Stuffed! That lingering 'cold' could be sinusitis The first chill of winter always prompted Marilynn Larkin to stock up on tissues, pills, and nasal sprays. The stuffed nose she endured most of the year worsened in the winter. So did her postnasal drip, coughing, and morning headaches. If she didn't take a decongestant before bedtime, she would wake up in the night short of breath and unable to go back to sleep. "I never really thought of going to the doctor, since I didn't have fever or the flu," she says. It wasn't until Larkin's symptoms stopped responding to over-the-counter products that she finally saw a doctor. He diagnosed chronic sinusitis, caused by an underlying allergy and complicated by a bacterial infection. He prescribed antibiotics, vigorous allergy treatment, nasal rinses, and avoidance of allergens and irritants. Several weeks later, Larkin--who went on to write this report--was symptom-free at last. Chronic sinusitis is the most common chronic disease in the U.S., affecting more than 30 million Americans. Briefer bouts of the condition, called acute sinusitis, are even more common, by far. And studies show that the chronic form typically lowers the quality of life just as much as chronic heart or lung disease. In rare cases, a sinus infection can even spread to the eyes or the brain. Unfortunately, the condition is often overlooked or mistreated, causing needless discomfort and potential health risk. Dr. Michael Kaliner of the Institute for Asthma and Allergy in Washington, D.C., studied 200 sinusitis patients and found that they'd had symptoms, on average, for 14 years. Says Kaliner, "The bulk of them either weren't seeing physicians or were seeing doctors who didn't know how to treat sinusitis." In fact, he adds, many doctors learned very little about sinusitis in medical school, where the condition was largely overlooked until recently. Here's how to keep sinusitis from taking hold--and how to get the treatment that can root it out if it does become chronic. Sinusitis, cold, or allergy? Sinusitis is an inflammation of the mucous membrane lining the sinuses, the hollow air spaces in the front of the skull. Because the sinuses open into the nose and share a continuous membrane with it, anything that stuffs up the nose can cause the sinus membrane to swell. That can block the sinus openings and prevent mucus from draining out. The trapped mucus then becomes a breeding ground for bacterial infection, which either causes or complicates most cases of sinusitis. Misdiagnosing the underlying cause--or mistaking sinusitis itself for a cold or allergy--can lead to mistreatment, which may let the condition become entrenched. Distinguishing among colds, allergies, and sinusitis can be tricky, however. They can all cause some of the same symptoms, such as congestion and coughing. Further, an allergy often coexists with sinusitis, and a cold can overlap or precede it, too. But certain symptoms, while not exclusive to sinusitis, strongly suggest it, particularly if they persist Symptoms that start or worsen in winter. Dry heat lowers the humidity, inhibits mucus secretion, and is a major contributor to sinusitis, according to Dr. Ralph Metson, associate clinical professor of otology and laryngology at Harvard Medical School. Symptoms that worsen at night, since lying down increases the drainage into the throat. A thick, dark, yellow, green, or gray discharge from the nose or back of the throat, a likely sign of bacterial infection. Postnasal drip, as the mucus escapes into the throat rather than the nose. Moreover, the persistent drip can lead to sore throat and coughing--sinusitis signs that even a physician may miss, according to Dr. Sheldon Spector, clinical professor of medicine at UCLA. Facial pain or frontal headache, due to pressure in the sinuses. Loss of smell, then loss of taste. The key distinguishing feature of colds is brevity They almost always clear up in three to seven days. As for allergy, the key differentiating signs are itchy eyes and nose, and connection with either the hay fever season or another trigger, like dust or pets. Correctly identifying and treating sinusitis also requires distinguishing between the acute and chronic forms. The acute condition usually develops during or after a cold. Typically, you suffer an apparent relapse, often with pronounced symptoms such as fever and facial pain. Acute sinusitis usually clears up in one to three weeks--but it can turn chronic if it's neglected or incorrectly treated. By contrast, chronic sinusitis is more commonly caused by allergies; other causes include repeated colds, structural abnormalities like a deviated septum, growths such as nasal polyps, smoking, and fungal infection. Symptoms of chronic sinusitis are often milder but linger longer--at least eight weeks, sometimes many months or even years. Self-help for sinusitis If the symptoms aren't debilitating or chronic, you can make your own tentative diagnosis of acute sinusitis and try treating yourself. Use simple nondrug remedies first--they're safer (and cheaper) than drugs. And they tend to work regardless of the underlying cause. One crucial step is to irrigate the nose and sinuses. That step, done at least once or twice a day, helps clear away the mucus, thereby easing the discomfort, restoring drainage, and allowing the sinuses to heal. The most effective technique is to mix a half-teaspoon of salt in 8 ounces of warm water, pour the mixture into a rubber ear syringe (available at drugstores), and spray into one nostril while pinching the other one closed. Blow the secretions out after four to six sprays, and repeat the process until the secretions are completely gone. Then repeat that process in the other nostril. A simpler though less effective approach is to use a saline nasal spray