America’s Sinusitis Epidemic

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America’s Sinusitis Epidemic

This article is not meant to diagnose or provide medical advice—that responsibility lies with physicians. The author is not a licensed medical professional.

In 2012, I was driving down the interstate and experienced a medical emergency. It wasn’t a heart attack, stroke or childbirth. It was a sinus infection.

After rounds of antibiotics to kick one sinus infection after another, my doctor prescribed beefed up sulfa antibiotics, to which I soon discovered I was allergic while driving 60 miles per hour. Shortly after I took the first dose, my throat swelled and my heart began racing.

That was the end of the line for medicating my chronic sinusitis, which had left me exhausted and in pain for the better part of a year.

I had surgery to align my septum, the cartilage in the nose, and to cauterize the turbinates, the ridge-like structures on the inside of the nose. Surgery brought some relief, but the pursuit of a deep breath continues for me and millions of Americans who have sinusitis.

A Costly and Chronic Problem

According to the U.S. Centers for Disease Control and Prevention, more than 29 million American adults are diagnosed with sinusitis annually.

It’s a costly condition. Chronic sinusitis results in nearly 12 million visits to doctor’s offices each year. Then there’s sick leave from work (12.5 million lost work days), cost of treatment (a study from 1996 cited nearly $6 billion), and lost productivity, because sinusitis leaves sufferers in a fog at best, and in debilitating pain at worst.

Chronic sinusitis is characterized by inflammation of the nasal passages and symptoms like nasal discharge; congestion; pain or swelling around the eyes, cheek, nose, or forehead; and reduced sense of smell and taste. Other symptoms include ear pain, aching in the jaw or teeth, cough, bad breath, nausea and fatigue.

Sinusitis can caused by infection (bacterial, viral, or fungal) or can be triggered by allergies. The inflammation leads to blockage of drainage pathways and buildup of mucus. The resulting moist, warm environment is an ideal breeding ground for bacteria. If sinusitis lasts for at least 12 weeks, it’s considered chronic.

Perhaps the most maddening thing about chronic sinusitis, besides the mucus and drainage, is the inflammation. Even when my sinuses were clear of nasal discharge, they still felt puffy and tender.

Jeffrey Cutler M.D., an otolaryngologist at the Colorado Sinus Institute in Denver, Colorado, likens sinusitis to asthma.

“Inflammation is a big player in sinus conditions,” he said. “It’s similar to asthma in that way. Asthma is an inflammation of the bronchial tubes, and sinusitis is inflammation of the nasal passages.”

In more serious cases, patients can develop nasal polyps, or soft tissue growths that occur from chronic inflammation in the nose. Those patients are some of the most difficult to treat and control sinusitis in.

Baby Shampoo Up the Nose, and Other Treatments

Sinus surgery—after which I woke up with a black eye and swollen snout like a busted up Miss Piggy—ended the infections. But my nose still doesn’t operate as well as it used to. The drainage continued to ebb and flow.

“If I say, ‘I’m going to do this surgery and it’ll cure your sinuses,’ the patient will be disappointed,” Dr. Cutler said. “Surgery is part of a long-term treatment option that we hope reduces infections, but most patients with chronic problems need a follow-up plan even after surgery.”

Modern medicine did everything it could, and while steroidal sprays to lessen inflammation provided moderate relief, they weren’t as effective as I hoped.

I paid a visit to a naturopath in Seattle who offered alternative strategies—food allergy testing, herbal tinctures in a neti pot, taking probiotics orally and putting them into the neti pot. The saline and probiotic rinses in the neti pot made a big difference.

I also did some ill-advised medical experimenting. I read an account online by a woman who’d found relief by snorting kimchi juice that contained the probiotic strain lactobacillus casei. I tried it. There were tears. I don’t recommend it.

“That sounds spicy,” said Dewayne Bradley M.D., an otolaryngologist at The Polyclinic in Seattle. “But it’s not a completely crazy idea because the probiotic factor is interesting. The microbiome was a topic of discussion at our [American Academy of Otolaryngology] national meeting.”

Bradley says there’s growing interest in the field about the microbiome in the nose. The idea is that if the balance of natural bacteria in the nose is disrupted—say, by, antibiotics to treat a sinus infection—then the annoying nose drip sticks around.

A researcher at Baylor College of Medicine in Houston, Texas found that baby shampoo sinus irrigation and probiotic sinus rinses can lessen symptoms and ward off sinus infections. The baby shampoo dislodges biofilm, a kind of super snot formed by bad bacteria to protect itself from irrigation.

Replenishing that happy balance of bacteria has proven important in other areas. Dr. Bradley points to research that tested swabbing babies born by C-section with friendly microbes from the mother’s birth canal that a baby delivered vaginally would be naturally exposed to. The researchers behind that study, in the journal Nature Medicine, think that conditions like asthma, allergies, Type 1 diabetes, celiac disease and obesity may be related to disturbances in the microbiome.

Floating Balloons and Ideas on Sinusitis

In other new treatments, doctors are inserting balloons in the nose and inflating them to drain and widen the sinus passages in an outpatient procedure that takes a little more than an hour. Dr. Bradley had the procedure done on himself by a colleague when it was still new. He had a persistent sinus infection and wanted to avoid an invasive procedure because he was signed up to run an Ironman race in Texas.

“I heard some crunching and cracking as the balloon inflated,” he said, “I nursed a bloody nose, and went to my son’s baseball game.”

He said the procedure caused some discomfort, but he hasn’t had any sinus infections since, and it beats the two-week recovery and foul healing process (so much drainage) I endured after surgery.

Sinusitis is a vexing condition to have and to treat. The Multidisciplinary Digital Publishing Institute even launched a peer-reviewed journal in 2015 devoted entirely to sinusitis research.

Dr. Hassan Ramadan, an otolaryngologist at West Virginia University, wrote in the first issue that controversies surround the definition, diagnosis and treatment of sinusitis.

“Sinusitis will allow scientists from all over the world to have one forum that will allow them to share and discuss scientific ideas about sinusitis in one place,” Ramadan writes.

In the meantime, 29 million Americans and I will keep reaching for tissues.

Didi Kader is a health and science writer based in Seattle. She hoards facial tissues and ginger tea.

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