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Sinus & Allergy

The Basics

It is important that patients understand some basic Anatomy and Terms. The inside of your nose is complex. Many people become confused with the terms “sinusitis,” “allergy,” and “congestion,” often using the terms interchangeably when they are very different!

Anatomy

The septum is the wall that divides the left and right side of the nose and if crooked, it is called a deviated septum which may cause nasal obstruction or block your sinuses.
The turbinates are the fleshy shelves inside your nose that may become enlarged from a cold or allergy. When swollen, the turbinates are what contributes to the sensation of nasal congestion or “stuffiness.”
The sinuses are air filled cavities in the skull and facial bones. You have four sinus cavities:

  • Maxillary Sinuses: in the cheeks
  • Ethmoid Sinuses: in the roof of nose
  • Frontal Sinuses: in the forehead
  • Sphenoid Sinuses: in the back of the nose

The sinuses are air-filled cavities in the skull and facial bones. You have four sinus cavities:

Diagram - Normal Nasal & Sinus Anatomy

  1. Frontal Recess
  2. Middle Turbinate
  3. Inferior Turbinate
  4. Septum
  5. Frontal Sinuses
  6. Ethmoid Sinuses
  7. Maxillary Sinuses

Sphenoid Sinuses are located in the back of the nose.

Sinus & Allergy Terms

Sinusitis is the inflammation (-itis) of the lining of the sinuses. Acute sinusitis is a short-term condition (<1-2 weeks) that responds well to antibiotics and decongestants. Acute sinusitis is often caused by a bacterial or viral infection and may be treated by your primary care provider. Chronic or Recurrent sinusitis is a long-term or recurrent condition caused by many potential factors such as allergies, nasal blockage, or nasal polyps that may require a combination of medical and surgical management. Chronic sinusitis is often not caused by infection and is treated inappropriately with recurrent antibiotics. Our clinic specializes in the comprehensive management of recurrent sinus issues.
Sinusitis symptoms include:

  • Facial Pain or Pressure
  • Headaches
  • Nasal Congestion
  • Post Nasal Drip
  • Loss of Smell (Anosmia)
  • Bad Breath/Bad Odor

Your sinuses cannot be seen in routine exams. If Dr. Pasha suspects you may be having recurrent sinus infections, he may order a CAT scan or CT scan, which is a detailed X-ray of the sinuses. He will also examine the inside of your nose painlessly with a microscope or endoscope in the office to evaluate the details of your septum, turbinates, and the opening of your sinuses.

  • Sneezing
  • Itchy, watery eyes
  • Runny nose and post-nasal drip
  • Itchy throat
  • Stuffy nose
  • Hives

Vasomotor Rhinitis is a cause of allergy-like symptoms, nasal congestion, and a runny nose. Everyone’s nose congests and decongests throughout the day. This normal nasal reaction is stimulated by a number of triggers such as a change in weather, exercise, food, postural changes, stress, perfumes, hormonal imbalance, smoke, as well as many others that causes the nose to swell and drain. Vasomotor rhinitis occurs when you have an overly sensitive nose. This provokes your nose to overreact to these everyday triggers causing congestion, runny nose, or post-nasal drip. Vasomotor rhinitis is common is Houston because of the humidity, mold, and pollution.

FAQ about Sinus & Allergy

What are the symptoms of sinusitis versus other causes of a runny nose?

Symptoms of sinusitis are caused by infection or swelling of the nasal and sinus mucosa (lining). Although sinusitis may be present with a stuffy, runny nose, the hallmark of a sinus infection is facial pain or pressure that is worse when bending over.
Sinusitis may cause:

  • Facial pain pressure or headaches
  • Runny nose, nasal obstruction, and diminished sense of smell
  • Cough, fever, bad breath, and fatigue
  • Ear pressure
  • Mouth breathing

Not all runny noses are from sinuses. Patients often think that all draining noses are from the sinuses. A draining nose may be from inflammation of the nose without involving the sinuses. As a result, nasal draining is one way your body know how to clear sinuses.

What causes recurrent sinusitis?

Recurrent sinus disease may be caused by several factors:

Allergies
Environmental allergies, most commonly related to dust, mold, grasses, and weeds, can cause enough inflammation of the nasal passage to block the openings of the sinuses causing infection.

Infection
Bacterial or viral disease may stimulate nasal secretions and cause the sinus and nasal lining to swell.

Structural Problems
There are many things that may block the sinuses from draining, causing sinusitis. Common structural problems of the nose include a misaligned nasal septum. Other problems may be from blocked or small openings to the sinuses. The turbinates (fleshy tissue that hangs from the inside of the side of the nose) may also become too large and block the sinus openings. Structural problems of the nose typically require surgical correction.

Vasomotor Rhinitis
This disorder is like having a hyper-reactive nose. The inside of the nose normally swells up and down throughout the day from various factors such as foods, exercise, change in weather, stress, or hormonal changes. Your nose may be hyper-responsive and overreact causing congestion, obstruction, sinus pain, and excess nasal secretion.

