Smart Sinus Care: From Prevention to Treatment

The pounding headache. The stuffed-up head and post-nasal drip. In cold and flu season, this pain is all too familiar as germs and mucus make their home inside your head -- specifically, in the complex set of chambers called the sinuses.

Your sinuses open off your nasal cavity like rooms off a hallway, with doorways no wider than a pencil lead. There are four pairs, each like mirror images on either side of your face.

Ethmoid sinuses: Put your finger alongside your nose, with your fingertip just inside the corner of your eye. That fingertip is pointing to the ethmoid sinuses -- a network of five to 10 small chambers that run horizontally front-to-back between the bridge of your nose and your eye sockets. These form the central drainage system for your sinuses -- all the others drain through here. Pressure pain in the ethmoids might make you want to pinch the bridge of your nose.

Maxillary sinuses: Leaving your finger next to your nose, feel where your first finger joint hits the top of your cheekbone. That bone protects the largest set of sinuses -- the maxillaries. Each about the size of a walnut, these chambers are connected to the nasal passages by openings at the top, so they must defy gravity to move mucus up and out. They sit so close to your upper teeth that maxillary infections are often mistaken for toothaches.

Frontal sinuses: Sitting behind your forehead, just above your eyebrows, are your frontal sinuses. These sinuses actually determine the shape of your brow -- and can cause sinus headaches.

Sphenoid sinuses: You won't be able to put a finger on these sinuses! About the size of a large grape, the sphenoids sit deep within your head, just below your brain -- making an infection there all the more dangerous. Some people feel the pain of sphenoid congestion at the back of their necks.

A thin layer of sticky mucus coats your nasal and sinus cavities, trapping dust particles, bacteria and other pollutants before they can get into your lungs. When everything is working properly, tiny hairs called cilia sweep mucus into the back of your throat where it can be swallowed and neutralized in your stomach.

When a cold, flu or allergy causes tissues to become swollen and fill with mucus, cilia may be unable to move the thick mucus out, and your sinuses become clogged. Trapped air creates a painful pressure build-up. Trapped mucus provides a safe haven for germs and infection.

Symptoms of Sinus Congestion

Sinus headache and postnasal drip are the most common complaints from sinus congestion, but others include:

-- Facial pressure or pain

-- Congestion or stuffy nose

-- Thick, yellow-green nasal discharge

-- Low fever (99 to 100 degrees Fahrenheit)

-- Bad breath

-- Pain in the upper teeth

The sinuses are formed by facial bones, so they get larger as we grow. That's one reason sinus congestion and infection in children cause different symptoms than in adults, such as:

-- A "cold" lasting more than 10 to 14 days, sometimes with a fever lasting three to four days in a row

-- Postnasal drip, leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting

-- Irritability or fatigue

-- Swelling or dark circles around the eyes, especially in the morning

Prevention: Simple Sinus Care

You can prevent most sinus problems by using moisture and heat to thin mucus and reduce sinus pressure.

-- Apply a warm, moist washcloth to your face, eyes and nose several times a day to soften mucus and warm the air inside your sinuses, which will relieve pressure.

-- Use a saltwater nasal wash for the inside of your nose. Studies show that a mixture of concentrated salt water and baking soda (bicarbonate) helps the nose work better and move mucus out faster. Buy a nasal wash kit or premixed solution at pharmacies and allergy supply stores or make your own.

-- Drink lots of fluids to keep your body (including your sinuses) hydrated; avoid alcohol and caffeine, which can have a drying effect.

-- Inhale steam to moisten and soften mucus. Do this in the shower, or create your own mini-nasal-sauna by draping a towel over your head as you lean over a basin full of hot water. (Add a few drops of essential oils for custom-made aromatherapy.)

-- Keep nasal passages moist with saline (saltwater) sprays. The salt helps match the water to your body's natural pH chemistry, but try to find sprays without BAC (benzalkonium chloride), a common preservative that many people find irritating.

-- Apply moisturizing gel inside your nostrils to relieve dry nasal passages -- try ones with eucalyptus, menthol or essential oils like peppermint or clove.

-- Run a cool-mist humidifier in your bedroom while sleeping. Clean and dry the humidifier daily to prevent bacteria or mold from growing in it (follow the instructions that came with the humidifier). Keep humidity levels below 50 percent to deter mold and dust mites. Hot water vaporizers are not recommended because they can cause scalds or burns.

-- Stay away from smoke and air pollution, which can damage cilia and make them unable to sweep mucus efficiently.

About Medicine

-- Over-the-counter decongestant pills, capsules or liquids relieve nasal swelling and pressure but do not treat the cause of inflammation.

-- Nonprescription nasal decongestant sprays will reduce swelling in nasal passages, allowing mucus to flow more easily. Never use them for more than three to five days, because long-term use can actually increase congestion.

-- Nasal corticosteroid sprays will reduce nasal inflammation and swelling, but may take at least four to five days to reach full effect; use daily as directed.

-- Corticosteroid pills or injections are sometimes given as treatment to relieve severe sinus inflammation cased by bacteria, viruses or allergies.

-- If your physician prescribes antibiotics, take them for the full duration prescribed; don't stop when you start to feel better.

When to See Your Doctor

A sinus headache does not necessarily mean you have an infection requiring a doctor's care or prescription medication. Many cases of sinusitis will clear up by themselves within a week, especially if you follow the self-help treatments recommended above.

However, the American Academy of Otolaryngology-Head and Neck Surgery recommends adults see a doctor if any three of the above symptoms persist for 10 days or longer.

Do sinusitis symptoms persist for months? Are they seasonal? Is there also an asthma diagnosis? It could be allergies that are causing symptoms, and it's worth undergoing testing and treatment from a board-certified allergist. Patients should also have their immune system checked, as symptoms could be connected to primary immune deficiency disease, or PIDD.

Treatment of sinusitis in children is very similar to adults. Children frequently get sick from the school or daycare, and it's usually treated with antibiotics. If the sinus infections are accompanied by high fever and require frequent courses of antibiotics, or there are growths in the sinuses called nasal polyps, the children should be evaluated for more serious conditions such as cystic fibrosis or PIDD.

Purvi Parikh, MD, is an allergist and immunologist with Allergy & Asthma Network , the leading nonprofit patient education organization for people with allergies, asthma and related conditions. She practices in New York City at Allergy and Asthma Associates of Murray Hill and New York University School of Medicine. She sits on the Board of Directors for the advocacy council of the American College of Allergy, Asthma & Immunology.