Sinuses are air filled cavities within the facial bones. They are located behind the forehead (e.g., frontal), behind the eyes (e.g., ethmoid, sphenoid), and behind the cheek bones (i.e., maxillary). The membranes lining the inside of these cavities secrete mucus which normally drains into the nasal cavity through small openings.
When the nasal cavity becomes inflamed (i.e., rhinitis) either due to allergen or irritant exposure or due to microbial infections, the pores through which the sinuses drain can become clogged. This clogging of the pores may lead to the back up of secretions within the enclosed sinus cavities. Accumulation of mucus within the sinuses can result in proliferation of viruses and bacteria and can lead to chronic sinus infections (i.e., chronic sinusitis), defined as persisting sinus-related symptoms lasting for more than 12 weeks.
The common symptoms of a chronic sinus infection or chronic inflammation of the sinuses may include facial pressure/pain, headache, discolored nasal and post-nasal secretions, cough and/or malaise. The diagnosis of this condition requires a detailed history of onset and progression of specific symptoms, a physical examination, and imaging studies such as sinus X-rays and/or CT scans.
Some common medical treatments of chronic sinusitis are as follows and may include combinations of the treatment regimens listed below:
- Saline nasal sprays and/or irrigations: These are useful in the mechanical clearance of irritants, allergens, and microbes from nasal and sinus cavities. They are inexpensive and easy to use although they can cause some discomfort during usage is some individuals. Their main use is as an adjunctive therapy to other more specific treatments.
- Topical steroid sprays: These are considered first-line treatments for chronic sinusitis. They act by controlling inflammation and reducing the swelling of the tissues and decreasing excessive secretions. They are useful both in chronic sinusitis with nasal polyps and chronic sinusitis without polyps. They are widely available and easy to use. Some of the potential drawbacks of topical steroids may include a burning sensation of the nose, headaches, sore throat, and/or occasional nosebleeds.
- 3. Topical antibiotics: These are sometimes useful in local treatment of bacterial infections. The effects are usually short-lived. These agents are not currently recommended for routine use but offer the potential for improved directed treatment as the ability to identify the effects of specific pathogens evolves.
- 4. Surfactants: Some clinical trials demonstrated benefits of surfactants in the control of biofilms. Surfactants are widely used as detergents, emulsifiers, foaming agents and dispersants in the cosmetics, hygiene, food, and oil industries. Their use in the medical field is also common, particularly within the field of wound care. Many wound cleansers contain surfactants and help in the enhancement of wound closure. Their use however can be associated with considerable discomfort and their role in management of chronic sinusitis is not clearly determined at this time.
- Oral steroids: They can effectively reduce inflammation and are especially useful for shrinking nasal polyps, though they also may result in the multisystem improvement of symptoms. Due to their significant systemic side effects (e.g., weight gain, endocrine dysfunction, thinning of bones, peptic ulcers, cataract formation, depression), they are utilized judiciously and only for short periods of time.
- Oral antibiotics: These are often used to control acute flare-ups of bacterial infections. Some classes of drugs such as macrolides [(e.g., Biaxin (clarithromycin), Zithromax (azithromycin), erythromycin] also have anti-inflammatory effects in addition to their antibacterial properties. Potential side effects include gastrointestinal distress and possible development of bacterial resistance on repeated usage.
- Biologicals: As more research sheds light on specific inflammatory molecules and pathways driving the inflammation in chronic sinusitis (i.e., phenotypes and endotypes), biological medications can offer targeted and more effective treatment options. The potential advantages are the reduced need for oral or topical steroids as well as the need for sinus surgery. A few of these agents are currently being used for the control of asthma but none of them have been currently approved for chronic sinusitis.
Preventive measures for chronic sinusitis include identification of specific allergen sensitivities by allergy testing by a board certified allergist. Allergy testing can be done by skin testing or blood testing depending upon the circumstance and age of the patient. The aggressive treatment of allergic seasonal and/or perennial rhinitis (i.e., hay fever) promotes proper sinus drainage and improves upper airway function.
The board certified allergists and immunologists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Our allergists have been treating chronic sinusitis as well as acute sinusitis and other sinus-related conditions for many years. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you or someone you know has an allergic condition that predisposes you to sinus problems or sinus infections, please make an appointment so that we may help you. Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years and would be happy to provide allergy and sinus relief for you in a caring and professional atmosphere.