Sinus problems? Nasal cavity difficulties affect millions
July 23, 2013
Consider the mystery of the sinuses. They are a system of connected cavities that exist in the lower forehead, the cheekbones, between the eyes, and in bones behind the nasal cavity. Not even modern medicine can say for sure what their purpose is, although some say they may serve to filter and humidify the air we breathe.
Yet they can be impacted by allergy, infection, and anatomical abnormalities, some of which can be acutely painful. About 37 million Americans suffer from chronic sinus issues.
Fortunately, Janette Carpenter, MSN, MD, is passionate about sinuses, along with other problems affecting her ear-nose-throat (ENT) specialty. She is a board certified otolaryngologist (certified in both medicine and surgery) who has been practicing in Grass Valley for two years, with the Dignity Health Medical Group.
"I fell in love with ENT because it's very, very complicated," she said. "It's where so much that makes us human occurs, like smelling and tasting. It's an exquisite and complicated anatomy, and a perfect specialty for people like me who love exacting detail."
She also loves the tools of her profession, which include the image guided ENT surgery fusion navigation system available at Sierra Nevada Memorial Hospital (SNMH), thanks in part to her efforts.
"We would have to refer many patients to Sacramento if we didn't have this here," she explained. "It allows us to treat people locally, and safely."
This system links endoscopic technology with computer-based scanning and allows a physician to more safely "see" inside the sinus cavities with a scope without damaging tissue or bone. That helps not only to diagnose sinus problems, but in the discovery of tumors, polyps, or anatomical deviations that otherwise might not be seen, she explained.
One of her challenges is to help people understand the differences between two major problems that affect the sinuses: allergies and bacterial infections.
"Some of the symptoms are similar, but treatments are different," she said.
If you simply have a clear, runny nose, headache, and pressure, your sinuses are more likely clogged because of an allergy, she said.
"You can rinse your nose with a saline solution, or take temporary decongestants to relieve allergy symptoms," Dr. Carpenter said.
But she cautioned that nasal decongestant sprays should never be used more than three days in a row. Over-the-counter decongestants should not be used by people with high blood pressure, as they can increase blood pressure, she noted. However, it is OK to use antihistamines if you have high blood pressure.
"Read the package to make sure you understand what you are taking," she advised.
Irrigation of the sinuses with a saline rinse is a "huge help" in keeping the nose and sinuses healthy, and in treating the common cold, she said.
The symptoms of acute bacterial infection may include the issue of green or yellow pus from the nose, fever, tooth pain, facial pain or redness of the cheeks, headache, and extreme fatigue, Dr. Carpenter said. These are signs that should prompt a visit to your primary care doctor who may ask you to see an ENT, she added. Left untreated, an infection could lead to very serious problems, including meningitis, and abscesses around the eye and brain, although she noted those are rather rare possibilities.
If symptoms occur only on one side of the face, see an otolaryngologist immediately, she warned, because that could signal the development of a tumor.
At times bacterial infections must be cleared out with the help of antibiotics or endoscopic surgery. The goal of surgery is to remove infected tissue, polyps, and anything else that may be blocking a nasal or sinus passage. Sometimes the problem requires a widening of openings to allow draining to occur. Sometimes blockage is the result of a structural abnormality or injury, which may also be repaired.
Endoscopic procedures have largely taken the place of more traditional sinus surgery methods, Dr. Carpenter said. They may be done in her office or in an operating room, depending on severity.
She is enthusiastic about emerging treatments for sinusitis, including the development of probiotics for the sinus cavity, balloon surgery techniques, as well as wider use of the fusion navigation system at SNMH.
Can she offer any advice? If your sinuses are bothering you, don't let it go on too long before seeing your doctor or an ENT specialist, and having a thorough examination.
"Thorough means more than looking at your throat with a tongue depressor," Dr. Carpenter said. "You want a full examination of sinuses, nose, and throat, by someone like me who is really snoopy. It's good to be snoopy if you're an ENT doctor."
All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.