October 17, 2017

Expert Q&A: Sinus issues


Oh, the pressure. Here’s what causes it and what can be done about sinus issues.

To just be pockets of air, sinuses certainly can cause serious discomfort. Here, Bobo Tanner, M.D., co-founder of the Vanderbilt Asthma, Sinus, Allergy Program, answers questions about what causes sinus issues and how these conditions are treated.

Question: Where are the sinuses located?
Answer: We all have multiple sinuses, which are really just air pockets in your skull. You’ve got a set across your brow, one apiece under your eyes, several on either side of the bridge of your nose, and then a big one straight back from the bridge of your nose as well. Our sinuses help resonate our voice. And they can get infected as well.

Question: What causes sinus pain, pressure, and other sinus issues?
Answer: These air pockets are not closed. All of them have a little opening into the back of the nose or throat area. So it’s very important that air is able to circulate in and out of your sinuses as well as the natural mucous that’s produced in the lining of your sinuses. It has to be swept out as well. Those openings need to be open all the time. And if they close or swell shut for whatever reason, an infection or allergies, then the pressure will build up and that can lead to sinus pain. There are nerve endings right there that sense that pressure, and you can feel as though something’s not right. It could be a headache, facial pain, or a variety of other symptoms sometimes. It’s not reliable to say that just that pain or pressure’s a sinus infection, but certainly, if you have one, it’s not unusual to have that sense of pain and pressure from those areas.

Question: Are some people more prone to sinus issues?
Answer: The anatomy of your nose is very important. So it’s great if those opening easily stay open, as we like to say, a nice four-lane highway for fresh air to get in and mucous to get out. If there are lots of curves and twists and you have a deviated septum or polyps, or if you have allergies that cause the lining to swell shut, then those opening no longer can facilitate the air coming in and going out, and the mucous. Then you will get pressure. When the mucous accumulates and fills up these air pockets, it becomes a great culture medium for bacteria. They love to jump in there and swim and eat and live, and it becomes a real problem. So the idea is to keep the sinuses open, fresh air in, mucous out, and then you avoid those sinus infections.

Question: How can people who are prone to sinus issues prevent them from getting worse?
Answer: For example, if you do have problems with allergies, or non-allergic rhinitis, or anything that makes the lining swell shut so that the air can’t get in and mucous can’t get out, then you need to do what you can to try to reduce the swelling and reduce thick mucus production and maintain open passages. There are a lot of good techniques that involve simply just washing your nose out with saline. There are also over-the-counter medications that don’t require prescriptions that allow you to spray medications in there that also reduce the swelling in the lining and cut back on mucous production. Obviously, if you have severe problems with the anatomy or polyps, a surgeon needs to get involved. If it’s allergies, you can be treated with lots of over-the-counter medication, but also allergy shots are our most therapeutic avenue to reduce the reactions from the things to which you are allergic.

Question: How do I know if I have a sinus infection? What are the signs that I need to help?
Answer: Unfortunately, sinus infections share symptoms with lots of other conditions, for example, migraines, common cold, and general facial discomfort for other reasons. Using pain and pressure as an indication of sinus infection is not terribly reliable. Therefore, if you have signs of swollen tissue, maybe even a low-grade fever, your nose is stopped up and maybe you’re making some discolored mucous, and it goes on beyond what we would consider a cold — beyond seven days, and you’re on the tenth day — and things are getting worse instead of better, then it’s a reasonable time to be evaluated for a bacterial sinus infection.

If it’s clearly not a migraine and it’s clearly not due to viruses or other problems like dental work, then sometimes antibiotics can be helpful, along with decongestants. Sometimes a CT scan of your sinuses will answer the question. And one way to reduce the use of antibiotics is to make sure that there is a genuine sinus infection before prescribing them.

Question: So what is the typical sinus-infection treatment for people who have chronic issues?
Answer: First thing, we want to get a history and understand if this is just an acute event or a recurring pattern. Does it have any remarkable correlation with seasons, or maybe exposures to cats or dogs, or some kind of activity like raking the yard or mowing the grass? Then we can start putting together a picture of somebody with allergies. And we can skin test to find out if things that float around in the air are what land in your nose and cause it to swell shut and trap the mucous. Skin testing is a very reliable way to know that when they correlate with the clinical history. On the other hand, if this is something that has been grinding on and just not gotten better, and antibiotics have failed, it’s probably a good time to get a CT scan of the sinuses and look at the anatomy. Also, see if in fact there is an air-fluid level that would suggest a chronic or acute sinus infection as part of it.

Question: What else is involved in an evaluation?
Answer: Asthma is an associated problem with sinus disease, and so we want to make sure that any of your symptoms that are occurring are not actually related to asthma rather than just the sinus infection. These two conditions travel together and can be a little bit confusing. And so we can look into all that. It’s an opportunity to have a very thorough evaluation.

Question: Is there anything else you would like people to know about sinus issues?
Answer: I think it’s important to know that in this day and age, that is one area of medicine where we have a lot of knowledge, and there is a lot of opportunities to be treated and get better. And so, for those patients that are suffering in silence, it’s time to come out and be seen, because there are chances are that you can get better.

Need help?

Vanderbilt Asthma, Sinus and Allergy Program for an evaluation and the most up-to-date treatment recommendations. Call 615-936-2727 for an appointment.

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