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Keep sinuses open to prevent infection

Cold, allergies, other triggers can block healthy drainage

Q: I have a lingering cold that actually seems to be getting worse. I am congested and feel painful pressure in my forehead and under my eyes. I have headaches and am constantly tired. Would antibiotics help?

A: Given the pain and pressure in your face, it sounds like you have sinusitis, the medical term for a sinus infection.

Sinuses are air-filled chambers in the bones of the face. Everyone has four pairs of sinuses, which are lined by a mucus-producing membrane. When you're healthy, the mucus is a clear fluid that flows freely from your sinuses into your nose.

Sinusitis develops when your sinuses become inflamed and the mucus gets so thick and sticky that it can't drain into your nose. As the mucus builds up, so does the pressure and pain. And bacteria that normally don't cause trouble get caught inside, multiply and cause infection.

What triggers sinusitis? The common cold is the leading culprit. Colds are caused by viruses, not bacteria, and antibiotics are useless for treating them. But cold viruses swell nasal tissues, which sometimes can block the sinuses. Colds also change the mucus, preventing it from doing its normal job of trapping bacteria.

You may get some sinus pressure when you get a cold, but that doesn't mean you have sinusitis. Only about one cold in 100 leads to sinusitis. Other things that can block your sinuses and lead to infection include allergies, cigarette smoke and irritating fumes, changes in pressure during flying or scuba diving and nasal growths.

Not surprisingly, sinusitis is quite common. More than 20 million Americans will have at least one episode of sinusitis this year. In most cases, it can be treated easily. But if you don't take steps to treat it, you can develop a chronic infection. When the condition lasts more than three weeks or occurs more than three times a year, it's called chronic sinusitis.

Sinus pressure can be felt in your forehead, over the cheeks or in the upper jaw and teeth, or even at the top of the head. It usually increases when you bend forward. Other symptoms include nasal congestion and a thick, dark-colored nasal discharge. You may also have a cough and feel achy, tired and feverish.

The key to treating sinusitis is restoring drainage so that mucus can flow out. Here's how:

--Drink plenty of water. This helps thin the mucus.

--Inhale steam two to four times a day by lingering in a hot shower or holding your head safely over a pot of boiling water. Even hot tea or chicken soup will help.

--Use decongestants to help open your sinus passages. Sprays and tablets may have side effects, so ask your doctor which product to use.

--Avoid antihistamines. They make mucus thicker and harder to drain.

--Put a warm compress on your face to soothe the pain.

--Use over-the-counter pain relievers such as aspirin or acetaminophen to lessen any pain and reduce fever.

Magazine and TV ads try to market antibiotics as the best way to beat your infection. As a result, people often ask their doctor for a prescription, and most comply. It's true that antibiotics have been a great step forward in the treatment of sinusitis, but they won't work unless you improve drainage — and if you do that, antibiotics probably aren't necessary.

Antibiotics also have some disadvantages. For example, they can cause side effects and trigger allergic reactions. Widespread use of antibiotics has encouraged the spread of "superbugs," bacteria that are resistant to the drugs. They also can be expensive.

If your sinusitis does not improve after promoting drainage for two to four days, or if your condition is severe, your doctor should prescribe an antibiotic. You won't necessarily need a newer, more expensive drug; studies have shown that older, less expensive antibiotics are just as effective.

To prevent sinus infections in the future, stay well hydrated. Avoid smoke and toxic fumes. If you have allergies, avoid things that trigger symptoms. To keep from catching a cold, wash your hands regularly and keep your distance from people who are sick. If you do catch a cold, blow your nose gently without pinching it closed. Forceful blowing can actually push bacteria back up into your sinuses.

No one really knows why we have sinuses or what good they do for us. But doctors certainly do know what can go wrong, and sinusitis sufferers like you are all too familiar with the discomfort caused by this common infection.

Keeping your sinuses open and draining freely will help them — and you — stay healthy and happy.

The Harvard Medical School Adviser is researched and written by the faculty and staff of Harvard Medical School. Visit www.health. harvard.edu/adviser.

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