"Doc, I got sinus"

“Doc, I got sinus!”

We hear that statement a lot. Determining what a patient means by “sinus” is sometimes a challenge. Most people mean that they have nasal congestion and pressure. Some also have a feeling of nasal drainage. Many have sinus headaches. Some will present with the stuff they blow out of their nose. Whatever, the case, “sinus” has a broad differential diagnosis. All of the possible causes, however, have a common thread – namely, inflammation.

Onset and duration of symptoms often determines the underlying disease process. The most common cause of nasal/sinus symptoms is the viral upper respiratory infection or common cold. This will usually present with acute onset of nasal obstruction and congestion with fever and either clear or discolored nasal discharge. Contrary to popular belief, the color of the nasal discharge alone is not indicative of bacterial versus viral rhinosinusitis. The above symptoms can be treated with over-the-counter medications and home remedies and they should resolve naturally in seven to ten days. Symptoms that worsen after five days or persist for more than ten days will benefit from more aggressive treatment, such as topical and/or oral steroids and oral antibiotics. These treatments will shorten the severity and duration of symptoms. The second sickening, worsening of symptoms after a period of seeming to get better, or symptoms lasting greater than ten days, suggests that the acute viral illness has become complicated by bacterial infection.

Another very common cause of “sinus” that has a more persistent nature and often has seasonal variation is allergic rhinitis. The classic cause of allergic rhinitis is an IgE mediated response to an inhaled allergen, such as pollen or dust antigen. Seasonal allergens like grass and tree pollen peak in the Spring and early Summer. Ragweed and goldenrod peak in the early Fall. Some allergens are present year-round, such as dust mite and molds. Allergy symptoms are typically characterized by sneezing, itchy/watery eyes, and copious amounts of clear nasal discharge. These symptoms can often be treated effectively with over-the-counter anti-histamines such as Zyrtec and Claritin. Recalcitrant symptoms may require other medications, such as nasal steroids and/or leukotriene inhibitors. Some patients may either need or be interested in immunotherapy.

There are other causes of a runny nose and sinus pressure which will require examination and, sometimes radiographic evaluation to find the underlying cause. We can help you sort through these issues. Call 205-980-2091 to schedule an appointment.

God bless you.

Kris Lay, M.D.