You’re coughing and sneezing and tired and achy. You think that you might be getting a cold. Later, when the medicines you’ve been taking to relieve the symptoms of the common cold are not working and you’ve now got a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms and perhaps doing a sinus X-ray, the doctor says you have sinusitis.
Sinusitis simply means inflammation of the sinuses, but this gives little indication of the misery and pain this condition can cause. Chronic sinusitis, sinusitis that recurs frequently, affects an estimated 32 million people in the United States. Americans spend millions of dollars each year for medications that promise relief from their sinus symptoms.
Sinuses are hollow air spaces, of which there are many in the human body. When people say, “I’m having a sinus attack,” they usually are referring to symptoms in one or more of four pairs of cavities, or spaces, known as paranasal sinuses. These cavities, located within the skull or bones of the head surrounding the nose, include the frontal sinuses over the eyes in the brow area, the maxillary sinuses inside each cheekbone, the ethmoids just behind the bridge of the nose and between the eyes, and behind them, the sphenoids in the upper region of the nose and behind the eyes.
Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose-an infection or an allergic reaction-also can affect the sinuses. Air trapped within an obstructed sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.
Sinusitis has its own localized pain signals, depending upon the particular sinus affected. Headache upon awakening in the morning is characteristic of sinus involvement. Pain when the forehead over the frontal sinuses is touched may indicate inflammation of the frontal sinuses. Infection in the maxillary sinuses can cause the upper jaw and teeth to ache and the cheeks to become tender to the touch. Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around the eyes and pain between the eyes. Ethmoid inflammation also can cause tenderness when the sides of the nose are touched, a loss of smell, and a stuffy nose. Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of the head.
Other symptoms of sinusitis can include fever, weakness, tiredness, a cough that may be more severe at night, and runny nose or nasal congestion. In addition, drainage of mucus from the sphenoids down the back of the throat (postnasal drip) can cause a sore throat and can irritate the membranes lining the larynx (upper windpipe).
Most cases of acute sinusitis are caused by viruses and will clear up without treatment within two weeks. Viruses can enter the body through the nasal passages and set off a chain reaction resulting in sinusitis. For example, the nose reacts to an invasion by viruses that cause infections such as the common cold, flu, or measles by producing mucus and sending white blood cells to the lining of the nose, which congest and swell the nasal passages. When this swelling involves the adjacent mucous membranes of the sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. If the sinus openings become too narrow to permit drainage of the mucus, then bacteria, which normally are present in the respiratory tract, begin to multiply. Most apparently healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no ill effects until the body’s defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. The bacteria that may have been living harmlessly in the nose, throat, or sinus area can multiply and cause an acute sinus infection.
Medicines, too, can set off a nasal reaction with accompanying sinusitis. For example, intolerance to aspirin and other related non-steroidal anti-inflammatory medications, such as ibuprofen, can be associated with sinusitis in patients with asthma or nasal polyps (small growths on the mucous membrane lining of the sinuses).
Sometimes, fungal infections can cause acute sinusitis. Although these organisms are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus and Curvularia, can cause serious illness, in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages (rhinitis) also can lead to sinusitis. Allergic rhinitis or hay fever (discussed below) is the most common cause of chronic sinusitis and is a frequent cause of acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also can result in a sinus infection.
Chronic sinusitis refers to inflammation of the sinuses that continues for weeks, months, or even years.
As noted above, allergies are the most common cause of chronic sinusitis. Inhalation of airborne allergens (foreign substances that provoke an allergic reaction), such as dust, mold, and pollen, often set off allergic reactions (allergic rhinitis) that, in turn, may contribute to sinusitis. People who are allergic to fungi can develop a condition called “allergic fungal sinusitis.” As body cells react against these inhaled substances, they release chemical compounds, such as histamine, at the mucosal surface. These chemicals then cause the nasal passages to swell and block drainage from the sinuses, resulting in sinusitis.
Damp weather, especially in northern temperate climates, or pollutants in the air and in buildings also can affect people subject to chronic sinusitis.
Chronic sinusitis can be caused by structural abnormalities of the nose, such as a deviated septum (the bony partition separating the two nasal passages), or by small growths called nasal polyps, both of which can trap mucus in the sinuses.
