Salt water helps: Colds can lead to sinusitis

Felix Unger from The Odd Couple has a bad rap. C'mon, if you had to live with an ultra slob like Oscar Madison– who probably smells like spoiled Oscar Mayer– versus nice, clean, and responsible Felix with chronic sinus infections, I think the choice is clear. Plus, Felix is a great name. "Hey, Felix! I'm home! Where's dinner?" "Felix, clean the bathroom!" "Felix, feed the cat!"

Okay, he's obsessive-compulsive disorder-ish, but not like Howard Hughes. Perhaps Felix would have been a happier person if he had a good ENT to prevent all his sinus problems. We have to wonder about Felix's sinus infections.

Acute sinusitis is an infection of one or more of the paranasal sinuses. In your face, you have three main pairs of sinus cavities– cavities as in "caves," not as in "needing fillings," like teeth. Most sinus infections occur in the maxillary sinuses­ located beside the nose by the cheeks. Ethmoid sinuses are between the eyes, and frontal sinuses are above the eyebrows.

Contrary to popular belief, the #1 cause of acute sinusitis is... viral. "Huh, not bacterial?" Yes, Vern, it's viral. Only two percent of the time is a cold with sinusitis due to bacteria. Viral sinus infection resolves within 7-10 days, and even bacterial sinusitis resolves 75 percent of the time within one month.

But then, who likes to walk around with a bacterial sinus infection: mild fevers, pus-filled sputum, post-nasal drip causing a sore throat, coughing from the drip (like Adelaide's Lament– achoo!), and sometimes upper tooth pain, headaches, and fatigue? (When I was a resident, I was running down the hall to a code (i.e. a person's heart had stopped), and my upper right teeth hurt with each pounding step. Considering I was blowing out orange sputum from my right nostril, and my right maxillary sinus was filled with pus, I self-diagnosed sinusitis.)

Twenty million cases of bacterial sinusitis occur each year in the US. Two percent of common colds are complicated by bacterial sinus infections, which tend to develop a week later. Why? Think about your congestion and runny nose. It's like a haven for bacteria to creep into the sinuses and "party like it's 1999" (Prince, I still love you!). Too bad we don't have something like Raid to spray into your sinuses to prevent these infections.

Swimmers and those with nose allergies and obstructed sinuses (like deviated septums or bony abnormalities) are more prone to bacterial sinus infections. People who blow their noses too hard can actually push bacteria into the sinuses. (I wonder if elephants get sinusitis?)

It's difficult for primary care physicians to determine if a sinus infection is viral or bacterial. I can say from professional experience that if the doctor doesn't treat sinusitis with antibiotics and the patient isn't better after 7-10 days, some of them go commando. On the other hand, treating viral sinusitis with antibiotics doesn't prevent bacterial sinusitis from developing– then the patient complains, "That dumb doctor didn't give me the right antibiotic!" We just can't win!

To help prevent bacterial sinusitis from developing during a cold, don't smoke, drink plenty of fluids, avoid antihistamines that can dry you up, and maybe use a nasal steroid to reduce inflammation. I recommend nasal saline– salt water spray– to my patients. It moisturizes the sinuses to help honk out bacteria.

My father had the honor of sticking nasal saline up my nose whenever I had a cold or sinusitis. He would turn my head upside down, ram the medicine dropper into my nose, and squeeze out his homemade concoction of nasal saline into my head so I felt like I was an extra in the final scene of Titanic. He used Morton's Salt, and for me, the company's slogan was true: "When it rains, it pours."