The Clogged Drain Inside Your Head

Relieving the misery of sinusitis

By Lisa Marshall

With three young kids at home and a busy medical practice to tend to, Boulder ear, nose and throat specialist Doug Warren, M.D., needed to be on his game. But each fall he became his own frequent patient.

“The kids would come home with a cold and be sick for four days. I’d end up with a sinus infection and be sick for six weeks,” recalls Warren, 53. Just when he started feeling better, another bug would sweep through the house, launching him into another long round of sleepless nights and congested days. When all else failed, he opted for surgery. “It was a constant nuisance. I just couldn’t live my life like that.”

According to the Centers for Disease Control, more than 30 million Americans are diagnosed annually with sinusitis, an inflammation of the sinus cavity that can lead to stuffy nose and postnasal drip; pressure around the eyes, cheeks and forehead; tooth pain; bad breath; and an impaired sense of taste and smell. As many as 14 percent of adults suffer from recurring or months-long bouts, making sinusitis one of the nation’s most common chronic health conditions. It ranks alongside arthritis, depression and fibromyalgia when it comes to its negative impact on quality of life. In Boulder, where the air is dusty and cold weather drives people into drying forced-air heat, the condition is “epidemic,” says Pierre Brunschwig, M.D., of Helios Integrative Medicine. “The Front Range is a hotbed of chronic sinus problems.”

The good news, area experts agree: Most cases can be prevented or managed without going under the knife or loading up on prescription drugs. “There is hope. You don’t have to live with this,” says Rob Ivker, D.O., a sinus specialist at Fully Alive Medicine in Boulder and author of Sinus Survival (Penguin Group).

KNOW YOUR SINUSES

The air-filled cavities behind our cheeks and brows are believed to serve multiple evolutionary purposes, such as making the head lighter, increasing the resonance of the voice, and making mucus that ushers out harmful particles. “They provide a defense mechanism against viruses and bacteria that we inhale,” says Todd Kingdom, M.D., director of the University of Colorado Sinus Center. 

But when the lining inside our sinuses gets inflamed from a lingering cold, allergies or environmental irritants, those passages narrow and mucus backs up like a clogged drain. In some cases, microbes (typically viruses) settle into the stagnant mucus, causing infection. (If your cold symptoms escalate after a week or 10 days, you may have a sinus infection).  In many other cases, the inflammation alone causes symptoms, such as pressure around the eyes and cheeks. 

The key to prevention: Nip inflammation in the bud, Kingdom says.

AVOID ALLERGIC TRIGGERS 

Studies show that as many as half of chronic sinus problems are rooted in food or environmental allergies, which can prompt swelling in the lining of the nose and sinuses. Brunschwig suggests that patients eliminate common food allergens, such as gluten and dairy, for three weeks to see if symptoms subside and then reintroduce them one by one to see if symptoms return.

To keep the nasal and sinus cavities clear of airborne allergens, like pollen, dust or pollutants, clean your nose out at least twice daily with a saline rinse. For a home brew, use one-quarter teaspoon sea salt and a cup of warm water, and a neti pot or bulb syringe. 

To keep the nasal mucosa lubricated, use a humidifier in your room at night. Consider investing in a high-quality air filter and changing the filter on your furnace every one to two months during winter.

NIP COLDS IN THE BUD

If you’re one of those people who ends up with a sinus infection every time you catch a cold, try to get on top of every cold at the first sign of symptoms, Warren says. “You need to do everything you can to cut down on swelling in the nose and keep those sinus passages clear from the beginning.” He recommends judicious use of over-the-counter nasal sprays like Afrin, and antihistamines like Sudafed, at the first sign of a cold.

Ivker warns that using over-the-counter nasal sprays for more than three days can lead to a “rebound effect” in which the nasal lining begins to produce even more mucus, and some antihistamine medications can cause drowsiness. Instead, he recommends rubbing a dab of peppermint oil on the nostrils to boost blood flow to the mucous membrane, and using a natural nasal spray that contains antimicrobials (like grapeseed extract and xylitol) and anti-inflammatory herbs like aloe, calendula and yarrow leaf.  For a natural antihistamine, try quercetin (a supplement taken from the skins of onions, apples, grapes and other sources). To avoid getting too sick in the first place, try garlic (in the form of allicin) at the first sign of symptoms. 

For those with a compromised immune system, Brunschwig recommends zinc and glutathione supplements. “Zinc and glutathione are essential for the protection of the mucous membranes,” says Brunschwig, noting that allergy sufferers tend to be low on glutathione, which exacerbates the chronic sinus cycle.

RETHINK ANTIBIOTICS

Warren and Kingdom say they have seen little evidence that dietary supplements and herbs work for chronic sinusitis. But everyone interviewed for this story agreed on one thing: Antibiotics are rarely necessary. “One of the biggest problems we have is people demanding antibiotics all the time,” says Kingdom. “In the vast majority of the cases, they are not needed.”

One 2001 study of 188 children with chronic sinusitis, published in the journal Pediatrics, found no difference in the outcome of those placed on antibiotics for 14 days and those on placebo. (A December 2007 study in the Journal of the American Medical Association found similar results in adults.) Yet today, prescribing rates for sinus sufferers have changed little, research shows.

In some cases, Brunschwig warns, recurring use of antibiotics can backfire, killing the friendly bacteria in the body and leading to a yeast overgrowth within the sinus cavity. He recommends that patients have a stool culture to see what is growing in the gut, because it may also be growing in the sinuses. If a yeast infection is suspected, it can be treated with antifungal medication, herbs or nasal spray. 

MINIMALLY INVASIVE SURGERY 

In some cases, unusually narrow drainage pathways in the sinus cavities can leave people predisposed to a lifetime of sinus problems. “If you have a small sinus drainage pathway, then just a little bit of swelling can be enough to occlude it,” Warren says. Benign polyps inside the sinuses are also sometimes to blame.

Through minimally invasive techniques like functional endoscopic sinus surgery, or a new procedure called balloon sinuplasty, surgeons can now widen that pathway without cutting into the skull. An estimated half-million people per year have sinus surgery.

Warren, a senior partner at Boulder Valley Ear, Nose & Throat Associates, says he rarely recommends surgery for his patients, first pointing them to other options instead. But in some cases—like his own—it can provide relief when nothing else has worked. Seventeen years after his own surgery, “I can breathe through my nose, and my sense of smell and taste is good,” he says. “It changed my life.” 

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Lisa Marshall is a freelance health writer and mother of four who lives in the hills west of Lyons.

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