Although a stuffy nose can occur in other conditions, like the common cold, many people confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about seven days and disappears without treatment. Acute sinusitis often lasts longer than a week. A doctor can diagnose sinusitis by medical history, physical examination, X-rays, and if necessary, MRIs or CT scans (magnetic resonance imaging and computed tomography).
After diagnosing sinusitis and identifying a possible cause, a doctor can prescribe a course of treatment that will clear up the source of the inflammation and relieve the symptoms. Sinusitis is treated by re-establishing drainage of the nasal passages, controlling or eliminating the source of the inflammation, and relieving the pain. Doctors generally recommend decongestants to reduce the congestion, antibiotics to control a bacterial infection, if present, and pain relievers to reduce the pain.
Over-the-counter and prescription decongestant nose drops and sprays, however, should not be used for more than a few days. When used for longer periods, these drugs can lead to even more congestion and swelling of the nasal passages.
If symptoms do not improve within 10 to 14 days, the cause of sinusitis is likely to be bacterial. Most patients with sinusitis that is caused by bacteria can be treated successfully with antibiotics used along with a nasal or oral decongestant. A narrow-spectrum antibiotic — one that fights the most common bacteria — is the initial treatment recommended.
For many years, the combination of allergic disease and infectious sinusitis has been considered the most difficult form of sinus disease to treat. The patient with uncontrolled nasal allergies frequently experiences a lot of congestion, swelling, excess secretions, and discomfort in the sinus areas. Therefore, the patient should work with a doctor who understands the diagnosis and treatment of allergic diseases to pinpoint the cause of the allergies and follow an allergy care program to help alleviate sinusitis.
Doctors often prescribe steroid nasal sprays, along with other treatments, to reduce the congestion, swelling, and inflammation of sinusitis. Because steroid nasal sprays have no serious side effects, they can be used for long-term treatment. In some people, however, they irritate the nasal passages.
For patients with severe chronic sinusitis, a doctor may prescribe oral steroids, such as prednisone. Because oral steroids can have significant side effects, they are prescribed only when other medications have not been effective.
Although sinus infection cannot be cured by home remedies, people can use them to lessen their discomfort. Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities. Another treatment is saline nasal spray, which can be purchased in a pharmacy. A hot water bottle; hot, wet compresses; or an electric heating pad applied over the inflamed area also can be comforting.
In treating patients with severe sinusitis, a physician may use special procedures. One technique requires the patient to lie on his back with his head over the edge of the examining table. A decongestant fluid is placed in the nose, and air is suctioned out of the nose so that the decongestant fluid can shrink the sinus membranes sufficiently to permit drainage. Or, a thin tube can be inserted into the sinuses for washing out entrapped pus and mucus.
Sometimes, however, surgery is the only alternative for preventing chronic sinusitis. In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages. Adults who have had allergic and infectious conditions over the years sometimes develop polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms. The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage.
Although people cannot prevent all sinus disorders-any more than they can avoid all colds or bacterial infections-they can take certain measures to reduce the number and severity of the attacks and possibly prevent sinusitis from becoming chronic. Appropriate amounts of rest, a well-balanced diet, and exercise can help the body function at its most efficient level and maintain a general resistance to infections. Eliminating environmental factors, such as climate and pollutants, is not always possible, but they can often be controlled.
Many people with sinusitis find partial relief from their symptoms when humidifiers are installed in their homes, particularly if room air is heated by a dry forced-air system. Air conditioners help to provide an even temperature, and electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.
A person susceptible to sinus disorders, particularly one who also is allergic, should avoid cigarette smoke and other air pollutants.
Inflammation in the nose caused by allergies predisposes a patient to a strong reaction to all irritants. Drinking alcohol also causes the nasal-sinus membranes to swell.
Sinusitis-prone persons may be uncomfortable in swimming pools treated with chlorine, since it irritates the lining of the nose and sinuses. Persons often experience congestion with resulting infection when water is forced into the sinuses from the nasal passages.
