral to the Ear, Nose and Throat service may be considered by your doctor. Additional referrals to an allergy service may also be needed.
Dr. Suri A Vanan is with Vanan Ear, Nose, Throat and Sinus Center, Celina.