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Ask the Doctor: Sinusitis

by John Zettelmaier, MD

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Sinus Man

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My sinuses are killing me. What can I do? And what are sinuses for anyway?

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There are four pairs of sinuses: frontal (forehead), ethmoid (the area between the eyes), sphenoid (behind the nose, deep in the head), and maxillary (cheekbone area). The sinus and nose mucous lining produces one to two liters of fluid a day. The purpose of this mucous blanket is to defend the body against infection. It traps bacteria and particulate matter that we breathe in, and then sends them down our throat and into our stomach where the stomach acid destroys the invaders. In addition, the sinuses humidify and warm the air we breathe in. The sinuses drain into the nose and any blockage of these small passages predisposes us to the symptoms of sinusitis.

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Sinusitis is conveniently divided into two categories: acute and chronic. Acute sinusitis lasts less than one month; chronic or recurrent sinusitis longer than one month. The acute type is generally caused by viral infections, bacterial infections, or allergies. Other causes do exist but are much less common. The viral variety can improve with a trial of self-treatment. The bacteria-caused sinusitis requires antibiotics, so see your doctor. The allergic type also requires a physician’s evaluation.

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Symptoms and signs of sinusitis include pain in the eyes, ears, or nose area; fever; headache; fatigue; runny or stuffy nose; post-nasal discharge; decreased ability to smell or taste; cough; dental pain in the upper teeth; halitosis; and tenderness in the sinus areas.

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If you are not running a high or prolonged temperature and don’t have severe pain, over-the-counter (OTC) drugs such as acetaminophen or ibuprophen can provide symptomatic treatment of pain and low-level fever. For the cough, an OTC dextromethorphan may provide some relief, and decongestants can help with the stuffy and runny nose. Thick secretions can yield to guaifenesin or nasal irrigation with normal saline solutions, but if you use nose drops, don’t exceed three days. If you go longer, your nose membranes can become “addicted” to the nasal decongestants and won’t work normally without them, yielding a dependence on nose drops to open the nasal passages.

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For the fatigue, get plenty of extra rest. And you may find that humidification helps the dry or burning nose sensation.

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If you are having severe or persisting symptoms, it’s time to see your doctor. The doctor may prescribe antibiotics or order X-rays or other special procedures.

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Good luck!

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John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

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