Sinusitis

Lately, I’ve received reports of an uptick in people suffering from something called “sinusitis.” Sinusitis is Latin for “inflammation of the sinuses.” This is a relatively common issue that the medic be able to diagnose, treat, and prevent.

As I often write about survival scenarios, you probably wonder why I’m writing an article about sinus infections. Believing that mundane problems are no big deal can lead to ignoring symptoms that cause sickness and loss of productivity. The end result is decreased chance of survival in austere settings.

WHAT ARE SINUSES?

The sinuses are almost like a tiny cave system in your head. They’re little air-filled cavities in the skull and facial bones that are located near the nose and connect to the nasal cavity (yes, that makes us all “airheads”). You have several pairs of sinuses named after the bones in which they reside. They include:

MAXILLARY SINUSES: The largest of all the sinuses, they’re located behind the cheekbones near the upper jaw.

FRONTAL SINUSES: Located in the forehead above each eye.

ETHMOID SINUSES: Located between the nose and the eyes.

SPHENOID SINUSES: Located in a butterfly-shaped bone behind the eyes.

WHY DO WE HAVE SINUSES?

Sinuses drain into the nose through tiny openings called “ostia.” Mucus from the sinus linings drain into the nasal passages and then down the back of the throat, where they’re swallowed. The draining mucus helps keep the nose moist and filters out dust and bacteria, but that’s not all the sinuses do. They also:

• Humidify inhaled air.
• Support the respiratory immune response.
• Improve voice quality and tone.
• Help protect the face from trauma.
• Insulate against rapid temperature changes in the nasal cavity.

ACUTE SINUSITIS

Infections can spread from the nasal lining to the sinuses, causing swelling, inflammation, and thick mucus, a condition called “sinusitis.” There are two general types: acute and  chronic.

The viral common cold is most often the cause of acute sinusitis. Yellow-greenish mucus build-up fails to drain well, causing:

• Difficulty breathing through the nose.
• Draining down the back of the throat (postnasal drip).
• Swelling, pain, and/or pressure in the face, especially the eyes, cheeks, nose, forehead, and ears.
• Headache
• Fatigue
• Decreased sense of smell.

A fever and cough may be seen in severe cases. Luckily, the normal course of acute sinusitis is short, about a week or so unless a secondary infection with bacteria develops. Treatment consists of treating symptoms with nasal decongestants, corticosteroid sprays like fluticasone (Flonase) or beclomethasone (Beconase), fever reducers, and mucus thinners like guaifenesin (Mucinex). Antibiotics are used in the worst cases where bacterial infection is suspected. Drugs of choice are usually amoxicillin 500 mg (Amoxil) three times a day or amoxicillin with clavulanate 500-875 mg (Augmentin) every twelve hours for a week or so. Doxycycline 100 mg twice a day for a week or so is recommended for those allergic to penicillin-family drugs.

Saline nasal rinses, also called “lavages,” can help clear sinuses as well. These use devices called “neti pots” or other commercially available aids, which would be useful to have in your storage. Saline nasal sprays are also available, but not as thorough. It’s important to know that sterile water or saline must be used or you might introduce infection that can be serious. Off the grid, boil water with ¼ teaspoon of salt added.

Other options include warm compresses on the face for ten minutes several times a day, Steam inhalation therapy or hot showers, if available, are also helpful.

CHRONIC SINUSITIS

Chronic sinusitis resembles acute sinusitis, except that the symptoms last at least three months in the chronic version. Fever may not be seen as often in chronic cases. Some people have a tendency to develop it, especially if they have:

• Dental infections
• A deviated nasal septum
• Nasal polyps
• Exposure to pollutants (smoke, etc.)
• Fungal infections

Untreated, chronic sinusitis may rarely progress to something more serious, including vision problems. It may even spread to the brain and spinal cord, leading to a life-threatening condition called “meningitis.” Early treatment with antibiotics and oral/injectable corticosteroids may help prevent progression.

PREVENTION OF SINUSITIS

Perhaps the most important thing you can do to avoid sinusitis is to stay away from people who are sick with colds and other infections. As a caretaker, this may not be possible, so wash your hands frequently with soap and water.

For those who develop allergy-related sinusitis, avoid triggers in possible. Pollutants like cigarette smoke can irritate nasal passages and sinuses. A humidifier may help if your home is in a dry area. Adding moisture to the air is helpful as long as the device is kept clear and free of mold.

Joe Alton MD

Dr. Alton

P.S. For a lot more information about antibiotics in survival settings, check out “Alton’s Antibiotics and Infectious Disease: The Layman’s Guide”!