MEDICAL SURFARI: PAIN FROM SINUSITIS SHOULD BE CHECKED BY PHYSICIAN

The oblique rays of sunlight made a dazzling glare on the leaves of a few colorful scrub oaks lining the otherwise bald clay bluffs. The muddy brown and sluggish Mississippi stretched to the skyline north and south. I noticed this for only a moment and then the technicolor was gone and my head once again felt like a swollen river stream undermining the bluff and my sinuses felt as full as the spumy mud banks of the old Mississippi.

If you have experienced the misery and pain, headache and prolific mucus of sinusitis as an estimated 32 million other people in the United States have, you know what I mean when I say, "the technicolor was gone"; as the discomfort, and sometimes frequent recurrence of sinusitis is enough to cause life to lose this dimension.

Sinusitis simply means inflammation of the sinuses, the paired hollow air spaces located within the skull or bones of the head surrounding the nose. Each sinus has a small opening in the nose for the free exchange of air and mucus. The sinuses are lined by mucus membrane lining that may react to a variety of irritants, including bacteria that may result in swollen mucus membrane, pus and/or excessive mucus secretion blocking the small passages between the various sinuses, resulting in headache, a sense of fullness in the face, difficulty breathing through the nose and pain behind the eyes.

Depending upon the sinus that is most affected, the pain pattern may vary and an infection may even cause the teeth to ache and the cheeks to become tender to the touch. Other forms of sinusitis may affect the nearby tear ducts in the corners of the eyes, causing swelling of the eyelids and tissues around the eyes. Sinusitis may cause deep aching at the top of the head, fever, weakness, tiredness, runny nose, cough, nasal congestion and sore throat. Most cases of acute sinusitis are caused by viruses that enter the nasal passages and produce an inflammatory response. Sometimes if the sinus openings become too narrow to permit the normal drainage of mucus, bacteria which normally are present in the respiratory tract may stagnate and multiply. The immediate result is acute sinusitis. Chronic sinusitis is much less common and this is when sinusitis recurs frequently or lasts for a prolonged time.

Sinusitis is diagnosed most often by carefully listening to a patient's complaints and taking these together with the findings of a thorough examination. In some cases an MRI or CT scan of the sinuses may be performed, although a positive history and physical examination are sufficient to treat. Most cases of acute sinusitis will resolve spontaneously but antibiotics sometimes shorten the time course and provided some relief of symptoms. In some people there are anatomic problems that may predispose to sinusitis. The cartilage and bone in the center of the nose, called the septum, can be shifted to one side and this may be natural or the result of trauma. If this shift is severe, normal sinus drainage may be obstructed resulting in a buildup of nasal secretions resulting in sinusitis. Also, some people develop growths, called polyps, that may trap mucus, providing a breeding ground for bacteria.

As we enter into the season for colds and flu, you should see a doctor if you experience green/yellow nasal discharge, facial pressure around the cheeks, eyes and forehead, especially with swelling, fever of 102 or greater and upper molar tooth pain because any of these may be signs and symptoms of sinusitis that may quickly steal away life with technicolor.

World Wide Web Resources

National Institute of Allergy and Infectious Diseases

www.niaid.hih.gov/factsheets/sinusitis.htm

This is a fact sheet provided by the National Institutes of Health on the causes, diagnosis, treatment and prevention of sinusitis.

American Academy of Otolaryngology

www.netdoor.com/entinfo/sinusaao.html

This Web site provides information on "Getting the Facts About -- Sinus Pain, Drainage and Infection."

Healthanswers

www.healthanswers.com/database/ami/converted/000647.html

Healthanswers provides information on a variety of health care topics, including a valuable fact sheet on sinusitis.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, MO 63701.