Managing sinusitis

First there’s a headache that weighs heavily above your eyes and on your cheekbones. Then there’s the pounding pressure when you bend forward or press your fingers to your face. That’s accompanied by a blocked nose and postnasal drip. Finally the pain in your face is so bad it feels as if every tooth in your mouth is aching. Not to mention that desperate fatigue.

For Louise van der Merwe (40) of Onrus this story is all too familiar. She’s one of more than 16 million South Africans – about 30 per cent of the population – who suffer from sinusitis. The prevalence of this condition, as well as allergies, has at least doubled and possibly even trebled over the past 20 years.

Louise remembers constant bouts of childhood hay fever, complete with blocked nose, runny eyes, dull headaches and even punctured eardrums as a toddler. As in most cases her sinusitis can be traced back to these allergies and consequent hay fever.

The headaches were often so bad she’d smear Deep Heat on her face and take up to 12 Panados a day in an attempt to relieve the pain.

“I tried everything including cortisone, antibiotics, acupuncture, herbs, homeopathy and about every nasal spray on the market,” she says.

Louise gets hay fever from pollen, certain cleaning materials and cat dander. But since the allergy improved – thanks to a salt and bicarbonate of soda nasal spray she gets from her pharmacist – the sinusitis is also on the mend. “This simple remedy has improved my life by 70 per cent,” she says with obvious relief.

Andrea Taylor* (42) of Roodepoort is one of the unfortunate few who develop rare but extremely dangerous complications as a result of sinusitis. Four years ago she was admitted to hospital unconscious and with a serious brain infection and doctors had to fight to save her life.

Later they determined it had all begun with a chronic infection in her sinuses.

Surgery was the only solution for Hardie Mills (35) of Plettenberg Bay. His problem was polyps (growths probably caused by inflammation) in the sinuses. These were eventually removed in an operation and now he uses a steroid nasal spray to prevent recurrence.

What is sinusitis?

It’s the inflammation – with or without infection — of the mucous membranes in the sinus cavities of the nose, behind the eyes and in the forehead, says Knysna-based ear, nose and throat specialist Dr Martin Young.

There are between 14 and 16 air-filled sinus cavities in the skull: on either side of the nose, behind and between the eyes, in the forehead and even deeper towards the back of the skull. These cavities make the bones lighter, improve voice resonance and absorb impact if you receive a hard blow to the head.

Air reaches the sinuses through tiny openings in the skull. The membrane that lines the sinuses secretes mucus to warm and moisten the inhaled air and the air in the cavities themselves. Therein lies the problem.

Normally the small amount of mucus that is secreted as a filter moves almost like a conveyor belt over the tiny delicate hairs of the nostrils, then down the throat, where it’s swallowed.

“But when swelling blocks the tiny air openings in the facial bones the air can’t penetrate the cavities and the mucus can’t drain,” Dr Young says. “It accumulates and thickens and there’s a good chance that bacteria, viruses or fungi will grow in it.”

The four culprits

- Hay fever is the most common cause of sinusitis, says Dr Harris Steinman, an expert at the Allergy Society of South Africa (Allsa). Dust, pollen, animal hair, house-dust mites, some over-the-counter nasal sprays and cigarette smoke can all irritate the mucous membranes and lead to hay fever. Dry air does the same, as can exhaust gases, petrol and paint fumes, perfume, insecticides and household cleaners.
Hay fever is most prevalent in areas where people are exposed to a great deal of grass and tree pollen, or smoke and pollution. Yet all over the country people suffer from sinusitis. It occurs increasingly and throughout the year, says Dr Poens van der Merwe, an ear, nose and throat specialist at Panorama Medi-Clinic in Parow, Cape Town.

- Another contributor to sinusitis is the anatomy of the nose and facial bones. This can cause the sinus cavity openings to become more easily blocked – even if you don’t have allergies. But these sufferers are far fewer in number than specialists previously believed.

Sinus operations were often done to enlarge the connecting openings between the sinus cavities and ease the drainage of mucus to other sinus cavities and ultimately the nostrils. But it’s now thought too many of these procedures were done unnecessarily, often leading to other problems. A patient runs a small risk of subsequently developing meningitis or going blind because the infection can spread to the brain or eyes through the bone that has been drilled open. In addition, about one in five people still had sinus trouble after the procedure.

“These days, sinus operations are considered controversial and performed only as a last resort,” Dr Young says.

- A third possible cause of sinusitis is the presence of polyps – growths that develop in the nose, most probably as a result of inflammation – and other growths in the nose and sinus cavities that cause blockages. Some people are more inclined to developnose polyps than others and if they regularly take high doses of aspirin the chances are even greater.

- Immune problems are a fourth cause of sinusitis. “If you’re constantly struggling with  sinus infections ask an allergy specialist to check your immune system – especially if an operation is being considered,” Dr Steinman says. Often the operation isn’t necessary and the immune problem can be solved with less invasive treatment.

* Not her real name.

The best medicine

Headaches are the most common and first symptom of sinusitis, Dr Steinman says. If the openings in the skull are blocked, air can’t reach the sinus cavities. This causes a vacuum in the sinuses, leading to pain.

A sinus headache usually lasts a few hours and dissipates once the openings have been unblocked. Decongestant medications such as Sinutab are available over the counter. But if these don’t help take aspirin (not in the case of children), paracetamol or ibuprofen and always in accordance with the recommended dose.