Nasal Polyps
Nasal polyps are “small balloons” that are caused by long-term nasal and sinus inflammation. They often obstruct the sinuses and often require surgical removal.

Fungal Sinusitis
An infection by fungi or an allergic response to fungi can result in sinusitis. This condition affects less than 10 percent of those who suffer from long-term sinus problems. Fungal sinusitis may require surgical intervention to remove the fungus.

How do you manage sinusitis with medicine?

Management of sinusitis all depends on the cause of your recurrent infections. Basically there are four ways of treating recurrent sinus disease:

Antibiotics may be considered if you have an acute (short-term) infection. There are many types of antibiotics that are available. Sometimes you may require multiple antibiotics to resolve your infection. Antibiotics are not harmless and can lead to resistance and side effects from the medicine. If you are given antibiotics year-after-year then you need a formal evaluation of the cause of your recurrent sinusitis.

Corticosteroid Nasal Sprays such as Nasonex™, Flonase™, Fluticasone, Veramyst™, Omnaris™, Nasacort™, as well as others may be used daily to reduce the swelling in your nose. These type of nasal sprays only work if used everyday. Single use or “as needed” use will not be effective since the benefit from nasal corticosteroids takes 1-2 weeks. The side effects of nasal steroid sprays are minimal since the steroid has little penetration into the bloodstream. They are not addicting.

Salt water (Saline) Sprays are an excellent, safe way to rinse your sinuses of trapped mucous and keep your sinuses clean. These sprays are available over-the counter (Nedipot™, Ayr spray™, Ocean Spray™) and may be used safely throughout the day.

Nasal Decongestants such as Afrin™ or Neo-Synephrine™ are over the counter medications that reduce swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating temporary severe nasal congestion. Nasal decongestant sprays are safe to use for only 3-5 days. Prolonged use leads to rebound congestion or “nasal spray addiction.”

Oral Decongestants are primarily over-the counter such as pseudoephedrine (Sudafed™) and phenylpropanolamine. They may also be considered for temporary relief of nasal congestion. Oral decongestant may cause anxiety, urination difficulty (enlarged prostate), worsened high blood pressure, and an increased heart rate. Patients with high blood pressure, enlarged prostate, or heart problems should consult with Dr. Pasha before using decongestants. Please note that some decongestants are combined to reduce the number of pills and are often given the suffix “-D” such as Claritin-D™, Allegra-D™. Other combination decongestant products include Tylenol–Sinus™ or Advil Cold and Sinus™.

A major concern in the world today is antibiotic resistance. If one uses antibiotics for a long period of time or if one takes several antibiotics and continues to have infections, the bacteria may have developed resistance to the most commonly prescribed antibiotics. You do not become “immune” to antibiotics but rather the bacteria “learns” to tolerate the antibiotics (especially amoxicillin).

Additionally, all medications have the potential for side effects (especially when taken for the long-term). Some patients are poorly tolerant of antibiotics, with gastrointestinal side effects or rashes. Finally, antibiotics do not treat the underlying cause of sinusitis and therefore may result in repeated infections and discomfort for you.

How do you treat recurrent sinusitis?

Management of chronic sinusitis all depends on the cause of your recurrent infections. Often times, continuously prescribing antibiotics does not address the underlying problem with your sinuses, resulting in minimal long term benefit. Basically there are four additional ways of treating recurrent sinus disease:

1. Identify Underlying Cause For any medical condition, one must first find out the underlying cause of your disease not just treat the symptoms. For instance, if you have recurrent sinusitis because of a clogged sinus opening, treating your recurrent sinusitis with antibiotics will not result in a long term solution.

2. Allergy Management Allergies may be a cause of seasonal sinusitis. Dr. Pasha will screen for allergies as a source of your sinusitis and treat you appropriately. Allergies are covered in a separate section.

3. In-Office Procedures Dr. Pasha has a special interest in minimally invasive techniques for nasal congestion and recurrent sinusitis. He has become a leading pioneer in some of these techniques. For those of you who have constant nasal congestion there is a minimally invasive procedure that addresses the most common source of nasal obstruction: the turbinates. Dr. Pasha may consider an in-office turbinate reduction with little to no recovery time. Dr. Pasha also offers in-office Balloon Sinuplasty™ to address your sinuses.

4. Surgical Solutions If you are one who suffers from chronic or repeated sinus infections and desire long-term results you may be a candidate for various surgical methods including endoscopic sinus surgery and septoplasties. Sinus surgery is designed to “unblock” the sinus opening, remove diseased sinus mucosa (lining), and drain the infection. Dr. Pasha is trained in the latest surgical techniques including Balloon Sinuplasty™, intraoperative stereotacting guidance systems, and other minimally invasive methods.

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