Air travel, too, poses a problem for the individual suffering from acute or chronic sinusitis. A bubble of air trapped within the body expands as air pressure in a plane is reduced. This expansion causes pressure on surrounding tissues and can result in a blockage of the sinuses or the eustachian tubes in the ears. The result may be discomfort in the sinus or middle ear during the plane’s ascent or descent. Doctors recommend using decongestant nose drops or inhalers before the flight to avoid this difficulty.
People who suspect that their sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger a respiratory reaction-should consult a doctor. Various tests can determine the cause of the allergy and also help the doctor recommend steps to reduce or limit allergy symptoms.
Prepared by: The Consumer Product Safety Commission (CPSC), and
The American Lung Association, The Christmas Seal People
What are Biological Pollutants?
The Scope of the Problem
Health Effects Of Biological Pollutants
Talking to Your Doctor
Coping with the Problem
Self-Inspection: A Walk Through Your Home
What You Can Do About Biological Pollutants
Moisture Control
Maintain and Clean All Appliances that Contact Water
Dust Control
Where Biological Pollutants May be Found in the Home
Correcting Water Damage
Additional Sources of Information
This page will help you understand:
Outdoor air pollution in cities is a major health problem. Much effort and money continues to be spent cleaning up pollution in the outdoor air. But air pollution can be a problem where you least expect it, in the place you may have thought was safest–your home. Many ordinary activities such as cooking, heating, cooling, cleaning, and redecorating can cause the release and spread of indoor pollutants at home. Studies have shown that the air in our homes can be even more polluted than outdoor air.
Many Americans spend up to 90 percent of their time indoors, often at home. Therefore, breathing clean indoor air can have an important impact on health. People who are inside a great deal may be at greater risk of developing health problems, or having problems made worse by indoor air pollutants. These people include infants, young children, the elderly, and those with chronic illnesses.
Biological pollutants are or were living organisms. They promote poor indoor air quality and may be a major cause of days lost from work or school, and of doctor and hospital visits. Some can even damage surfaces inside and outside your house. Biological pollutants can travel through the air and are often invisible.
Some common indoor biological pollutants are:
Some of these substances are in every home. It is impossible to get rid of them all. Even a spotless home may permit the growth of biological pollutants. Two conditions are essential to support biological growth: nutrients and moisture. These conditions can be found in many locations, such as bathrooms, damp or flooded basements, wet appliances (such as humidifiers or air conditioners), and even some carpets and furniture.
Modern materials and construction techniques may reduce the amount of outside air brought into buildings which may result in high moisture levels inside. Using humidifiers, unvented heaters, and air conditioners in our homes has increased the chances of moisture forming on interior surfaces. This encourages the growth of certain biological pollutants.
Most information about sources and health effects of biological pollutants is based on studies of large office buildings and two surveys of homes in northern U.S. and Canada. These surveys show that 30% to 50% of all structures have damp conditions which may encourage the growth and buildup of biological pollutants. This percentage is likely to be higher in warm, moist climates.
Some diseases or illnesses have been linked with biological pollutants in the indoor environment. However, many of them also have causes unrelated to the indoor environment. Therefore, we do not know how many health problems relate only to poor indoor air.
All of us are exposed to biological pollutants. However, the effects on our health depend upon the type and amount of biological pollution and the individual person. Some people do not experience health reactions from certain biological pollutants, while others may experience one or more of the following reactions:
Except for the spread of infections indoors, ALLERGIC REACTIONS may be the most common health problem with indoor air quality in homes. They are often connected with animal dander (mostly from cats and dogs), with house dust mites (microscopic animals living in household dust), and with pollen. Allergic reactions can range from mildly uncomfortable to life-threatening, as in a severe asthma attack. Some common signs and symptoms are:
Health experts are especially concerned about people with asthma. These people have very sensitive airways that can react to various irritants, making breathing difficult. The number of people who have asthma has greatly increased in recent years. The number of people with asthma has gone up by 59 percent since 1970, to a total of 9.6 million people. Asthma in children under 15 years of age has increased 41 percent in the same period, to a total of 2.6 million children. The number of deaths from asthma is up by 68 percent since 1979, to a total of almost 4,400 deaths per year.
