For most of us, sinus infections resolve on their own after about five days. Some last longer and require a course of antibiotics. But infections that keep returning after weeks of treatment are considered chronic sinusitis, says endoscopic sinus surgeon Jordan Josephson, MD.
Symptoms: Yellow-green discharge, postnasal drip, nasal obstruction, mouth breathing, sinus pressure, headache, fever, fatigue, decreased sense of smell and/or taste, coughing, nosebleeds, dizziness, ringing ears, tearing eyes, asthma and even depression. Chronic infections also cause polyps in the sinus cavities that worsen the blockage. Worst case: Ongoing infections can lead to meningitis, a serious infection of the fluid and membranes around the brain and spinal cord.
Chronic sinusitis is part of a complicated disease process that Dr. Josephson has coined chronic airway-digestive inflammatory disease (CAID), an inflammatory process that affects the respiratory and digestive tracts. CAID includes chronic sinusitis, allergies, asthma, snoring, sleep apnea and gastroesophageal reflux disease (GERD) as well as ulcerative colitis and Crohn’s disease. Genetic abnormalities predispose some people to inflammation when exposed to certain foods, allergens, viral or bacterial infection, mold and other environmental irritants.
Treatments…
Look at your environment and lifestyle for triggers. Does drinking wine or eating tomatoes cause congestion? Do you change your home’s air filters regularly or use an air purifier? Are your mattress and pillows covered to protect from dust mites?
Irrigate your sinuses regularly with distilled saltwater. This is important when you have an infection but should also be done for maintenance using an over-the-counter neti pot, squeeze bottle or electric pulsatile irrigating machine. Follow the instructions, and don’t use ordinary tap water.
Avoid most over-the-counter (OTC) sinus remedies. Taking OTC products over the long term can be dangerous for people with certain conditions. Examples: Pseudoephedrine, found in many OTC products, can be risky for people with cardiac issues or high blood pressure. Afrin nasal spray can lead to rhinitis medicamentosa, causing congestion to get worse. Possible exception: The steroid nasal spray fluticasone (Flonase), but ask your doctor if it’s safe for you.
See an otolaryngologist. Also known as an ear, nose and throat (ENT) doctor, he/she may order scans or perform an endoscopy to look in your nose and airway and/or a sinus culture to see whether the infection is viral, bacterial or fungal. Such cultures give doctors a sense of which medications to try first.
If you can’t shake the infections after repeated treatment, your doctor may recommend endoscopic surgery to clear the infection, open the passageways and/or remove polyps and infected tissue. While not a cure, this surgery can make a huge difference for your breathing and your health, but you still may need medicines and irrigation and to avoid allergens and irritants.
If you suffer from other CAID-related issues, follow through with other specialists to treat your symptoms—allergists, gastroenterologists, pulmonary specialists and/or sleep doctors. Your ENT doctor should oversee the interdisciplinary care.
