It can be confusing, but you can identify sinus problems by any symptom related to the sinuses – most commonly congestion, pressure and post-nasal drip. These symptoms are caused by inflammation and sometimes infection. Allergies are just one cause of sinus problems. Studies show that about half of patients with sinus symptoms have allergies. Many patients, even those who have allergies, experience symptoms that are not solely due to allergies. Recurrent sinus infections and loss of smell could indicate chronic sinusitis and require further evaluation.
How to evaluate sinus problems
It is very important to start with a thorough patient history. Many patients can be initially treated with over-the-counter treatments, such as nasal rinses or a trial of intranasal steroids or antihistamines. When symptoms persist or include the need for antibiotics or steroids, it is best to have an office exam and nasal endoscopy. Often, doctors will order a CT (computed tomography) scan of the sinuses and, if needed, will perform allergy testing.
Allergy testing
To evaluate if an allergy is contributing to the problem, it helps to look at environmental factors to see if there is a trigger. When symptoms occur consistently with exposure to a cat, dog or potential allergen, it is usually an allergy. The most common allergens are pollen, dust mites, pet dander, mold and cockroaches. Seasonal allergies are mainly due to pollen and molds. Several molds are present year-round, and others are more common indoors. In the Midwest during the spring, there will be tree and grass pollen, and in the fall, there will be ragweed pollen. In recent years, pollen counts have been at record highs, as a warmer atmosphere causes plants to produce more pollen over a longer period of time.
Many times, testing is needed to see if allergies are a contributor to sinus problems. Allergy testing, either by blood or skin, is a way to quickly identify what someone is allergic to.
For skin testing, a small prick is used to scratch the skin. A positive test occurs if there is an inflammatory reaction to scratching the skin with the allergen. When undergoing allergy testing, patients are typically asked to temporarily stop their use of antihistamines. If a patient is unable to stop for a short period of time, a blood test may be preferred. A blood test involves drawing blood, which will then be analyzed in a lab.
Nasal endoscopy and imaging
The nasal endoscopy is an in-office procedure during which a small camera is introduced into a patient’s nose. This allows the doctor to look for inflammation, infections, structural irregularity such as a deviated septum, nasal polyps and, in rare cases, a malignant (cancer) growth. The doctor may also recommend a CT scan of the sinuses to further evaluate the cause and severity of sinus problems.
Those with recurrent infections may also need blood testing to evaluate their immune system.
Treatments and strategies
The most effective treatment options can be environmental control measures. For people with pets, removing the pet is the most severe option, but when that is not a consideration, creating an allergen-free zone is recommended, such as not having the dog sleep in the bedroom. With a less-extensive presence of the allergen, symptoms often decrease.
It's recommended to close windows at those times of the day when pollen counts are higher. If children are outside, especially when tree and grass pollen counts are high, have them take a shower as soon as they’re done playing and back in the house for the night.
There are also effective over-the-counter medications for allergies, including oral antihistamines and sprays. When over-the-counter treatments do not work, individuals can consider allergy shots (immunotherapy). Learn more about allergy treatments.
Goal of treatment
For a small percentage of patients, infections recur or persist even after long courses of medication. Such patients often benefit from surgery. After reviewing your medical history and imaging studies, your ear, nose and throat (ENT) specialist can determine if you are a surgical candidate. Endoscopic sinus surgery is a procedure designed to open the natural drainage pathways of the sinuses to restore their function and health. In chronic sinusitis, the sinuses are unable to drain adequately due to inflammation of the narrow drainage pathways. As a result, nasal secretions can become trapped in
the sinuses, which become chronically infected. The goal of surgery is to carefully remove the thin, delicate bone and mucous membranes that block the drainage pathways of the sinuses. The term “endoscopic” refers to the use of small fiber optic device that allows all of the surgery to be performed through the nostrils, without the need for any skin incisions. Endoscopic sinus surgery is generally performed on an outpatient basis. There are also promising new medications for inflammation which use biologics, injectable medications that target specific molecules involved in the immune response.
Endeavor Health offers a unique comprehensive clinic in which Dr. Joseph Raviv and Dr. Auddie Musa Sweis, ENT physicians and Dr. Ewa Schafer and Dr. Evelyn Konsurs, physicians who specialize in allergy and immunology, work together to optimize patient outcomes and follow-up care. Not all patients need to see both specialists, but for those who do, it provides a higher level of individualized care. If you are struggling with allergy or sinus issues, visit us online or call (847) 504-3300.
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