Transcription:
Sinusitis vs. Sinus Headache

Melanie Cole (Host): Have you experienced coughing and sneezing, itchy or runny nose and eyes during certain times of the year? If so, you may suffer from seasonal allergies. Chronic sinusitis, however, is a more serious condition and is often sometimes mistaken by patients for seasonal allergies. How can you tell if you're experiencing these seasonal allergies or something more serious? My guest today is Dr. Chris Brook. He's an otolaryngologist at Boston Medical Center specializing in sinus disorders. Welcome to the show, Dr. Brook. So, sinusitis, people hear sinus infections, "Oh, I have a sinus infection." What exactly is sinusitis and how do we know that that's what we've got?

Dr. Chris Brook (Guest): Hi, Melanie, thanks for having me on. Sinusitis is often misconstrued in the lay public and I think it can be very hard for people to understand whether or not they're suffering from sinus disease or allergies. Both of them have a lot of overlapping symptoms with nasal congestion and drainage from the nose, and both of them can make a significant impact on a patient's quality of life. To differentiate the two is often, it often requires the assistance of the specialist to take a look in the nose and run some additional test to make this final diagnosis.

Melanie: Okay. So, people have got these symptoms and they want to come and see you, how do you determine what it is that's going on?

Dr. Brook: So, I talk to them about their symptoms and, as I said, they tend to be overlapping. So, people have a lot of nasal congestion. They have drainage from the nose, a lot of people have smell loss, or facial pain and pressure. Those last two symptoms can help make a differentiation between the two different conditions. So, patients with smell loss often suffer from chronic sinusitis because they have nasal polyps or things within the nose that are preventing the smell from getting to where you can perceive it.

Melanie: Okay. So, all of these things together, you're deciding based on their history and their symptoms what it is that they have? Does sometimes a headache go along with it or can a sinus headache be a separate thing altogether and you don't have to have sinusitis to have a sinus headache?

Dr. Brook: Certainly. I think that sinus headache is something that people say all the time that they're suffering from and what they mean is that they have a headache that's lying over their forehead or over their cheeks and that's not always related to sinus disease. So, again, it's sort of a combination of the symptoms that they're having, and when people, their primary complaint is headaches, I'm often suspicious that it's not really a sinus disorder but when the headache is coupled with other signs of sinusitis, like chronic nasal congestion or drainage from the nose or smell loss, that's when I get more suspicious that those symptoms are coming from sinusitis. Regardless, when people come and present themselves for that type of complaint, I think the most helpful thing that we can do is take a look in their nose with an endoscope, which is a little telescope that looks inside the nose and looks for drainage of infection from within the sinuses or looks for nasal polyps, which are both a clue to the diagnosis and help us direct treatment more appropriately.

Melanie: Does green or yellow nasal drainage always mean that there's an infection present?

Dr. Brook: It doesn't always mean that there's an infection present that needs antibiotics. It usually indicates that there's some inflammation in the nose that's causing discharge. Sometimes, that could be from just allergies. Sometimes, it can be from a viral illness. So, we like to see people once they've been suffering their symptoms for at least a week or so before we start prescribing antibiotics for an infection.

Melanie: Well, I'm glad you brought that up, Dr. Brook, because I would imagine people always think right away if they've got a sinus infection, they need an antibiotic and is that always the case?

Dr. Brook: No, that's not always the case. The vast majority of sinus infections are actually viral diseases. So, anytime you get a cold, you have a viral illness and that can spread into your sinuses and cause congestion and drainage from your sinuses. But, we really don't start thinking about it being a bacterial infection until it's been present for about 10 days or so, and usually there's sort of a classic, we call it a “double-worsening”, meaning you start to feel a little bit better and then all of the sudden, it gets worse again with thick drainage from the nose, and that's usually when people should start thinking about contacting their primary doctor and getting put on antibiotics.

Melanie: And, sometimes, do the sinuses drain down into the lungs and then that causes a cough? Because people don't always know if these two things go together?

