 For tonight's Your Health segment, we are joined by Dr. Andrea Hebert, assistant professor of otorhinolaryngology, that is head and neck surgery at the University of Maryland School of Medicine and ear, nose, and throat physician at the University of Maryland Medical Center, which I should note is a top 10 ranked specialty. Glad you're with us. Thank you. We'll talk about the mysteries of sinuses. Let's start with this. Why do we have them? What do they do? So they help to actually lighten the head. So they're air-filled cavities, four of them, two, you know, sets of pairs. And they lighten the head, they help to circulate the air, humidify it, filter it, warm it as we breathe it through our nose. And they also help to serve as a protective mechanism for a head-on collision. Wow. So why do people have so much trouble? Tens of millions of people have sinus problems. Why? Yeah. So 12 to 15 percent of the population develops a sinus infection every year. And really the underlying pathophysiology or problem is that their inflammation starts in the lining of the sinuses and the lining of the nasal cavity. And it blocks the normal mucus that drains from these sinuses. And that's when you get trouble, that's when you get your infections. They can be acute, lasting less than four weeks or chronic, lasting three months or longer. You happen to bring your sinuses with you in the form of this little model, which may be hard to make out on TV, but I think people, you can point to where the, it's not one spot where the sinuses are. Correct, correct. So this is a cross-section of the head right down the middle. And here we see two of the four pairs of sinuses. So this is the frontal sinus here, kind of right in front of your forehead, or right in your forehead. This is the sphenoid sinus, which is actually kind of in the middle of your head as you can see here. You also have your maxillary sinuses, which are the cheek sinuses right underneath your cheeks, and the ethmoid sinuses, which I describe as a honeycomb shaped sinus between your eyes. So you can't really see it on this picture, but. You can see how if you had a problem in there, it would, there's no easy way out that way. Right, right. So yeah, there are very small drainage pathways for each of these sinuses. And if they get swollen, if the lining becomes inflamed and swollen, really things can get kind of stuck in there. What kind of pain do people get when they have a specific problem in one of those spots? So people will generally describe a specific pain in that location. For example, for the maxillary, the cheek sinuses, they will describe cheek pain or even tooth pain. They'll think it's a tooth infection. For the ethmoid sinuses, they'll describe pain between the eyes or behind the eyes. Frontal, you have a pain right in the front of your head. And then the sphenoid sinus, interestingly, you can present with pain right at the top of your head called a vertex headache or right in the back of your head called an occipital headache. Not to pick on quickie clinics, but when somebody shows up and has sort of vague, you know, it sort of hurts. Can they tell? I mean, can a regular internist, I mean, from a diagnostic standpoint, are there enough clues to make a decent diagnosis? Yeah, so most of the time we have to discern from a constellation of symptoms. So it's not only facial pain and pressure, but it's also decreased ability to breathe through your nose, discolored drainage from your nose, and then changing your sense of smell. So really, we use those four constellation of symptoms to determine whether or not someone has a sinus infection. And based on that, that's where we, and then the duration of symptoms as well will determine how we treat the patient. We don't usually recommend for any other imaging or anything like that at that point in time when they present with an acute symptom. Let me remind our viewers, if you have a question about sinus issues, now is your chance. Give us a call. We'll have the phone number up on the screen. You can also email us live questions at mpt.org. And let's start with a question from a viewer, can reoccurring sinus infections cause damage to other nearby areas, the eardrums, the throat, the brain? So that's a great question. So acute sinus infections can cause complications. They can spread to the brain. They can spread to the eye. So they can be pretty detrimental. It's not necessarily the recurrence of them, but it's just if you have one very bad severe one. So yes, acute sinus infections can be very detrimental. And typically, we recommend if you've had an infection for over 10 days, or if you've had it at five days, if you have worsening in your symptoms, you really should get checked out by a physician. Okay, what does the physician do? What's the... Well, before that. Self-care. Yeah. I would probably load up on decongestants, pseudofed, maybe a saline spray. Is that... Yeah, exactly. So from, you know, when you first start noticing that you're coming down with something, you want to start with the symptomatic management. So decongestants, both topical and oral, the saline rinses. So I usually really tell my patients that, you know, it can't hurt to use a saline rinse, particularly if you're using one with distilled or boiled water. That helps to kind of flush the mucus out, flush anything out, and help to clean things out. And then symptomatic treatment in terms of pain management also can help at that point. You really, at the time when you're, if you notice improvement and then worsening after about five days or so, or if it's been about 10 days, that's when you really want to seek medical care. And what's the first thing medical care is going to do? So they're going to most likely put you on an antibiotic based on, at that point in time, based on your symptoms, and based on what the most common bacteria are that cause sinus infections. Not necessarily based on a culture, just a guess or a broad spectrum. Correct. Based on what the most common bacteria are that cause sinus infections. Does that typically resolve it? And how, over what period of time? Yeah, so that typically does resolve it. It can take, you know, a few weeks or so to feel kind of back to your baseline. But, you know, it's going to be about a 10 to 14 day course of medicine, depending on