March 30, 2020 - Monday

Sinus, Sinusitis and the Allergist

“My head hurts, my nose is stuffy and it runs like a faucet. I have sinusitis. ”

From the desk of Dr. Walter M. Ryan, III

Sinus, Sinusitis and the AllergistBut what is sinusitis. As with most terms in medicine – the “itis” ending means inflammation. Inflammation is a way for the body to protect itself, and help with the healing process. The inflammatory process will include white blood cells and chemicals that are the work horses for inflammatory response. Among the cause of inflammation are infections or trauma.

So what is sinusitis (inflammation of the sinuses)? First what are sinuses? Sinuses are openings or pocket of air or cavities within the head- the skull to be more precise. The functions of the sinus is to make the skull lighter, help with the quality of our voice, but the primary function is thought to be help in production of mucus and the warm and moisten air before it travel to the lungs. There are four types of sinuses-maxillary, ethmoid, frontal, sphenoid. There are 2 maxillary on each cheek; there are about eight ethmoids sinuses on each side of the nose between the eyes. The frontal sinuses are up between the eyebrows, the sphenoid sinuses are behind the ethmoids. The sinuses are lined with a mucosal layer. All of them have a drainage site at the bottom of the cavity except the maxillary. Its drainage site is near the top like the overflow hole in a sink.

When the drainage sites swell, the air in the sinus gets absorb, which causes a negative pressure and that results in discomfort. Think of when ears get blocked when flying in a plane of diving deep under water.

What cause these the drainage site to get blocked? It can be do mechanical obstruction such as a deviated septum or nasal polyps or from inflammation of the nose either from infections or allergies.

The infections can be virus, bacterial fungus. The most common infection would be a virus. Usually a virus will last 5 to 7 days. That is why most infectious sinus complaints are not treated with an antibiotic until symptoms persist for 7 to 10 days. The symptoms may include fever, muscle aches, loss of smell, thick green mucus from the nose, bad breath, headache, pain in the upper teeth, copious amount of mucus draining down the throat.

Allergies – allergic rhinitis – cause swelling in the nasal passages. The symptoms can be runny nose, sneezing, stuffy nose, itchy nose. There is usually no significant fever no muscle aches. The individual may have a family history of allergic disorders such as asthma or eczema. The individual may be able to identify a seasonal component or a particular trigger such as dust, animals, etc. Allergic rhinitis is a risk factor for developing sinusitis
Those are the most common causes of sinusitis –  though there are others such as immune deficiencies, chronic inflammatory disease.

The diagnosis can be made by history and physical. But sometimes additional tests are necessary such as imaging (usually CT of sinus), rhinoscopy, and allergy testing (either skin testing or blood). Rarely are cultures necessary.

Treatment will depend on the finding-it can range from symptomatic treatment for viral infections, to antibiotics for bacterial infection. If allergies are the contributing cause – the treatment may range from topical nasal steroids, antihistamine, to leukotriene modifiers, immunotherapy. If there is a structural cause it may require a surgical intervention.

Florida Center for Allergy & Asthma Care
1-877-4-ALLERGY (1.877.4.255.3749)

Palm Beach Gardens
3365 Burns Rd., Suite 206, Palm Beach Gardens, FL 33410 PH. 561-227-1456
F. 561-775-7980 M.

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