Sinusitis

Sinusitis is a common infection or inflammation for people with HIV. As CD4 cell counts drop, the risk of getting sinusitis rises. A person with HIV may have many bouts of sinusitis a year.

The sinuses are four pairs of hollow spaces above and below the eyes and on each side of the nose. They warm the air before it is inhaled. Each sinus has a lining that makes a constant flow of mucus. This traps bacteria and other foreign matter that comes up the nose. The mucus then drains into the nose or lungs.

Sinusitis can be:

• Acute, which usually lasts four weeks or less. This type is usually caused by infections
• Chronic, which lasts for eight weeks or more or occurs four times a year or more. It can, however, go on for months or even years. This type is often caused by allergies.

Symptoms

It is easy to mistake sinusitis for a cold. Many of the signs are similar. If the symptoms last more than a week, itÕs probably not a cold. Sinusitis usually causes:

• A cough that gets worse at night
• A stuffy or runny nose. When the nose does drain, the mucus may be thick and colored.
• Drainage down the back of the throat (postnasal drip). This may cause a bad taste in the mouth, bad breath or hoarseness.
• Ear pain or stuffiness. This may make it hard to hear well.
• Fever
• Headache
• Not being able to smell
• Not feeling well
• Pain or pressure on or near the cheekbones, jaw line, teeth, eyes and forehead.
• Stuffy head

Causes

The sinuses have tiny holes that drain mucus. Because of colds or allergies, these holes can get plugged. The mucus backs up, pressure builds and pain occurs.

Sometimes bacteria, fungi or viruses grow in the mucus. This can lead to an infection. Tiny hairs in the nose and sinuses move the mucus and pus from the infection to the back of the nose. It then drains down the back of the throat.

Other things that can cause nasal and sinus problems are:

• A weak immune system. Normal infections that a person with a strong immune system can easily fight off can become serious in a person with HIV.
• Allergies such as hay fever can cause the linings of the nose and sinuses to swell. Pollution, damp weather, dust, mold, pollen and mites can all contribute to sinusitis.
• Asthma. This disease causes the airways of the lower lungs to be unusually sensitive. People who have asthma may have nasal airways that over react. This can lead to sinusitis or nasal polyps. In addition, people may get asthma attacks from the draining of the sinuses during a sinus infection.
• Dental problems. The upper teeth lie just below the sinuses. An infection in a tooth can easily travel into the sinuses.
• Diseases such s cystic fibrosis that cause problems with how mucus is produced and moved in the body can also lead to sinusitis.
• Flying or scuba diving. Both of these activities involve changes in air pressure. These changes can cause the linings of the sinuses to swell. A person who has a cold and who flies has a greater chance of developing sinus problems than usual.
• Pregnancy. Many women develop an inflamed nose when they are pregnant. This is caused by the changes in hormones that happen during pregnancy.
• Structural problems. For example, if the septum (the cartilage that divides the nose into a left side and a right side, isnÕt straight there can be problems. (This is called a deviated septum.) Sometimes growths (polyps) in the nose cause the passages inside the nose to be narrow.

Prevention

It's not possible to prevent all sinus problems. Taking these steps can help:

• Avoid catching a cold.
• Avoid diving into a pool. This forces water into the sinuses from the nose.
• Avoid drinking alcohol. It causes the linings of the nose and sinuses to swell.
• Avoid pollutants such as smoking or chemical fumes (even from household products)
• Avoid swimming in water with chlorine in it. The chlorine, which helps keep the water free of bacteria, irritates the linings of the nose and sinuses.
• Before traveling in an airplane, talk to a doctor or health care provider. Taking a decongestant or nose drops or spray may be helpful in avoiding sinus problems.
• Inhale steam when the sinuses feel stuffy. Either cool or warm mist can be helpful. This should be done at the first sign of sinus infection. Holding a towel-covered head over a bowl of hot water can do this. Face steamers for skin care or special steamers for people with sinus problems can also be used.
• Keep the temperature even by using an air conditioner
• Eat a well balanced diet and take vitamins daily. Vitamin C can be especially helpful in protecting the nose, sinuses and air passages of the lungs.
• Use a humidifier
• Use special filters on the air conditioner to help remove allergens from the air. These should be changed regularly.
• Vacuum and dust living areas often
• Wash the hands frequently

Diagnosis

A doctor can usually diagnose sinusitis by the symptoms. He or she will do a physical examination. This usually means looking into the nose. Other tests may be ordered too. These include:

• Blood tests to rule out other conditions that cause similar symptoms
• Cultures, where a lab tries to grow bacteria or fungi from a blood sample. This can help identify the cause of the infection.
• Taking a sample of tissue from the nose to check under a microscope. This is called a biopsy. It is done to see the health of the tissues.
• A computed tomography (CT) scans. This is only done if the symptoms are vague or continue even after treatment.

Treatment

Treating sinusitis usually focuses on three things:

• Getting rid of any infection
• Shrinking swollen sinus tissues
• Draining pooled mucus

If bacteria or fungi cause the sinusitis, it is important to use the right antibiotic. Different drugs work against different sources of infection. Sometimes itÕs not possible to identify the cause of an infection. In that case, a doctor may use one or more drugs that are most likely to cure the infection. Treatment should be continued for several weeks to reduce the chances of recurrence.

Swollen sinus tissues can be treated by using a corticosteroid nose spray such as beclometasone (Beconase) or budesonide (Rhinocort). Pseudoephedrine (Galpseud/ Sudafed) tablets can help shrink the tissue.

It is important to avoid using decongestant sprays. The more these sprays are used, the more the body fights against their effects. This is called Òrebound congestion.Ó Soon, the nose is always congested unless the spray is used.

Pooled mucus can be drained by sniffing warm salt water into the nose from a cup. The water is then sneezed into a bowl. This washes out the nose and sinuses and helps reduce the chance of infection.

In some cases, surgery may be needed. This is done if there are growths in the nose or structural problems such as a deviated septum.

The pain of sinusitis can be helped by:

• Breathing warm, moist air from a vaporizer
• Applying warm, moist compresses to the painful areasPain relievers such as aspirin or ibuprofen