Signs of Sinusitis

Patients with chronic sinusitis have constant problems; patients with recurrent acute sinusitis have symptoms that clear temporarily between episodes of infection.

For many patients, nasal stuffiness, pain, and discharge become constant. Over time, sinusitis may become debilitating and its symptoms can become severe enough to interfere with normal activities.

Nasal stuffiness is the most common symptom of possible infection. Others include:

• Large quantities of thick, often discolored, mucus that drains down the throat or from the front of the nose, sometimes causing an unpleasant or foul odor
• Facial pain, toothache and headache resulting from trapped infection and uneven air pressure in the sinus cavities
• Decreased sense of smell and taste
• Severe cough or asthma
• Sense of generalized illness

Underlying Causes of Sinusitis

Acid Reflux: Many patients are surprised to learn that stomach acid reflux into the throat and nose is a common underlying cause of chronic sinusitis. This type of acid reflux often occurs without heartburn or indigestion. Many who experience reflux also experience heavy postnasal drip and sometimes a choking sensation. Dietary and lifestyle changes can reduce reflux. Limiting the following foods is key:

• chocolate
• caffeine
• excessive alcohol
• high fat and fried foods
• mint
• tomatoes
• citrus (especially orange and grapefruit juice)

Smoking is never a healthy practice, but it should especially be avoided by patients with sinusitis as it increases the production of stomach acid.

Elevating the head of the bed and not eating for three hours prior to bedtime is also helpful in reducing nighttime symptoms of acid reflux, such as coughing and choking.

When drug treatment is recommended, proton pump inhibitors (Nexium, Protonix, Prilosec, Prevacid, Aciphex and Zegerid) and/or H2 blockers (Zantac, Axid, Pepcid, and Tagamet) that decrease stomach acid production may be prescribed.

Allergies: Environmental allergy can be a major factor contributing to chronic sinusitis. While many patients have obvious seasonal symptoms, such as sneezing, itching, and runny eyes, others may have more subtle year-round symptoms that can make diagnosis more difficult. Accurate allergy diagnosis requires a thorough medical history review, blood work and often skin testing. Treatment typically involves identifying and avoiding the offending allergens and, when necessary, anti-histamines, nasal sprays, and desensitizing allergy shots.

Asthma: Asthma and sinusitis are characterized as reactive airway diseases. Coughing and wheezing frequently accompany sinusitis, even in patients with no previous history of asthma. Many patients successfully treated for sinusitis report an improvement of asthma symptoms as well.

Immune Disorders: Although and unusual cause, immune disorders, including the inability to manufacture antibodies properly, can lead to chronic sinusitis. In such cases, diagnosis may include tests to check the patient’s ability to make antibodies after being vaccinated. Intravenous gamma globulin antibody therapy may be recommended as part of the subsequent treatment protocol.

Mold: Mayo Clinic investigators recently established that inhaled fungus and mold trapped in the nasal mucus are a major cause of sinusitis. Cleansing the nasal and sinus passages will wash away such trapped inhalants.