‘An entire world inside your nose’
In addition to colds and flu, it’s also sinusitis season for millions
Fourteen-year-old Dawit “D.J.” Debebe, a freshman at Perkiomen Valley High School, had long struggled with allergies, but something new, and much worse, attacked his sinuses in September.
He started having headaches so painful he had to sit out football practice. He worried he might have a concussion. “It was just constant pain,” he said.
The pain was so horrific that his mother, Victoria Debebe, took him to an emergency department. An MRI revealed that all of the sinuses on his left side — air-filled cavities in the skull that produce mucus and, ideally, wash away impurities — were not only completely clogged, but that bone surrounding the larger sinuses was bending from the force of the trapped mucus.
Antibiotics and steroids were no help. James Palmer, director of rhinology (sinus surgery) at Penn Medicine, concluded an allergic immune response to fungus was the problem. The only reliable treatment was endoscopic sinus surgery, a procedure done from inside the nose without outside incisions.
So D.J. found himself in an operating room in Penn’s Perelman Center for Advanced Medicine, anesthetized as Palmer pulled thick green blobs of infected mucus from his nasal passages and snipped and drilled away at a honeycomb of thin, nonessential bones in his sinuses to improve drainage.
D.J. is an extreme example of what can go wrong with sinuses. But each fall and winter these little caves in our heads torment millions with pain, pressure and thick, yucky mucus that lengthens the misery after seasonal viral ailments have run their course.
This is not just cold and flu season. It’s sinusitis season.
You can get a sinus infection at any time of the year, but doctors say they see more patients with sinus complaints in fall and winter because cold, dry air and respiratory bugs set the stage for sinus malfunction.
Unlike the flu, sinus infections rarely kill, but they are still a big deal. Count yourself lucky if you’ve never had a clogged sinus make it feel as if your head might explode. According to the U.S. Centers for Disease Control and Prevention, 29 million adults — 11% of the population — were diagnosed with sinusitis in 2018. Palmer says 5% to 20% of the population has chronic sinusitis — sinus inflammation that lasts more than a couple of months. The American College of Allergy, Asthma and Immunology estimates that people spend $1 billion a year on over-the-counter medications and $150 million on prescription drugs for sinus infections. Twenty percent of prescriptions for antibiotics are for sinus infections, said Noam Cohen, a Penn Medicine otorhinolaryngologist.
Troubling as they can be, sinuses are also weird and interesting. “There’s an entire world inside your nose. It’s a window to your entire body,” Palmer said. “Sinuses are a reflection of the overall health of the patient a lot of times.” Sinus malfunction, he said, has been associated with sleep, heart and lung problems.
We’re most likely to worry about sinus infections, but you don’t necessarily need bacterial infection to have nasty sinus symptoms. Doctors more often use the broader term sinusitis or rhinosinusitis, which refers to inflammation and swelling in the nose and sinus cavities that lead to poor sinus drainage. Sinusitis can be caused by viruses, fungi, allergies and irritants, said Kenneth Einhorn, chief of the division of otolaryngology at Abington-Jefferson Health.
The inflammation can pave the way for bacteria. When mucus gets trapped in a sinus, it provides what Donald Solomon, an ENT at Cooper University Hospital, calls a “warm, happy environment” for bacteria that might normally be swept away.
Sinusitis can be acute, recurrent or chronic. It’s considered acute if it lasts no more than a month or two. Some people have frequent, short-term sinus problems that they’re able to clear. These are recurrent. Still others end up with sinus problems that linger for many weeks or months. This is chronic sinusitis.
Typically, true sinus infections happen after you’ve had something else, like a cold or the flu, so you’re looking for symptoms that get worse after a couple of weeks. Sinus infection symptoms, Einhorn said, include thick mucus, pressure pain over an inflamed sinus, pressure in upper molars, ear fullness, postnasal drip, sore throat and coughing that’s worse at night. Headaches, fatigue and fever can also be present.
Sinus specialists are big fans of good sinus hygiene. Rinsing frequently with salt water — sprays don’t do the job — clears out the sinuses and helps keep tissue moist, doctors said. A neti pot can work, but doctors said the NeilMed squeeze bottle available in drugstores is well-designed.
Sinus sufferers need to take particular care to keep symptoms under control during their allergy season or when they catch a respiratory virus.
With a cold, Palmer said, “hit the saline hard.” Steam, including long showers, is also helpful. Use a humidifier in the winter.
Einhorn recommends starting an over-thecounter steroid spray like Flonase or Nasacort. Use a decongestant spray like Afrin for no more than three or four days.
If you’ve taken all the preventive measures above for 10 to 14 days and you still have symptoms, it’s probably time to see a doctor.