Sinusitis, Rhinitis and Allergies

Sinusitis, Rhinitis and Allergies

Rhinitis is an inflammation or infection of the nose. The infection can be bacterial such as a sinus infection, or viral such as a cold or an allergic reaction with inflammation. The nasal passageway is like a main hallway in which air is constantly flowing in and out from respirations from the lungs through the nose.

Extending off this main hallway on each side are hollow areas like empty rooms with no doors. These empty rooms extending off the nasal hallway are your sinuses. As air flows through the main nasal hallway, it will swirl around in these empty rooms of your sinuses. As air swirls in and about your sinuses, the sinuses slowly gather dust, dirt, and bacteria. The sinuses do act somewhat as a basic filter for small amounts of debris. But when overloaded, the airway passages in your nose and in the rooms of the hallway of sinuses get excessive debris and bacteria. This will often cause pooling of fluids, swelling (edema), and further complicating obstruction, bacterial, and /or other infections. The nose has turbinates in the sinus cavity that normally warms, cleanses and humidifies the air.

Typically, there are 4 primary sinuses usually in pairs. There can be multiple sinuses:

A. The frontal sinuses are located in the lower central region of your forehead. They are just above and on both sides of your nose. They are just above and behind the central area of your eyebrows under your forehead and in the bones of the skull.
B. Your maxillary sinuses are on both sides of the base of your nose, under
the bones in your eyes on your face, under your cheek muscles. Their size can be like a hollow golf ball.
C. Your sphenoid and ethmoid sinuses are slightly lower, deep inside behind the central region between your eyes and nose. They are set back deeper in the bones of your skull below your brain. They are about the quarter of volume of the maxillary sinuses.

Rhinitis is a common medical condition that affects more than 40 million people in the U.S. Often, patients suffer from Seasonal Allergic Rhinitis (SAR). These symptoms are in the patient’s seasonal history of sneezing, postnasal drip, cough, stuffy or runny nose, and watery eyes. They absolutely affect the patient’s quality of life. They can lead to recurrent respiratory, sinus, ear, and throat infections. They usually include an asthma exacerbation, headache, fatigue, and/or bronchitis. Unavoidable, SAR is treated with medical agents singly or in multiple combinations to reduce the response and improve the quality of life. The prevalence of rhinitis is vastly increasing and is a great health concern. It can often be considered as the starting trigger of a complex mechanism. Therapy is daily nasal steroids. Rhinitis is a common chronic disorder in many children. Rhinitis, sinusitis, and allergies may additionally give anyone daytime fatigue, irritability, impaired learning, cough, interruption of sleep, and great reduction in the quality of life. Rhinitis, sinusitis, and allergies involve lost workdays and reduced productivity. Allergy triggers should be identified and avoided if possible. If environment triggers cannot be avoided; antihistamines, decongestants, mast-cell stabilizers, immunotherapy and/or steroids may be prescribed.

X-rays of the sinuses and even CAT scan of the sinuses may get to the bottom of why problems are occurring. There may be polyps (a growth resulting from this condition over a long-term period), poor drainage, obstruction, a bad tooth, partial tooth (root) extractions, and often-congenital malformations. These differences on a simple x-ray may reveal extremely important information of short, long-term, and precise direction of appropriate therapy. The patient could often (and often does) perceive these chronic, varying symptoms as sudden or new when in reality, they have been ominously present for weeks, months, or years.
Antibiotics often work to kill the bacterial infections that have developed. They are very often used and truly necessary. They should only be sparingly given to clear advanced infections. Antibiotics are not benign drugs without possible complications. In the Atlanta area, Amoxicillian, the book drug of choice, has possibly 70% resistance. Biaxin, Bactrim, Cipro and Ceftin often used by ear/nose/throat surgeons may not work which could result in surgery. There is in vitro, (“In the laboratory” in Latin) which actually happens to people in life. And there is “In Duluth”, which is where our varied patients at Doctors Medical Center are treated precisely from the history, x-ray, physical style, exposures, past trials with failures, and specific sensitivities or appropriate testing which determines yearly antibiotics.

Specific allergy testing could be necessary. From simple to very complex starting with the basics of common things you are often exposed to in the real world, and things you commonly ingest as food. More specific individual testing and gross widespread allergist testing from the family dog to food spices may be effective and necessary to be tailored to you. This is usually not the first step directive, but they may be immediately considered for you with your specific history, physical exam, x-ray, severity, and system type.

OTC Decongestants are agents giving vasoconstriction of nasal blood vessels (Sinex, Dristan, Neosynephrine, and nasal sprays). They are fast acting and usually perceived by the public to give an immediate response and apparently are more effective. They are likely to cause rebound congestion within hours, worsening of symptoms, and possible addiction with extended use. They may possibly lengthen the time of the infection. Oral decongestants (Sudafed) are longer lasting but have many side effects (fast heartbeat, excitability) and may not be effective in the elderly. The above medicine usually should not be taken for more then 1 to 3 days and usually never longer than 10 days because they may have rebound congestion. These are quite addictive.

Nasal corticosteriods are often considered important first line treatments. They stop the synthesis, triggering or making of allergy mediators often starting a complex process of SAR or Allergy.

Epinephrines stop cholinergic receptors in the nose. They stop nasal secretions in the nose possibly affecting increasing infection count and the constructive normal immunoglobulin response (Atrovent). They can give excessive nasal dryness or nosebleeds. Mast-cell stabilizers block the degranulation of mast cells from releasing allergy and inflammatory mediators but usually they last about 6 hours.

Allergy Shot for allergens desensitize a patient with allergy injections. Serum injections may take up to 3 to 5 years on a consistent basis to be truly effective, but are a solution. They may as well constructively desensitize allergy.

Antihistamines block the binding or release of histamine to its receptors stopping the symptoms resulting from the effects of histamine of the eyes, nose, and sinuses (Zyrtec, Allegra, and Claritin). They could be administered with a steroid or in combinations with decongestants, antibiotics, and many other medications and/or specific therapies with specific testing.

Immunizations of flu and pneumonia vaccine, which protect you from complications of chronic bronchitis and pneumonia for years to life, are often very helpful as great therapeutic preventatives in these very special medical problems.

John Drew Laurusonis, MD
Doctors Medical Center