such as Breathe Free or Ayr. Other useful steps include Inhaling steam. The simplest way is to recreate "granny's steam tent" by pouring boiling water into a basin, putting a towel over your head, and letting the steam waft up into your nose and sinuses. Using a bedside humidifier. Drinking plenty of fluids. Sleeping with your upper body or the head of your bed elevated. Exercising, to promote drainage. OTC drugs Use with care If self-help doesn't relieve the mild, acute symptoms--or if you just want faster relief--you could add over-the-counter drugs to your home regimen. Stick with single-ingredient products--not the hodgepodge of antihistamines, decongestants, and analgesics promoted as "cold and sinus" remedies. Single-ingredient products let you tailor both the dosage and the length of treatment to your particular symptoms--and also let you avoid needless ingredients. Be aware that most sinusitis drugs have risks or other drawbacks that require particularly cautious use. Regardless of what's causing the sinusitis, the choices include Decongestant sprays such as xylometazoline (Otrivin) or oxymetazoline (Afrin, Neo-Synephrine 12-Hour). Don't use them for more than a few days, or you may experience "rebound" congestion that's worse than the original problem. Oral decongestants such as pseudoephedrine (Halofed, Sudafed) and phenylpropanolamine (Propagest). While there's no risk of rebound, both drugs can raise blood pressure and cause difficulty urinating. People with hypertension, heart disease, diabetes, prostate enlargement, or thyroid disease requiring medication should avoid these drugs entirely. Expectorants such as guaifenesin (Breonesin, Hytuss) may thin the mucus and help you cough or blow it out. If you think an allergy is causing the acute sinusitis, these drugs may help Cromolyn sodium nasal spray (Nasalcrom), which helps shrink the swollen membranes, is the best OTC choice for an underlying allergy. Antihistamine pills may help by reducing any allergy symptoms that are causing or contributing to the sinusitis. But they have two drawbacks They might actually worsen the sinusitis by drying the mucus, and nonprescription antihistamines such as brompheniramine (Bromphen, Dimetapp Allergy) or diphenhydramine (Banophen, Benadryl Allergy) can cause drowsiness that compounds the fatigue. You may want to ask your doctor to prescribe a nonsedating drug such as fexofenadine (Allegra) or loratadine (Claritin). Either way, be prepared to abandon the drug if it's making you feel worse. When to see a doctor To help prevent chronic sinusitis, see a physician if the nasal congestion and other symptoms are severe, recur, or last longer than ten days or so--particularly if you have fever or persistent green or gray mucus. A general practitioner should be able to treat routine cases of sinusitis by prescribing antiallergy medication, antibiotics, or both. But if you're not starting to improve after about five days on an antibiotic, ask your doctor about switching you to a different one. Seek a specialist--an otolaryngologist or allergist--if you have chronic sinusitis, or if you're not getting better after two or three weeks of treatment. Specialists can perform more-sophisticated tests than a general practitioner--particularly nasal endoscopy, the insertion of a thin tube for viewing the nose and sinuses. And they have more experience treating chronic sinusitis. Specialists can also confirm an allergy, identify the triggers, and possibly treat you with steroid nasal sprays, other anti-inflammatory drugs, or allergy shots. If medical treatment doesn't help, you might consider surgery, to clean out infected sinus membranes and enlarge the sinus openings--or to remove a nasal growth, correct a structural defect, or help eradicate a stubborn fungal infection. Surgery is usually performed on an outpatient basis, sometimes under local anesthesia. The operation improves sinusitis in some 80 to 90 percent of patients, with about a 3 percent average risk of complications, primarily bleeding. However, the problem may recur. That's one more reason not to rush into surgery unless the symptoms are debilitating and you've exhausted the alternatives. Sinusitis, cold, or allergy? As this table shows, some symptoms of these three conditions are the same. But other symptoms are either different or more common in one condition than in the others. -------------------------------------------------------------------------------- SINUSITIS -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- COLD -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ALLERGY -------------------------------------------------------------------------------- Key symptoms * Nasal congestion * Dark, thick, green, gray, or yellow discharge from nose or back of throat * Malaise * Postnasal drip x Key symptoms * Nasal congestion * Runny nose with thin, clear-to-yellow discharge * Malaise * Sneezing Key symptoms * Nasal congestion * Runny nose, with clear, watery discharge * Itchy eyes or nose * Sneezing Duration Acute, one to three weeks; chronic, eight weeks or more Duration Three to seven days Duration Seasonal, year-round, or present only during exposure to the triggering substance Other symptoms * Sore throat or coughing x * Facial pain or pressure x * Loss of smell or taste x * Headache x * Fever * Onset or worsening in winter or when lying down Other symptoms * Sore throat or coughing * Facial pain or pressure * Loss of smell or taste * Headache * Fever * Postnasal drip Other symptoms * Sore throat or coughing * Facial pain or pressure * Loss of smell or taste * Headache * Postnasal drip -------------------------------------------------------------------------------- x This symptom is more common or generally more prominent for sinusitis than for a cold or allergy.