The second phase involves excessive mucus secretion. This is usually a reaction to the irritation of the airways or because the bone openings are blocked. Decongestant nasal sprays, such as Dristan, Drixine, Iliadin and Nazene, are available over the counter and can bring temporary relief to a blocked nose but shouldn’t be used for more than three days.

If hay fever is the underlying cause an over-the-counter antihistamine such as Rhinolast can be used. Steroid nasal sprays containing cortisone, such as In?anaze, Nasonex and Avarnys, are the most effective treatments for hay fever and prevent bacterial and viral infections. They are available on prescription only.

The third phase, a sinus infection, is the most serious. It occurs when the mucus doesn’t drain, begins to thicken and becomes an ideal nursery for viruses and bacteria. The infection then causes the tissue in and around the sinus cavities to swell. This is usually accompanied by a fever.

Once bacteria have secured a foothold in the sinuses you’re likely to develop thick, yellow-green nasal mucus. This is when antibiotics are called for, which you’ll need to take for at least 10 to 14 days and in some cases for up to eight weeks because the drugs can’t penetrate the sinus cavities easily.

To reduce swelling and inflammation of the mucous membranes and unblock the openings in the bone, a steroid nasal spray is usually prescribed with the antibiotics.

But it’s never wise to stop taking the prescribed medication or steroid nasal spray before the end of the course. “Stopping this medication early is the most common reason why people develop persistent sinus infections,” Dr Steinman says.

Sinusitis or a simple cold?

How do you know if you have sinusitis and not just a cold?

- Do this simple test; Bend forward. If you feel pressure or pain behind the eyes it’s possible some of your sinus cavities are blocked.

- Sinusitis causes general facial pain but particularly when you press on your cheeks, the sides of the bridge of the nose or above your eyes.

- Headaches that don’t abate – even after taking paracetamol, aspirin, ibuprofen or an unblocking agent – might point to sinusitis.

- Other symptoms include facial swelling , yellow or green mucus in the nose and throat, persistent fever, toothache and fatigue from disturbed sleep caused by  breathing difficulties.

How to stop sinusitis in its tracks

Try these home remedies if your sinuses are acting up:

- To thin the mucus, drink at least eight glasses of water a day – even if you're not thirsty.

- Inhale steam: use a humidifier, stand under a hot shower or bend over a bowl of hot water (hot enough to produce steam but not so hot that you burn your face) with a towel over both the bowl and your head and inhale. Don't add anything to the water.

- If you have allergies don't raise the room's humidity above 50 per cent. Buy a humidifier that measures the air’s humidity. If you live in the Karoo or any area deep in the interior there's a greater chance the air will be dry and the mucus will dry up easily. But air that is too humid encourages the growth of fungi.

- Look at the back of your throat: if stripes of mucus are visible you probably have a postnasal drip. Gargle with lukewarm water to prevent a sore throat.

- Sleep with your head higher than your body in order to help drain mucus.

- Buy a syringe from your pharmacy and fill it with a salt and bicarbonate of soda nasal spray – mix 2,5 ml salt and 1 ml bicarbonate of soda in 250 ml lukewarm water. Inhale the solution as deeply as possible: close one nostril and sniff the solution through the other until it reaches the back of your nose and throat. Then blow your nose gently. Repeat two to four times a day A similar solution can also be bought from pharmacies.

- Drink less coffee and alcohol. These can dry out mucous membranes, leading to thickening of the mucous. This in turn can cause blockages of the sinus openings and exacerbated infections. Sulphites, histamines and other chemicals in wine can also lead to swelling and inflammation of the nasal mucous membranes.

- For a natural remedy try carefully inhaling the steam from a few drops of eucalyptus or menthol crystals dissolved in a cup of hot water to help open the nose. Be careful: the heat from the steam or the chemicals in the crystals could burn your nostrils.

Preventing sinusitis

The more sinus infections you get the greater the chance you’ll need a future operation. Prevention is best.

- If you have underlying allergies and hay fever find out what’s causing it and avoid the allergen as much as possible or have yourself desensitised with allergy injections. Reliable allergy tests are the skin-prick test, the Rast/Unicap IgE test, the CAST test and the Patch test. The BEST/Vega, IgG test are  not based on reliable scientific data, allergy expert Dr Harris Steinman says. Desensitising allergy injections must be taken for 36 months, begin working within six to 24 months, and the patient must still try to avoid the allergen as far as possible.

- Treat colds as quickly as you can – a blocked nose is the start of your problems. Air penetrates the sinuses twice as fast when you breathe through your nose as when you breathe through your mouth. Breathing through your nose also diminishes the chance of bacteria growing in your nose.

- Blow your nose gently and don’t close one nostril and blow hard because you could damage the mucous membranes.

- If you smoke, stop!

Fast facts

- Your sinuses secrete about one litre of mucus a day. It's swallowed and digested in the stomach.

- The membranes lining the sinus cavities are about the size of two A4 sheets of paper.

- A child has “nose tonsils" or adenoids – glands at the back of the nasal cavity that serve as an extra filter and help to catch irritating particles.  They usually disappear around the age of six.

- More adults than children suffer from sinusitis because a child’s nasal cavities aren’t yet fully developed. When a child’s nasal mucous membranes are irritated the nose produces mucous that can easily be blown out. The mucous might block the ear-throat canals and cause a middle-ear infection or burst eardrums but it doesn’t usually block the sinus cavities.

^{Article compiled with the assistance of the Allergy Society of South Africa (ALLSA), Dr Harrls Steinman (allergy expert), Dr Martin Young and Dr Poens van der Merwe (ear, nose and throat specialists).}