Dr. Brook: It can certainly cause post-nasal drip which can lead to a cough, and I see that all the time. Not all cough or post-nasal drip is actually sinusitis and a lot of it is not, but it definitely can cause those symptoms.

Melanie: Now, what do we think about over-the-counter remedies for some of these? What do you recommend, Dr. Brook, as far as maybe nasal lavage, people aren't sure if they're supposed to be using these or not, or some of the sprays? Sudafed? I mean, what are we supposed to do about this?

Dr. Brook: So, I think there are a lot of over-the-counter medications that are now excellent treatments for sinusitis. In the last five years, we've placed nasal steroids over the counter. So, things like fluticasone nasal spray, which can decrease the inflammation inside the nose. I think saline lavage, as you brought up, is actually an excellent treatment, and there's a lot of evidence that suggest that saline lavage and nasal steroids together are very, very good at relieving congestion and treating chronic and acute sinusitis. I do caution patients to be careful about using Sudafed regularly or anything of that nature that's a decongestant, because if you're using it on a regular basis, it can contribute to high blood pressure.

Melanie: That's a very good point to make. So, then, when does it come to something that might need a prescription?

Dr. Brook: So, I think that the time to start seeing your doctor for this sort of thing is if it's an acute infection, like you don't have symptoms in between, then you need to wait about 10 days but if you have chronic congestion that's lasting a while, I think that you should be seeing your doctor after two or three months and trying to get on a regular regimen of nasal steroid sprays, saline irrigation, possibly antihistamines, and then, if those things don't meet the bill and make you start feeling better, that's when to start, when you should start thinking about getting a referral to and ear, nose, and throat specialist to look at your sinuses.

Melanie: Sometimes, we've heard that antibiotics for sinusitis or a sinus infection take a little longer to work. Is that the case in some instances and why is that?

Dr. Brook: That can be the case in some instances. I think that there's a lot of misconception about chronic sinusitis versus sinusitis that's actually an infection or an acute sinus infection. I tend to think of chronic sinusitis as being a chronic inflammatory condition and it's not always well-suited to be treated with antibiotics. Some of the antibiotics that we prescribe in these cases, though, do have some anti-inflammatory properties, which may be why it takes a little bit longer or an extended course of antibiotics. That may be what your physician is thinking about when they put you on a long course of antibiotics.

Melanie: Is there any way to prevent sinus infection?

Dr. Brook: So, there is some evidence that patients that suffer from recurrent sinus infections may have some sort of immunodeficiency or some anatomy that predisposes them to sinus infections. Sometimes, if you've tried all of the over-the-counter remedies and you've tried all of the prescription medications, those people benefit from sinus surgery to prevent recurrent infections or alleviate symptoms in between.

Melanie: So, then, wrap it up for us with your best advice, Dr. Brook, on sinus, sinus infections, sinusitis, those headaches that sometimes go along with it and how you can tell the difference between something that might be allergies and something that you really need to see your doctor about.

Dr. Brook: So, I think that the duration of the symptoms is the most important thing. If you have a long-standing nasal problem that's been going on for two or three months and it's not resolving, that's time to start thinking about going to see your doctor. The things that should really point your toward a diagnosis of chronic sinusitis are nasal congestion, drainage from the nose, decreased smell loss, or decreased sense of smell. If you do have headaches that do overlay the sinuses, but don't have any of those other symptoms, it's not that it can't be from the sinuses, but it's much more likely to be a primary sinus disorder. I think the best treatments people can try at the start are using nasal steroid sprays which can be prescribed by your physician or bought over-the-counter, sinus irrigations like a Neti Pot or a NeilMed sinus irrigation system, and over-the-counter antihistamine like Claritin, Allegra, Zyrtec--all of those things can relieve symptoms. If those don't improve the way you're feeling, then I think it's time to start seeking more medical treatments and perhaps a referral.

Melanie: Thank you so much, Dr. Brook, for being with us today. You're listening to Boston Med Talks with Boston Medical Center and for more information, you can go to www.bmc.org. That's www.bmc.org. This is Melanie Cole. Thanks so much for listening.