Sinusitis and nasal allergies (allergic rhinitis) often occur together when sinus tissue becomes inflamed or swollen, causing the sinus cavities to be blocked. When the sinuses are blocked, they can become filled with mucus, creating an environment in which viruses, bacteria, and fungi can thrive and cause sinusitis (sinus infection). Common causes of sinus blockage are:
- Common cold
- Nasal polyps (growths in the nasal lining)
- Allergic rhinitis (nasal allergies)
- Deviated septum
Sinusitis affects approximately 37 million Americans at least once each year, and can be classified as:
- Acute: Cold-like symptoms begin suddenly and last from 10 days to 4 weeks
- Subacute: Sinus inflammation which lasts 4-8 weeks
- Chronic: Inflammation of the sinuses lasts longer than 8 weeks
- Recurrent: Several episodes of sinus inflammation occurring within one year
Symptoms of sinusitis can include:
- Nasal congestion
- Facial pressure or pain
- Thick yellow or green nasal discharge
- Dental pain
- Bad breath
Sinusitis and nasal allergies can cause similar sinus problems, so proper evaluation and treatment are key in controlling and relieving both sinusitis and allergic rhinitis. Along with a physical exam of the sinuses (checking for tenderness and inflamed paranasal sinus), your doctor may recommend:
- Mucus culture or nasal smear
- Allergy testing
- Nasal endoscopy
- CT scan
- Blood tests
Your doctor will evaluate your symptoms and medical history, along with any other test results to accurately diagnose your sinus problem. A nasal smear may be used to confirm a bacterial infection, viral infection, or an allergy as the cause of your symptoms.
Sinusitis treatment will depend on the severity and cause of the sinus problems you are experiencing. Because sinusitis is often a result of a viral infection, rather than a bacterial infection, antibiotics are many times unnecessary and ineffective. Overuse of antibiotics can breed super germs (bacteria resistant to antibiotics) and cause the medicines to be less effective when truly needed. Bacterial infections in the sinuses that are severe or worsening should be treated with antibiotics. Other effective sinusitis treatments include:
- Rest: To reserve your body’s energy to fight the infection
- Drink warm liquids: To loosen phlegm and thin out nasal secretions
- Gargle with warm salt water: To ease pain or swelling in throat
- Use humidity: Moist, warm air from a shower, bath, humidifier, or kettle can ease throat pain and loosen phlegm
- Flush nostrils: Use of a neti pot or nasal rinse can alleviate congestion
- Apply warm compresses: To relieve facial pressure
- Over-the-counter decongestants: Non-prescription medication, such as pseudoephedrine pills (Sudafed) or decongestant nasal spray or drops (Afrin), can reduce congestion. Be sure to use only for the recommended length of time.
- Oral steroids: If other methods are ineffective, your doctor may prescribe steroids to reduce inflammation.
If all sinus treatment methods have been exhausted without success, your doctor may recommend an outpatient or in-office surgical procedure. Sinus surgeries include:
- Endoscopic sinus surgery: Outpatient procedure which involves using a small lighted tool equipped with a camera (endoscope) and small surgical instruments to remove blockages in the sinuses
- Turbinectomy: Short procedure, usually done in-office, involving the use of radiofrequency to shrink the swollen nasal tissue
- Balloon sinuplasty: Non-invasive, in-office procedure in which the inflamed sinuses are opened using a small balloon which restructures the sinus walls when inflated
Allergic rhinitis occurs when the nasal membranes become inflamed due to an overreaction to particles (allergens) that are breathed in. Allergic rhinitis symptoms can include:
- Scratchy throat
- Clear nasal discharge
- Dark circles under the eyes
Symptoms of nasal allergies often start or get worse at the beginning of spring or fall when specific allergens, such as pollen, are prominent. Allergic rhinitis affects 1 in 5 American adults, and is the cause of countless missed workdays, as well as job and school underperformance.
Nasal allergies are often undertreated because patients just get used to coping with the chronic congestion and sinus problems. Proper treatment of allergic rhinitis, however, can help control and alleviate symptoms and avoid other medical complications from arising.
Common causes of allergic rhinitis are:
- Pollens (from grasses, trees, and weeds)
- Dust mites
- Animal dander
Diagnosing and Treating Allergic Rhinitis
Diagnosing allergic rhinitis will involve a physical exam and an evaluation of your symptoms and when you get them. Keeping a diary to track when your allergies flare up will help determine whether they stem from indoor or outdoor allergens. Your doctor may recommend a skin test to confirm what you are allergic to. Knowing what triggers your nasal allergies can help you limit your exposure and lessen your symptoms.
For mild allergic rhinitis, over-the-counter medication may be sufficient to control your sinus problems. Some effective over-the-counter allergy medicines include:
- Steroid nasal sprays: Flonase and Nasacort reduce nasal swelling and alleviate itching and sneezing.
- Decongestants: Oral medications that reduce nasal swelling include pseudoephedrine hydrochloride and phenylephrine (Sudogest and Sudafed). Nasal sprays containing oxymetazoline hydrochloride (Afrin), naphazoline (Privine), or phenylephrine hydrochloride (Sinex) should only be used for 3 concurrent days to avoid symptoms worsening from overuse.
- Antihistamines: Histamine blockers, such as loratadine, fexofenadine, and certirizine help relieve symptoms such as itching and sneezing. Older antihistamines, such as diphenhydramine and chlorpheniramine, cause drowsiness and are typically not recommended.
- Prescription medications: Prescription antihistamines and decongestants are available in pills, nasal sprays, and eye drops. Your doctor may also prescribe an oral steroid, such as prednisone, for flare-ups, but typically not on a long-term basis.
- Immunotherapy: Allergy shots, drops, or tablets expose the patient to small amounts of an allergen in order for the body to become accustomed to it. Effective in 85-90% of patients, allergy shots use a natural method of treatment and have a long-term effectiveness.
- Home treatments: Nasal irrigation (neti pot or nasal rinse), use of a humidifier or vaporizer, and limiting your exposure to specific allergens will help control symptoms. Supplements, such as quercetin and butterbur, show some evidence of lessening allergy symptoms, as well.
If you are experiencing symptoms of sinusitis or allergic rhinitis, contact Dr. Monty Trimble at DFWSinus.com or call 817-529-6200. He has offices in Fort Worth, Keller and soon to be Southlake, Texas.