More Than Just A Headache: The Under Recognized Pain and Disability of Chronic Sinusitis

Few words can fully describe the throbbing pain, pressure, and congestion of a chronic sinus infection.  Falling somewhere between a toothache, a migraine headache, and the flu, sinusitis not only impacts quality of life, but also puts sufferers at risk of developing more serious complications including blood clots and aneurysms, due to its close proximity to the brain and major blood vessels.  For the most part though, it’s more synonymous with missed work, painful headaches, and overall misery than with severe illness.

For the majority of sinusitis sufferers, impaired mucous clearance is where the trouble begins.  Anything from a simple cold or allergy to structural defects, such as badly formed nasal cartilage or benign nasal growths have the ability to affect sinus drainage.  Poor drainage, in turn, leads to a secondary bacterial infection—and the associated green, infected nasal discharge noted among sinusitis sufferers. While most people manage to kick sinusitis with a single course of antibiotics and little effort, for others it’s the beginning of a nightmare that lasts for months, if not years. 

My own personal bout with chronic sinusitis happened about 5 years ago.  Following several months of exposure to allergens, such as grass pollen, cat hair, and cigarette smoke, my nose became chronically congested—to the point of requiring an over-the-counter medication.  As I also suffer from a deviated septum—a malformation in the cartilage that separates the nostrils—I’m already prone to poor sinus drainage—and infections.  I began to develop fatigue, terrible headaches, and a stubborn low-grade fever.  After having taken both the first and second line antibiotics, over the course of several weeks, I was referred to an Ear, Nose, and Throat specialist.  After a quick cat scan, chronic sinusitis was confirmed.  For the next several months—altogether three in total—I was treated with a variety of antibiotics, in combination with a nasal steroid.  Although this combination helped for a while, any time I finished a course of antibiotics, my symptoms would inevitably return.  After some time, I decided to move apartments—owing to what looked like a significant mould problem.  Within a few weeks of moving, my symptoms began to improve and my sinusitis began to resolve—as the drainage in my nose slowly returned to normal.

While the reasons behind chronic sinusitis are not fully understood, recent research has shown that it may involve an exaggerated immune response to a cocktail of bacteria and fungi in the sinuses.  It’s possible that the bacteria and fungi trigger inflammation in the sinus passages, which, in turn, lead to poor drainage and increased infection.  Despite the large number of sufferers—a 2007 study estimates that approximately 5% of Americans are affected— there are few clear-cut solutions.  Due to its complexity, there are few effective medications; most strategies aim to control inflammation, but have had mixed results.  Under the current state of affairs, chronic sinusitis alone accounts for 18 to 22 million visits to American doctors, every year.  Between the lost productivity and widespread suffering, there are many incentives to develop more effective treatments for chronic sinusitis and to gain a better understanding of its origins.

As for myself, I find that daily nasal rinsing with saline water helps to keep my nasal problems more manageable.  With a sensitive nose, however, life is always a bit of a challenge and I still find myself worrying about developing nasal infections at the tail end of colds, or during allergy season.

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