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OF CHOICE Q. I keep getting sinus infections and they never clear up despite the antibiotics and antihistamines that I take. Are there any other things I can do to help myself feel better? Anyone who's ever had a sinus infection knows it's not pleasant: A pounding head, thick mucus, bad breath, lethargy and facial pain. Unfortunately for some, the symptoms seem to go on forever, even while taking antibiotics. That's why finding the right treatment is often key, says Gary S. Rachelefsky, an allergist and immunologist who is a clinical professor in the department of pediatrics, allergy and immunology at the University of California, Los Angeles. "Often the problem is trivialized and not diagnosed properly," he says. Sinus problems account for an estimated 16 million office visits annually and nearly $2 billion spent on over-the-counter medications. According to the American Academy of Otolaryngology, more than 37 million Americans suffer from sinusitis, an inflammation of the mucosal lining of the sinus. In part because it takes many forms--acute (lasting up to three weeks), recurrent (four or more episodes in a year), subacute (lasting between three weeks and three months) and chronic (lasting longer than three months and unresponsive to treatment)--sinusitis is often confused with other conditions. Some sufferers even go to the dentist thinking it's a toothache, says Robert Compton, a faculty member at Harvard Dental School who also is the director of disease management at Delta Dental, a national dental insurance network. "It can be confused with gum disease; many times the sinus is actually causing the tooth pain." Generally a cold or seasonal allergy precedes sinusitis. James Stankiewicz, director of the Sinus Treatment Center at Loyola University Medical Center in Chicago, says the common cold virus causes swelling, redness and irritation in the nasal passages. When these passages remain closed they become a dark, humid environment for bacteria. That's why Stankiewicz says it's important to shrink swelling with decongestants and thus prevent infections from developing. "Basically, you have to get it opened and draining," he says. Sinusitis is a growing problem, says Itzhak Brook, a professor in the departments of pediatrics and medicine at Georgetown University School of Medicine, because the bacteria most commonly found in sinusitis are becoming resistant to treatment. "Antibiotics are losing their grip. This is a serious public health threat," he says. "Because of the overuse and abuse of antibiotics, these bacteria have become resistant to the most commonly used drugs, like penicillin." That's why Brook, along with the other members of the Clinical Advisory Committee on Pediatric and Adult Sinusitis, recently released treatment guidelines for primary care clinicians. He suggests waiting seven to 10 days for the virus to clear, but if symptoms persist or worsen, antibiotics are necessary. For cases where commonly used antibiotic treatment fails or a resistant bacteria is suspected, Brook says, his committee has developed a listing of second-line drugs, including cefprozil, cefuroxine and cefpodoxime, and third-line agents. Brook adds that getting the right antibiotic and taking it for a longer duration than most prescriptions--often a month or more--will help most patients with sinusitus. Still, for some the condition persists, and they need to see a specialist, he says. Surgery Surgery is indicated when there is a nasal obstruction from small growths, such as polyps, or when the cartilage and bone in the center of the nose has shifted, a condition known as a deviated septum. "We'll go ahead and get a screening CAT scan of the sinus," says Thomas Troost, a Washington otolaryngologist who mostly treats ailments of the nose and throat. "If [the cause of the symptoms] is anatomical, I suggest surgery." Until the late 1980s sinus surgery was a major operation: An incision was made, sometimes under the gum, and a hole was punched into the sinus to scrape it out. While this procedure is still being performed, Troost prefers a newer, minimally invasive technique using an endoscope, a thin, flexible tube that is inserted into the nose. Dietary Changes Though not endorsed by all mainstream practitioners, other approaches to treating sinusitis have won some popularity. A change in diet can have a dramatic effect on sinusitis, says Carrie Demers, a board-certified internal medicine doctor and the director of a wellness center in Honesdale, Pa., that focuses on mind-body treatments. As Demers explains, the opening to the sinus is a mucus-lined membrane. When this membrane is healthy, tiny hairs, called cilia, beat and move a thin layer of mucus down the throat. If the mucus thickens--as a result of eating too much greasy food, for example--it becomes too heavy and can no longer move the particles of dust, pollen and toxins that are routinely inhaled. In addition to considering dietary changes, Demers has patients use a Neti Pot, a small ceramic device that looks like Aladdin's lamp, for nasal cleansing. After filling the pot with warm salt water, the spout is placed inside one nostril. With the head tilted, the solution is poured into the nostril, draining out on the other side. "It washes over the openings of the sinus, keeping passages clear," Demers says. An Eastern Approach In 1997 a National Institutes of Health consensus panel said clinical studies have shown acupuncture useful, by itself or combined with conventional therapies, for sinusitis. Peter Marinakis, a licensed acupuncturist practicing in Annapolis and Columbia, says acupuncture is excellent for moving qi, or energy, that has been blocked by an allergy to food, pollen or dust. "It promotes the flow of fluid and a downward drain of mucus," he says. "There are [acupuncture] points on the face, head, legs, chest, arms, that could be used for drainage." But if the blockage is caused by growths or anatomical problems, Marinakis says, acupuncture cannot help. For more information about sinusitis: * American Academy of Allergy, Asthma and Immunology: www.aaaai.org. * American College of Allergy, Asthma and Immunology: www.acaai.org. * National Institute of Allergy and Infectious Diseases: www.niaid.nih.gov. * American Academy of Otolaryngology: www.entnet.org. Treatment of Choice is a weekly description of mainstream and nontraditional therapies for common illnesses. Treatment of Choice is an educational column and is not a substitute for medical advice from your physician.
By Kathleen F. Phalen
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