Sinus problems are common when seasons change

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Especially at the change of seasons, people may start feeling their sinuses -- or is it a cold? Sometimes it's not so easy to tell. Here to explain is Dr. Mark Arnold. He's an assistant professor of otolaryngology and communication sciences at Upstate.

Welcome to "The Informed Patient," Dr. Arnold.

Mark Arnold, MD: Thank you so much for having me.

Host Amber Smith: How common is sinusitis?

Mark Arnold, MD: Sinusitis is really an inflammation or an infection of the sinuses that line our nasal cavity. And I think it's important we first make the distinction between acute and chronic sinusitis. They both have symptoms of nasal congestion, facial pressure or pain, and discharge, and sometimes a lack of sense of smell.

But acute sinusitis may be a virus or a bacterial infection that lasts for four weeks or less, while chronic sinusitis are symptoms that last for three months or longer. Both of these conditions are very common.

About 15% of us get diagnosed with an acute sinus infection every year. It's also the most common reason we get antibiotics prescribed for us in the United States.

Chronic sinusitis is also common, about 15% of us. And while it's not as common as things like hay fever or allergic rhinitis, it is actually a little bit more common than things like asthma.

Host Amber Smith: So if you get an acute sinusitis every spring, say, and it happens every spring, repeatedly, that's still considered acute?

It doesn't become chronic just because you seem to always get it every spring?

Mark Arnold, MD: So if the symptoms are about four weeks or less, most commonly they last between one and two weeks, it's still considered an acute sinus infection if your symptoms resolve between infections, which is important.

But certainly, as you're alluding to, certain times of the year, we may be more prone to get sinus infections. If things like our allergies flare, or we're exposed to certain outdoor pathogens, we may notice that sometimes we get them more commonly at certain times of the year than others.

Host Amber Smith: Are men and women affected equally? And do you see any racial disparities in who's affected by sinusitis?

Mark Arnold, MD: Sinusitis, both acute and chronic, affects really everyone throughout social demographics, as well as men and women, as well as people of every race. We do find that women tend to be more affected as far, as symptomatology goes, by their sinus problems, but still men and women are equally affected.

And as far as people of different races, again, everyone is affected. Certainly there are differences in treatment outcomes, as well as access to treatment. People who are African American actually account for about 12% of the U.S. population and the same rate of chronic sinusitis, yet only about 5% of those people end up undergoing surgery for this disease, so there are certainly disparities that we notice, but again, everyone's affected.

Host Amber Smith: Is sinusitis contagious from person to person?

Mark Arnold, MD: In the heightened sense of the COVID-19 pandemic, we're always worried about things being contagious. And while an upper respiratory infection certainly has a time period where it can be contagious, where we may or may not be coughing and having fevers, that portion of it certainly can be contagious.

But as far as for many people with chronic sinusitis, they've certainly cleared their infection but still having symptoms, and at that point, they're not really contagious anymore, although people may think they're contagious.

Host Amber Smith: Well, let me ask you to go over the symptoms.

What are the symptoms of sinusitis?

Mark Arnold, MD: So again, we characterize acute sinusitis by symptoms that are four weeks or less, and then chronic sinusitis with symptoms that are 12 weeks or longer. The symptoms really are a nasal discharge, which can be clear, may be purulent or mucusy, as well as nasal obstruction or congestion, kind of that feeling of stuffiness, which is pretty unique to our sinuses and face, and also, potentially, a lack of sense of smell and fullness or pressure or pain in the sinuses.

Host Amber Smith: What about fever?

Mark Arnold, MD: So fever can happen with certain types of acute sinusitis. Most times, acute sinusitis, I would say 90% to 95% of the time, are actually caused by a virus. So we still get those symptoms, and we most often don't have a fever.

Sometimes, we can get a really bad sinus infection with severe symptoms, severe pain, maybe a change in discharge, maybe a double worsening, where your sinuses were acting up and now they've gotten even worse. Those kinds of people may have a bacterial infection in their sinuses, and those people we tend to think may have something like a fever, but I would say most cases of both acute and chronic sinusitis, they may actually never end up having a fever.

