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Sunday, November 21, 1999 - Page updated at 12:00 AM

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Can't Shake That Cold? You May Have A Sinus Infection

The Gazette

If you can't seem to shake that cold, if you've been dragging for weeks and your face feels like it has been encased in concrete, odds are you don't have a cold.

Instead, you probably have a sinus infection. If you do, you're hardly alone: An estimated 37 million Americans or more a year suffer at least one episode of sinusitis, or sinus infection.

The good news: There are ways to ward off sinusitis. And ways to treat it once it has struck.

What is it?

When sinuses become inflamed and unable to drain properly, the mucus, which normally cleans and moisturizes your nasal passages, becomes trapped and a bacterial infection can develop.

Sinus infections generally are divided into two broad categories: acute sinusitis, a short-term condition that usually responds well to antibiotics, and chronic sinusitis, marked by frequent infections or one that lasts three months or more.

What causes it?

Anything that can inflame the sinuses or hamper sinus drainage, such as a cold, allergies or smoking, can lead to sinusitis.

There also appears to be "a great connection" between sinus problems and heartburn, says Dr. Joel Ernster, with Colorado Springs Otolaryngology Associates PC. That connection may be a reflex action; as stomach acid moves up into the esophagus, the sinuses may produce extra drainage in anticipation of "some caustic thing" invading.

A study published this fall by researchers at the Mayo Clinic suggests that a majority of chronic sinus infections are the result of an immune-system response to a common fungus. The researchers are doing more studies to confirm the findings and are working with several drug companies to set up experiments with anti-fungal drugs.

How can I tell if I have it?

Sinus infections often are mistaken for colds, but there are differences, says Dr. Mark Walton, an osteopath who sees plenty of sinus sufferers in his work at Expresscare Plus. A cold usually produces thin, pale-colored mucus; a sinus infection results in a thick, yellow or green discharge. Other sinusitis symptoms can include congestion, pain in the upper teeth, fever, increased sensitivity to light and facial pressure. Facial pressure is a much more reliable indicator than a headache; "too many people think their headache is due to sinus disease," when in the vast majority of cases it isn't, Ernster says.

How can I prevent a sinus infection?

Walton and Ernster both advise finding what triggers your sinus woes and removing the offending allergen if possible. But that's often not possible. So some other tactics include:

-- Think wet. Keep sinuses clean and hydrated by squirting shots of saline spray - common in any drugstore or grocery store - into your nostrils daily and drink plenty of fluids. A humidifier in your home can help, too.

-- Your doctor may prescribe a steroid-based nasal spray such as Flonase or Nasonex to reduce sinus inflammation. Over-the-counter, medicated nasal sprays also can decongest the swollen nasal membranes, but prolonged use can lead to dependence on the sprays or rebound congestion.

-- Use over-the-counter or prescription antihistamines to control allergy attacks. But check with your doctor: Antihistamines may thicken mucus and hamper drainage. And many over-the-counter antihistamines can cause drowsiness.

-- Avoid alcohol, which causes nasal and sinus membranes to swell.

I still have an infection - now what?

Antibiotics can fight the infection. Amoxicillin remains the drug of choice, Walton says. For sinus-infection sufferers, he'll usually issue a prescription for 14 to 21 days.

The majority of sinus infections will go away by themselves. Depending on the severity of your symptoms, you may want to wait it out for five to seven days before going to a doctor, Ernster says.

To avoid unnecessary discomfort, though, a persistent sinus infection should be treated. In rare instances, an untreated infection can lead to meningitis or brain abscess and infection of the bone or bone marrow.

An antibiotic can help clear up a sinus infection but doesn't attack the underlying problem. If you keep getting one infection after another, or suffer from one that just won't go away - "patients who have been on three different antibiotics over a three-month span of time" - it may be time to see a specialist, Ernster says.

"Plain sinus X-rays are notoriously inaccurate," he says; a CAT-scan may be needed to determine the problem. Outpatient sinus surgery may be suggested to enlarge the natural opening to the sinuses and aid drainage. New image-guided technology that shows the doctor exactly where he is in the sinuses is making the surgery safer and more efficient, Ernster says.

About 2 percent of sinus-infection sufferers go on to get surgery, Ernster says. The vast majority of us can fight back with simpler tools: hydrating and the occasional round of antibiotics.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

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