INFECTIOUS DISEASES caused by bacteria and viruses, such as flu, measles, chicken pox, and tuberculosis, may be spread indoors. Most infectious diseases pass from person to person through physical contact. Crowded conditions with poor air circulation can promote this spread. Some bacteria and viruses thrive in buildings and circulate through indoor ventilation systems. For example, the bacterium causing Legionnaire’s disease, a serious and sometimes lethal infection, and Pontiac Fever, a flu-like illness, have circulated in some large buildings.
Are you concerned about the effects on your health that may be related to biological pollutants in your home? Before you discuss your concerns with your doctor, you should know the answers to the following questions. This information can help the doctor determine whether your health problems may be related to biological pollution.
TOXIC REACTIONS are the least studied and understood health problem caused by some biological air pollutants in the home. Toxins can damage a variety of organs and tissues in the body, including the liver, the central nervous system, the digestive tract, and the immune system.
There is no simple and cheap way to sample the air in your home to determine the level of all biological pollutants. Experts suggest that sampling for biological pollutants is not a useful problem-solving tool. Even if you had your home tested, it is almost impossible to know which biological pollutant(s) cause various symptoms or health problems. The amount of most biological substances required to cause disease is unknown and varies from one person to the next.
Does this make the problem sound hopeless? On the contrary, you can take several simple, practical actions to help remove sources of biological pollutants, to help get rid of pollutants, and to prevent their return.
Begin by touring your household. Follow your nose, and use your eyes. Two major factors help create conditions for biological pollutants to grow: nutrients and constant moisture with poor air circulation.
Before you give away the family pet or move, there are less drastic steps that can be taken to reduce potential problems. Properly cleaning and maintaining your home can help reduce the problem and may avoid interrupting your normal routine. People who have health problems such as asthma, or are allergic, may need to do this and more. Discuss this with your doctor.
Water in your home can come from many sources. Water can enter your home by leaking or by seeping through basement floors. Showers or even cooking can add moisture to the air in your home. The amount of moisture that the air in your home can hold depends on the temperature of the air. As the temperature goes down, the air is able to hold less moisture. This is why, in cold weather, moisture condenses on cold surfaces (for example, drops of water form on the inside of a window). This moisture can encourage biological pollutants to grow.
There are many ways to control moisture in your home:
Controlling dust is very important for people who are allergic to animal dander and mites. You cannot see mites, but you can either remove their favorite breeding grounds or keep these areas dry and clean. Dust mites can thrive in sofas, stuffed chairs, carpets, and bedding. Open shelves, fabric wallpaper, knickknacks, and venetian blinds are also sources of dust mites. Dust mites live deep in the carpet and are not removed by vacuuming. Many doctors suggest that their mite-allergic patients use washable area rugs rather than wall-to-wall carpet.
Protect yourself by inspecting your potential new home. If you identify problems, have the landlord or seller correct them before you move in, or even consider moving elsewhere.
What if damage is already done? Follow these guidelines for correcting water damage:
DISCLAIMER: This document may be reproduced without change, in whole or in part, without permission, except for use as advertising material or product endorsement. Any such reproduction should credit the American Lung Association and the U.S. Consumer Product Safety Commission. The use of all or any part of this document in a deceptive or inaccurate manner or for purposes of endorsing a particular product may be subject to appropriate legal action.
Contact your local American Lung Association for copies of: Indoor Air Pollution Fact Sheets, Air Pollution in Your Home? and other publications on indoor air pollution.
Contact the U.S. Consumer Product Safety Commission, Washington, D.C. 20207, for copies of Humidifier Safety Alert.
To report an unsafe consumer product or product-related health problem, consumers may call the U.S. Consumer Product Safety Commission at 1-800-638-2772. A teletypewriter for the hearing impaired is available at 1-800-638-8270; the Maryland TTY number is 1-800-492-8104.
You may also contact EPA’s IAQ INFO Clearinghouse at 1-800-438-4318 (or (703) 356-4020) for more information on indoor air quality and to order publications from the list of IAQ publications.
Created: March 31, 1997, Last Modified: March 19, 1998
http://www.epa.gov/iaq/pubs/bio_1.html