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.

Sound familiar? Then you might very well be one of the estimated 16% of Australians who suffer from sinusitis. Symptoms of rhinosinusitis are prevalent in 16% of the general population. What’s more, according to an article in the Australian Prescriber, approximately 0.5% of common colds are complicated by sinusitis.

What, exactly, is sinusitis?

Sinusitis is 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 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’s 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

1.       Hay fever is the most common cause of sinusitis. 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.

2.       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’s 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.

3.       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 develop nose polyps than others and if they regularly take high doses of aspirin the chances are even greater.

4.       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. Often the operation isn’t necessary and the immune problem can be solved with less invasive treatment.

The best medicine

Headaches are the most common and first symptom of sinusitis. 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 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 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 can be used. Steroid nasal sprays containing cortisone are the most effective treatments for hay fever, and also prevent bacterial and viral infections. They’re 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.

Preventing sinusitis

The more sinus infections you get, the greater the chance you’ll need a future operation. Prevention is best. Here’s how to go about it:

    • 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. 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. Don’t close one nostril and blow hard because you could damage the mucous membranes.

    • If you smoke, stop!

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%. 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’s 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 2,5ml salt and 1ml bicarbonate of soda in 250ml 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.

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