Sinus Problems

WHEN TO SEE YOUR DOCTOR

* Your sinus pain is not helped by three to five days on over-the-counter oral decongestants.

* You also have a fever of over 101°F and a cough.

* You have a severe headache that lasts for more than a day or two.

* You develop swollen eyelids and swelling along the side of the nose.

* You have greenish or yellowish nasal discharge.

* You are also experiencing vision problems, such as blurred or double vision.

* Your sinus pain begins after underwater diving.

What Your Symptom Is Telling You

Your sinuses are a collection of hollow compartments in your head, leading from your nose up behind your eyes and cheekbones into your forehead. These compartments, which regularly produce mucus, have very small openings that readily swell shut in response to irritants like cigarette smoke, colds or allergies.

Once the tiny openings of the sinuses are obstructed, the mucus they produce can't drain out. Fluids build up in the cavities, causing pressure and pain. If you are susceptible to this kind of pain, you have plenty of company?more than 32 million Americans have sinus problems.

It's easy to see why problems develop so readily. Besides being tiny and prone to swelling shut, the openings that drain your maxillary sinuses are inconveniently located. The locations, in fact, might be thought of as a "design error," says Nelson Gantz, M.D., chairman of the Department of Medicine and chief of the Infectious Diseases Division at the Polyclinic Medical Center in Harrisburg, Pennsylvania, and clinical professor of medicine at the Pennsylvania State University College of Medicine in Hershey. The openings for the maxillary sinuses behind the cheekbones, for example, are located at the top of the sinus.

"You'd have to be standing on your head in order for them to drain properly," says Dr. Gantz.

Just how sensitive are these openings? Besides closing in response to exposure to smoke and viruses, these passages may close when allergens cause the tissue to swell or from air pressure changes, such as when an airplane descends. And infections can cause a benign nasal growth called a polyp that can make a sinus problem even worse.

Symptom Relief

Don't worry, you won't have to stand on your head to get relief from your sinus troubles.

Steam them open. Your first defense against sinus pain is steamy moisture, says Dr. Gantz. He recommends taking a hot shower twice a day to help your sinuses drain.

You can also buy a nasal steamer, or easily concoct your own, says Alexander Chester, M.D., a clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C.

"Boil a pot of water, remove it from the stove, drape a towel over your head and the pot and inhale the steam for 15 minutes three times a day," Dr. Chester suggests. Make sure your face is at least 18 inches from the pot so you don't burn yourself.

Clean up your air. If it's high-pollen season, have mercy on your sinuses by keeping windows closed and letting someone else mow the grass, says Lee Smith, M.D., secretary of the American Academy of Otolaryngic Allergy, who has a private practice in Princeton, West Virginia.

Dr. Smith also suggests staying away from smokers. And consider putting a negative-ion generator in your bedroom. "These are air cleaners that really work," he says. "If you can control your exposure to toxic and stressful substances at night, you'll be in better shape during the day," he says. (For other tips on avoiding substances that bring on allergic reactions, see "Attacking the Allergies" on page 391.)

Try healthy-sinus sleep habits. "Elevate the head of your bed about six inches to help sinuses drain," Dr. Chester suggests. You can do this by placing two six-inch wooden blocks under the legs of the headboard.

A warm-steam humidifier with a few drops of eucalyptus oil added to the water will also soothe your sinuses at night, says Dr. Chester. And make sure you don't get too much sleep. Excessive sleep?significantly more than you normally need?may worsen your sinus condition because of the prone position, he says.

Keep your nose aerobic. Aerobic exercise?usually 20 minutes once or twice a day?will have a decongesting effect on your nose and sinuses, Dr. Chester says. Brisk walking will do nicely.

Consider supplements. Dr. Chester often recommends daily vitamin supplements?3,000 milligrams of vitamin C and 30 milligrams of zinc?for people who suffer from sinus problems. "We suspect that these vitamins cause shrinking of swollen tissues in the nose," he says.

Pass on the cocoa. Concentrated sweets, particularly chocolate, may cause an allergic swelling in nasal membranes, says Dr. Chester. You may want to pass on the milk, too. "Ten percent of sinus sufferers have a milk allergy," he says. "Try avoiding milk products for two weeks to see if your sinuses improve."

Help from Your Doctor

Your doctor may determine that a sinus infection?sinusitis?is the cause of your pain.

Zap the infection. Your doctor will prescribe antibiotics and oral decongestants for a sinus infection, says Randy Oppenheimer, M.D., an otolaryngologist in Encinitas, California. "I believe the combination of the two really can break the cycle," he says.

For the first few days, your doctor may also suggest an over-the-counter decongestant nasal spray like Afrin, says Dr. Oppenheimer. "Use these sprays for only two to four days," he warns. "After that, if you have to use it to breathe, the spray won't work anymore and will cause more swelling."

Get help for chronic problems, too. When your sinuses get infected over and over again, your doctor may need to evaluate you for possible nasal polyps, says Dr. Oppenheimer.

A thin fiber-optic scope allows your doctor to examine the sinus cavity, and the polyps can be removed surgically through the nose. Your doctor may also prescribe a steroid medication for a few weeks after the surgery to prevent the regrowth of the polyps.

See also Nose, Stuffy