Samaritan Health Services

As winter arrives, so does the cold and flu season that is oh so familiar to us all. The paranasal sinuses often are the target of viral invaders, along with the entire respiratory tract, from the nose to the lungs. What we call “sinus” problems are actually just a part of the overall infection.

The sinuses are air-filled spaces in the facial bones. They secrete some mucus, though not as much as the nose itself produces. When the sinuses are able to drain and equalize pressure, they are symptom-free. With a cold or flu, they tend to get stopped up and secrete more mucus. This leads to the familiar blocked nose and full, pressurized feeling in the head. It may be painful. (It should be noted that pain alone, in the absence of other clear signs of infection, is not likely to be due to sinus disease.)

The typical attack of winter-time acute sinusitis begins with the common cold, or flu. The vast majority of cases are caused by viruses, so antibiotics are not useful in treating or lessening the severity of the illness. All the usual symptoms of a cold may be present:  fever, headache, clear watery nasal drainage, sneezing, sore throat, cough and blocked ears. CT scans of the sinuses are not usually indicated at this stage, as the pictures would look bad in every case. Within seven to ten days, natural healing takes place, using supportive, symptom relieving medications alone.

A danger sign is when the cold fails to go away in seven to ten days, or when it seems to get better, only to take a turn for the worse. This may indicate a secondary bacterial invasion of the weakened nose-sinus structures. Examination at this stage reveals continuing fever, nasal obstruction, purulent nasal discharge, and facial pain or headache. This is when antibiotics can be of great assistance. CT scans may be needed if complications occur or if healing is slow. 

Chronic sinusitis is bit different. It is not seasonal, but present for eight to twelve weeks without improvement. There may be little or no pain or headache. There is usually nasal blockage, some runny nose, decreased sense of smell and taste, and a possible history of allergy or prior nasal polyps and sinus surgery. CT scans, allergy evaluation and anti-inflammatory medications may be necessary. More and more, there is evidence that this is a condition of chronic inflammation, similar to asthma, and not just a continuation of the more common acute sinusitis. Surgery has a role to play in carefully chosen and maximally treated patients.