ASK THE DOCTOR:
Sinus pressure often is not a sinus infection
By DR. JIM MITTERANDO

People often come to the doctor’s office complaining of a runny nose, nasal congestion, sinus pressure and colorful mucus concerned that they have a sinus infection and wondering if they need an antibiotic.

In fact, most people with these symptoms have a viral illness - the common cold. In the past, viral infections were thought to cause only clear mucus and bacterial infections produced yellow or green mucus. Recent studies have dispelled this old myth showing that viral infections often have colorful mucus and that the majority of these head colds clear without any antibiotics.

Sinuses are air-filled spaces within the bones around your nose, eyebrows and cheeks. There are no sinuses near your temples or in the back of your head. Any pain in these areas is due to a headache rather than sinus pain.

Nasal congestion can impair drainage of the sinuses causing sinus pressure and pain. A similar ear problem can occur when congestion of the Eustachian tube prevents air flow from the throat to the middle ear, causing ear pressure, popping and pain. These symptoms are often relieved with decongestant pills and nasal spray s.

Bacterial sinus infections typically develop after a cold has been present more than seven days. Impaired drainage of the sinuses allows bacteria to accumulate and multiply leading to an infection. Fortunately, less than 1 percent of colds develop into sinus infections. The decongestant pill, pseudoephedrine (Sudafed and Actifed), can relieve nasal congestion and help the sinuses to drain. If you do not get relief with this medication, I recommend adding a decongestant nasal spray (Neo-Synephrine or Afrin) for no more than four days. Use decongestant nasal sprays cautiously; prolonged use can cause ‘‘addiction’’ by triggering rebound nasal congestion. Short-term use of these sprays is safe and may prevent a sinus infection by promoting drainage.

If sinus pain persists after several days of this decongestant combination, you probably have a bacterial, sinus infection that will require antibiotics. Other signs of sinus infection include a foul taste in your mouth, bad breath and pain of the upper teeth. Persistent nasal congestion is not a sinus infection.

Avoid taking decongestant pills near bedtime, because they can make you jittery and keep you awake (the opposite effect of sedating antihistamines). Decongestant nasal sprays can be used for nighttime relief without these side effects.

Decongestants may elevate blood pressure temporarily. They may also decrease the effectiveness of blood pressure medications but are considered safe for short-term use of one to two weeks. No one should take these medications chronically. If you find you need to take a medication daily to help with nasal congestion, talk to your doctor or nurse practitioner about preventative treatment with nasal steroid sprays.

Men with enlarged prostates that require medication to help with urination should avoid pseudoephedrine since it can cause temporary urine obstruction. People taking the older antidepressant drugs Nardil, Parnate (MAO inhibitors) should not take pseudoephedrine. Decongestants are safe with all other antidepressant drugs. People taking the Parkinson’s medication, Eldepryl should also avoid pseudoephedrine. Decongestant pills are safe in the second and third trimester of pregnancy but should be avoided during the first 12 weeks of pregnancy.

Older antihistamines, which dry up mucus, are less useful for sinus symptoms; they should be avoided during colds because they can thicken mucus thereby inhibiting sinus drainage, which may promote a sinus infection. Combination cold medications should also be avoided because they often contain a drying, antihistamine. Newer antihistamines such as Claritin, Allegra and Zyrtec are not drying and do not relieve cold symptoms. Antihistamines should only be used for allergy sympt oms.

Nasal steroid sprays (Flonase, Rhinocort, Nasonex, Nasacort) reduce inflammation and swelling of the nose promoting better drainage. They may hasten recovery from sinus infection and are particularly useful in preventing a recurrent sinus infection .

Not only colds cause sinus infections; seasonal allergy, deviated septum and nasal polyps can also cause sinus infections.

Some people have problems with recurrent or chronic sinus infections. Fortunately, nasal steroid sprays have reduced the need for sinus surgeries for people with persistent sinus problems. If the sprays do not help, sinus surgery can often open the sinus passages to enable better drainage and prevent sinus infectio n.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their Own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, March 11, 2003