But a good question.

Host Amber Smith: Are there health conditions that make sinusitis more likely?

Mark Arnold, MD: Most patients that I see with both acute and chronic sinusitis don't have an underlying condition, but there certainly are some that make sinusitis more likely. Patients with asthma, for example. We think of our upper airways and our lower airways as being part of the same system, so certainly patients with asthma more likely have inflammation of their lower airways. Similarly, patients with asthma are more likely to have chronic sinusitis, so this makes sense. In addition, patients with allergies, they may have a higher incidence of sinusitis in that they're being triggered.

Also, people with immune system problems or immune deficiencies, they certainly don't have the ability to fight sinus infections, so they get them more often.

And then finally, there are patients with conditions like cystic fibrosis. That's a problem with the lining of the sinuses, as well as a lining of the lower airways.

And they have small little cilia -- hairlike projections -- that help clear out mucus, and if there are problems underlying that, they can be prone to sinus infections as well.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

My guest is Dr. Mark Arnold, an assistant professor of otolaryngology and communication sciences at Upstate.

I'm curious about how sinusitis is diagnosed and how you, as a physician, go about telling the difference between a bad cold and a sinus infection. Or maybe, I guess, a person could have both at the same time, right?

Mark Arnold, MD: Exactly. You know, the symptoms of a cold and sinusitis can be similar, but there are some distinctions that we can make to help us distinguish the two. Colds typically last just a week or two, while sinus infections tend to be longer. They may have this period of worsening, where their symptoms of congestion, pressure and drainage just get worse. People often say their symptoms started out with a cold, but then they may go on to develop a sinus infection. Similarly, the discharge with a cold may be clear, but a sinus infection, you may have thick nasal discharge that's yellow or green.

Finally, facial pressure or fullness we think is kind of more distinct with a sinus infection ... a cold, you know, if you have a cough and otherwise not feeling well, but the real facial pressure, we think, is distinct to the sinuses.

Host Amber Smith: At what point might a person be referred from their primary doctor to a specialist like yourself?

Mark Arnold, MD: I see a variety of patients, with all sorts of sinus complaints, from mild to severe, but patients who have sinus symptoms that aren't resolving with just over-the-counter treatments or home remedies, and those that have a significant disruption in their daily lives due to their sinus symptoms, I think are great patients to be referred to myself or another otolaryngologist.

As symptoms last for more than a few months, despite treatments like antibiotics or medical therapies, it could represent a chronic sinusitis, so that's also an indication to see an otolaryngologist.

And also repeat sinus infections: Again, it's common for us to have one or two sinus infections a year, depending on the person, but if you're having three, four, five, I think it should be time to see an otolaryngologist as well.

And finally, I think any patient who has nasal polyps, those represent kind of a severe inflammation in the sinuses.

I think all of those people should be evaluated by an otolaryngologist. They could be polyps, they could be something else.

So that would be some times to see one.

Host Amber Smith: How would you like people to prepare for a visit with an otolaryngologist? Are there particular questions that you would be asking them that they need to be prepared to answer?

Mark Arnold, MD: So, the most important part of a visit with an otolaryngologist or myself in detailing chronic sinusitis is a detailed record of their path: when their symptoms started, what kind of treatments they've been on, such as nasal saline, topical steroids or antibiotics, and how their symptoms have changed throughout their treatment course. In addition, a detailed sinus history is important. If they've undergone any CT scans, bringing those discs or images with them to the visit, as well as any surgeries that they've had in their past.

All of those things, and their additional questions regarding their sinusitis, can make for a productive visit.

Host Amber Smith: Well, let's talk about treatment options, and I know it's going to differ depending on the cause and the individual person. But in general, if you remove polyps, or if you straighten a deviated septum, for instance, is that meant to eliminate sinusitis?

