Q: I've had four bouts of "bacterial sinusitis" over the past several months. How can I kick this infection for good?
A: Sinusitis is inflammation of the sinuses. Everyone has sinuses, and many of us are not happy about that. Like you, my sinuses frequently get inflamed. Sinuses are the moist air spaces behind the eyes, forehead, nose and cheeks on each side of our head.
Why do we have sinuses? I don't think anyone knows, and I'm not sure there's a good reason. They don't do anything good for us. All they seem to do is cause trouble. In that respect, they're sort of like our appendix.
What irritates the sinuses and leads to inflammation is most often a viral infection. Sometimes it's an allergic reaction to things in the air we breathe or to certain foods. Conditions that block the sinuses, such as polyps in the nose or a badly deviated septum, can do it. Cigarette smoke also is a common irritant, even secondhand smoke.
Sometimes it's swimming, particularly when there are substances in the water (like chlorine) that irritate the lining of the sinuses.
As you know, sinusitis causes pain and pressure, congestion and postnasal drip. Normally, the sinuses drain through small openings into your nose. Anything that obstructs that flow -- often a cold or allergies -- can cause a buildup of mucus in the sinuses.
This warm, moist environment serves as an ideal bacterial breeding ground. Bacteria that normally live in your sinuses rapidly multiply, causing an infection: bacterial sinusitis. That adds pus to the mucus. Sputum, the stuff that blows out of your nose or that you cough up from the back of your throat, turns yellow, brown or green. Also, bacterial sinusitis often causes a fever.
Bacterial sinusitis is actually pretty unusual and is over-diagnosed. Unfortunately, it is hard for a doctor to be sure there is a bacterial infection that requires antibiotic treatment. Most doctors will treat with antibiotics if someone has had the symptoms for 10 days or more without improvement. That's because viral infections usually are improving by that time.
Antibiotic treatment also is justified if symptoms are severe and have persisted for three days or more, or if a person has a high fever (over 102 degrees).
A typical course of antibiotics, lasting 10 to 14 days, can usually treat a bacterial infection of the sinuses. Your doctor can extend that course up to six weeks if needed. But sometimes antibiotics still fail to eliminate the infection, or they provide only temporary relief before symptoms return.
Bacterial sinusitis will return if you don't reduce the conditions that irritated the sinuses in the first place. So try:
• Treating your allergies. If allergies could be a factor, ask your doctor about more effective allergy treatment.
• Eliminating milk and/or wheat from your diet. Allergic reactions to these foods can set the stage for sinusitis.
• Quitting smoking. Cigarette smoking impairs the function of tiny hairs that sweep mucus and debris out of your sinuses.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.