NEW YORK—If your runny, stuffy nose and aching face have lasted more than 10 days, you may have something more than just the common cold.
Sinusitis, which is inflammation of the air-filled chambers behind your forehead, nose, and cheeks, often begins as a cold but can stealthily become a chronic disease without the sufferer realizing it because the symptoms can appear to improve.
Sinusitis can start when an allergic reaction or common viral cold sets the immune system on high alert and causes the body to produce extra mucus. As this mucus collects, it becomes the perfect habitat for bacteria to breed. The body responds to the bacteria colonies by sending immune cells to attack them, increasing inflammation and setting the stage for chronic sinusitis—if left untreated.
Luckily, unlike many other chronic conditions, sinusitis is very treatable after it is diagnosed.
However, many sufferers (and nonspecialist doctors) often misconstrue the symptoms of sinusitis and pursue treatments that have unnecessary side effects, according to Dr. Allan Levin, an ear, nose, and throat doctor (otolaryngologist), who specializes in nose and sinus conditions.
“A lot of times [patients] themselves delay their own diagnosis because they assume—they wrongly assume—they have a cold,” said Dr. Levin, who has been treating sinusitis for New Yorkers for more than two decades.
Another hindrance to seeking proper treatment, he said, is that general practitioners don’t have fiber-optic nasal endoscopes, the tool specialists use to diagnose sinusitis, and thus general doctors can have difficulty distinguishing sinusitis from other conditions.
As a result, many cases go untreated. Sinusitis afflicts 31 million Americans, who pay $1 billion annually for over-the-counter medications to treat it, and $150 billion on prescription medications, according to the American College of Allergy, Asthma, and Immunology.
How to Recognize Sinusitis
Sinusitis has three phases and the longer it progresses, the greater the chances that surgery will be needed to correct it, so identifying it early is important.
1. Acute Sinusitis
Acute sinusitis is the first phase that develops after a cold or allergic reaction. If your cold symptoms don’t go away after 10 days and you experience pressure or pain in your face, and a stuffy nose, with thick excess mucus that is “yellow or green—especially green,” then you should consult your doctor, Dr. Levin said.
The sub-acute phase lasts from four to eight weeks with symptoms that are the same but often less severe, than the acute ones. During this phase a patient may think, “Well, now I’m somewhat better … not perfect yet,” Dr. Levin said. “But what they don’t realize is that chronic sinusitis, then somewhat insidiously, lingers.” And without realizing it, they enter the chronic phase.
When sinusitis lasts more than 12 weeks it is considered chronic.
Symptoms of chronic sinusitis include post-nasal drip, congestion, reduced sense of smell, pain or pressure in the face, headaches, ear pain, coughing, sore throat, bad breath, fatigue, dental pain, fever, and nausea.
At this stage the sinusitis will most likely require some type of surgery. However, with advances in technology, Dr. Levin said, that most surgeries now are outpatient and people can usually return to work either the next day, or shortly afterward.
When people have several attacks of sinusitis in a year it is known as recurrent sinusitis.
The key to sinus health is the movement of mucus out of the sinus cavities. You have eight sinus cavities that connect to your nose via small openings called ostia. The sinuses produce and are lined with mucus that is moved along by microscopic hair-like organelles called cilia. The cilia live on the surface of the mucus membrane and wave back and forth about 1,000 times per minute to keep mucus moving so it doesn’t stagnate or block the ostia.
When you have sinusitis, the tissues lining the sinuses and nose swell and produce much more mucus than usual. This derails the cilia, and the ostia become clogged.
The most severe cases of chronic sinusitis require endoscopic sinus surgery in which surgical instruments are used to clean the sinuses. This surgery can be done in a surgical center with no overnight stay but does involve general anesthesia, according to Dr. Levin, who estimates that he has done around 2,000 of them (4,000 if you count the fact that most patients need the surgery done bilaterally).
After endoscopic surgery there is some bleeding so the nose needs to be packed with gauze and the patient may need to come back a couple times a week for a few weeks for follow-up care.
Whenever possible, Dr. Levin said he prefers to do a relatively new procedure called a balloon sinuplasty, which works “every bit as well as the surgery does” for many patients, and is less invasive. The procedure uses only local anesthesia (unless a patient prefers more sedation), needs no gauze packing, and patients can return to work the next day.
Balloon sinuplasty involves inserting a small balloon into the ostia, and when the balloon is inflated, it pushes against the eggshell thin bone plate that encircles the ostia, dilating it and remodeling the bone so it stays open.
If the balloon sinuplasty is not enough, Dr. Levin said he can do a hybrid procedure that uses both the balloon and surgical techniques to open the airways and remove problematic tissues.
In the best-case scenario, no surgical procedure is needed to treat sinusitis. If caught early enough, sinusitis symptoms can be resolved using a range of antibiotics, decongestants, pain relievers, anti-inflammatory, and mucus-thinning medications.
Dr. Levin said he urges caution about taking cold medicines with antihistamines. He said these medications are good if you truly have a cold or allergy with watery nose and eyes, but mucus needs to have the right consistency in order to flow properly and antihistamines can over-dry it.
He also warned against over-the-counter aerosol nasal sprays, which he said are generally good for treating sinus conditions, but contain antibacterial preservatives (such as benzokonium chloride and propylene glycol.) that have the negative side effect of damaging the cilia.
Over the past 30 years of working with sinus conditions, Dr. Levin has developed his own nasal flush with antibiotic, antifungal, and anti-inflammatory medications that doesn’t have preservatives, and can help people avoid surgery or having to take oral antibiotics, which can be hard on the gastrointestinal system.
The medication is used to flush the nose twice a day and can clear out colonies of fungus and bacteria, as well as a slime called biofilm that bacteria produce to help them resist antibiotics.
When asked why he decided to go into a profession that involves looking up noses all day (something many of us would find unpleasant), Dr. Levin said that during his specialty residency program, he found he was in his element when treating sinus conditions and that it brought out the best in him.
“When I go to work and put my white coat and my headlight on, for me it’s like what superman is supposed to feel he when walks into the telephone booth as Clark Kent, and he takes off his glasses and walks out with his cape. For me it’s being the best thing I can be … it never feels like work at all,” he said.
5 Tips for Sinus Health
1. Be aware of your environment. Check that your home and office are well-ventilated and free of dust and mold. Take extra precautions if there is construction in your neighborhood or home.
2. Keep humidifiers and vaporizers very clean. The moist environment inside them provides good conditions for growing mold that can then be pumped into your room.
3. It should be noted that air travel is hard on the sinuses because there are higher levels of ozone in plane cabins and ozone is toxic to lining of nose. Cold weather also inhibits the movement of the cilia and combined with plane flight, ups your risk of sinus problems.
4. Avoid over-the-counter decongestants after the first couple of days of a cold because they are toxic to the cilia, affecting their beat frequency and morphology.
5. Use a saline lavage when you first develop the symptoms of a cold. The lavage will help mobilize mucus, stimulate the movement of cilia, and flush away pollutant and irritants. Neti pots may not be as effective at cleansing the sinuses because the liquid drains down into the back of the throat and may not reach the sinuses above.
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