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Q: Seems like the sinuses clog up as often as faulty plumbing. What causes this annoying condition?


A: The paranasal sinuses-frontal, maxillary, ethmoid, and sphenoid-are normally filled with air. This limits the weight of the skull and gives resonance to the voice. But if these sinuses are inflamed or filled with fluid, they can easily become partially or totally blocked. This inflammation is called sinusitis. It's usually the result of a common cold, another rhinovirus infection, or allergic rhinitis.


Typical signs and symptoms of sinusitis include headache, cheek pain or toothache, purulent or colored nasal secretions, fever, fatigue, sore throat, diminished sense of smell, eyelid edema, facial congestion, and headache or sinus pain when bending forward. Acute bacterial rhinosinusitis is less common, but it should be suspected if the patient has a fever over 102[degrees] F (38.9[degrees] C) and symptoms are severe and persistent.


If the patient's symptoms are related to a viral or bacterial infection, purulent, colored drainage is common. The lower turbinates may appear edematous and reddened, and the posterior oropharynx may be reddened from irritation caused by postnasal drip; postnasal drip may be visible. If the patient has allergy-related symptoms, the nasal passages may reveal pale and boggy turbinates and clear to white nasal drainage; postnasal drip is also often present.


Viral sinusitis is best treated by decongesting with an intranasal saline solution. Saline irrigations, sprays, and gels help to keep the nose clear of debris and reduce inflammation. Eucalyptus oil added to saline sprays and gels can further help to open nasal passages. Treatment for allergic sinusitis is similar, with the addition of an antihistamine and an intranasal steroid spray.


Sympathomimetic nasal sprays, like phenylephrine or oxymetazoline (both available over the counter under various brand names), help to shrink nasal passages and clear congestion via vasoconstriction. The problem with these sprays is that they cause rebound nasal congestion if used for longer than a few days. Also, they should be used with caution in patients with hypertension.


Oral mucolytic agents containing guaifenesin may be helpful. They're generally well tolerated with few, if any, contraindications. Because products containing pseudoephedrine can increase blood pressure and heart rate, they should also be used with caution, if at all, in patients with hypertension, cardiovascular disease, or cardiac dysrhythmias.


Viral sinusitis will typically resolve spontaneously. If symptoms persist beyond 10 to 14 days after onset, or if symptoms aren't improving after 7 days, it's probably bacterial sinusitis. Amoxicillin is the preferred treatment. If the patient has fever, facial pain, or swelling around the eyes, antibiotic therapy can be started earlier.


And, at the end of the day, there's nothing better than a steaming hot cup of tea. Sipping hot drinks and drinking plenty of fluids in general can help ease the symptoms of sinusitis. Bottoms up!!