Mark Arnold, MD: I get this daily from patients, you know? Eliminating sinusitis is a long-term career goal of mine, but it really depends on the patient's cause of their underlying sinusitis as well as their response to treatment. For some patients, we can completely eliminate chronic sinusitis. They're free of all their symptoms. They're no longer on, really, any medical treatment, any sprays or any topical nasal steroids or antibiotics.

Yet others truly have a chronic condition that really is refractory or resistant to everything we try, including surgery and expensive medications. Their sinuses may continue to be inflamed, their sinuses may kind of close off, and their polyps may grow back.

But yet my goal is to see them along their treatment journey, improve their quality of life, get their lives back with reducing their sinus symptoms. And I would say for most patients we're able to achieve this. And certainly we work hard to do it.

Host Amber Smith: And for those who have allergies, can you or have you been able to, see a reduction of symptoms if that person gets their allergies under control?

Mark Arnold, MD: I do treat both allergies and sinusitis. I do try and make a distinction between the two because their treatment paths are a little bit different. And while their symptoms, especially nasal congestion, overlap, I think treating their allergies is a good starting point because that can help reduce their triggers.

They can help reduce their both acute and chronic sinus symptoms.

Host Amber Smith: I'm curious about whether sinusitis, if it's not treated, does it ever develop into something more dangerous?

Mark Arnold, MD: With certain types of acute sinusitis, if they do have severe symptoms, those can go on to develop problems with their sinuses.

Our sinuses are located between our eyes and underneath our brain.

Very rarely, can we have infections that spread to the eyes or infections that spread to the brain. Those are a surgical emergency and often those abscesses and infections need to be treated and drained. Again, most of the time though, sinusitis resolves on its own, even without antibiotic treatment.

But if there are severe symptoms like we discussed, a fever, a double worsening of symptoms, that's certainly an indication to get antibiotic treatment.

Host Amber Smith: Is there anything a person can do to reduce their overall risk of getting sinusitis? If we anticipate the seasonal changes, and we know that we tend to get sinusitis when the seasons change, can we get ahead of that and try to stop it from happening?

Mark Arnold, MD: There's not a lot that we know about what causes us to develop chronic sinusitis, so it's somewhat hard to know exactly how to prevent it. However, there are certain things we can do that might help and should honestly be practiced for our overall health. The first and foremost would be: Stop smoking. It's probably the best recommendation I can give to decrease sinonasal (the nose and sinus area) inflammation overall.

If you know your allergens, things you're allergic to, and triggers to your sinusitis, certainly that can be helpful.

When you are sick, rest, taking in plenty of fluids, managing stress when you can. Oftentimes I see patients who get a flare of their symptoms when they're under a particular period of stress, and it's maybe their immune system isn't quite functioning right, so I think that's helpful.

And like we discussed before, I think prompt treatment of a severe sinus infection is helpful. This includes topical nasal saline sprays, topical nasal steroid sprays, as well as an antibiotic if symptoms are lasting longer than 10 days, or if those symptoms are pretty severe.

Host Amber Smith: Are there home remedies that you recommend to patients once they have got sinusitis going on?

Mark Arnold, MD: The best treatment is time, initially, as most of these infections get better within a couple weeks, but there are several things we can do at home. Like I discussed, saline rinses can help remove mucus in the nose, help wash away things that are causing inflammation.

Many patients like to inhale steam or have a humidifier nearby that can help open things up. Certainly a warm shower can make us feel better, warm compresses. And of course, staying hydrated, getting rest and avoiding any irritants that we know that may be causing our symptoms to get worse.

Host Amber Smith: Well, Dr. Arnold, I appreciate you making time for this interview. Thank you.

Mark Arnold, MD: Thank you for having me.

Host Amber Smith: My guest has been Upstate assistant professor of otolaryngology and communication sciences Dr. Mark Arnold.

"The Informed Patient is a podcast covering health, science, and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.