what the antibiotic is. Typically, if you go to an internist, they're not going to necessarily culture your nose because the sensitivity of that culture is pretty poor. But if you go to an ear nose and throat doctor, a lot of times we will take a look in the nose with a camera. And we will, if we see pus, we will culture it to get you culture directed antibiotics. I was going to ask how clogged up somebody can get. But let me ask this, is it is it seasonal? Is it do you see more problems with, you know, colds in the winter, hay fever in the springtime? Yeah, I think maybe I'm a little bit biased just because I'm an ear nose and throat doctor and a lot of people come to me specifically for that. So I see patients with sinus infections all year round. But yes, definitely in the wintertime when people have an increased, you know, incidence of upper respiratory tract infections in the fall and the spring with, you know, seasonal allergies, that definitely increases the prevalence of patients with sinus infection. Let's take a phone call. This is from Cecil County. Haleen on the line. Thank you for the call. Go ahead. I guess about almost three weeks ago, only three weeks Saturday, I fell on my face really bad. I had, and I got a CPC, and I had a concussion, but I didn't have any damage, but my whole face, my cheek was swollen, really big because it hit the eyebrow and the face. And is there, I'm still having sinus problems. The top of my head and the back of my head. My goodness. Well, we'll get you an answer. Best of luck. Haleen, thank you for the phone call. Common? Yeah. So typically, you know, after facial trauma, you can definitely have a lot of facial pain. If she had any nosebleeds associated with this, you know, there can be some blood that remained in the sinus cavity, particularly in the cheek sinus, the maxillary sinus. And that can be a breeding ground for bacteria and for infection. So, you know, I would definitely recommend that she seek medical care, saline rinses again, definitely to help clean out that nose and see if there's anything else that needs to be done. Any further workup in terms of her trauma? Let's talk about netty pots. I think that's what they're called. Yeah. And it looks like a magic lantern. And you see people somehow pour water up one side of the nose and it comes out the other side. This doesn't sound like fun, but it must be helpful. Yes. I'm really a big, you know, netty pot enthusiast or saline rinse, I should say. We should have asked you to bring one and demonstrate. Yeah. So, you know, it's so basically it's water either boiled or distilled, plus a salt solution. And it's basically a shower for your nose. So you use it to clean out your nose and it really helps with what we call mucociliary clearance. So you want to basically help move that mucus along. So it's a great tool. It has minimal side effects. The one thing I do say is that some of the different tools that are out there can, you just want to be careful how you administer it because you can get some ear pressure or ear pain if you do it too forcefully. What is a sinus headache? You hear that mostly in advertising for medications. That's a great question. So we describe sinus headaches as frontal pain or sorry, excuse me, as pain or pressure in your face. There is really no actual true definition of a sinus headache. Headaches can be very multifactorial. And in fact, a lot of patients come in saying that they think they have chronic sinusitis. And we get a CT scan and their sinuses are clear. So even despite having the symptoms of pain and pressure in your face, that may not necessarily be your sinuses. That may be another source of headache. You were email titled sense of smell from Chris. The question is, what's the best treatment for chronic and nosmia and nosmia. So I would definitely recommend being evaluated for that. There can be a lot of reasons why people have anosmia, which must be something about your sense of smell. Yes. Anosmia is complete loss of sense of smell. And it can be very detrimental to people. You know, it is very closely associated with your sense of taste. And so people, you know, it's a big quality of life factor. There are a lot of reasons why people lose their sense of smell. There can be an upper respiratory tract infection that causes it. So they get a viral loss. There can be, you know, chronic sinus disease, so inflammation of the sinuses. And then there can be other things that are, you know, more concerning like tumors. So it's definitely important to get that worked up and rolled out. Unfortunately, and depending on what it is that caused the loss of sense of smell will really kind of dictate how to treat it. Unfortunately, there's not much to do in a lot of patients who have loss of sense of smell. We're looking for answers for that in the Rhinologic community. Call from Delaware Sussex County. This is Cynthia. Cynthia, thank you for calling. Go ahead. Hi, I have a question. I've had a sinus infection for over a year. Recently, it's become worse. My sinuses are swelling. You could see the swelling through my skin where it's red. I'm having discharge coming through my pores, my eyes, my gums of my teeth. And now it's recently made little pinholes in my lips and the discharge is coming out of there. It's like white foam. I've been treated with augmentation. I'm on now and see the tonsil in the past. And it's still, I gland is swollen and it's still not good. Cynthia, let's before I run out of time, let me get an answer on the air. Thank you for the call. OK, thank you very much. What would you advise? Yeah, so if she hasn't seen an ear, nose and third doctor, I would definitely advise that she see somebody. She needs to have imaging. She needs to have most likely a culture of whatever that drainage is to see what the appropriate antibiotics are. And she may need surgery at that point. Uncommon to hear a case that severe. Um, you know, I do see a lot of patients who have chronic sinus disease. It's actually not that uncommon for me again. But the the level of severity where she's saying it's extended externally is quite unusual. Very good. Dr. Andrea Hebert, University of Maryland Medical Center, Top 10 in Odo Rhino Laryngology. Thank you very much. We appreciate it. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.