FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SINUSITIS FREQUENT COMPLAINT, LESS FREQUENT REALITY

Question: I get headaches frequently. I think they are caused by sinus problems because they begin with pressure above my eyes and in my cheeks. Non-prescription sinus medication, like Tylenol Sinus, usually clears up the symptoms in two or three days. What signs should I use to tell when I need to go to the doctor for an antibiotic to treat a sinus infection?

Answer: True sinusitis is over diagnosed by individuals with "sinus" complaints as well as by physicians. The symptom you describe - pressure in the face - certainly can be from infection, but blockage of the sinus openings is a more common cause. This blockage can be due to nasal swelling caused by allergies, a condition with nasal swelling but without allergic cause called vasomotor rhinitis, or even the common cold. Tumors and cysts can also produce nasal blockage.

I've given you the medical reality, but the diagnosis of sinusitis as well as some other disorders often involves human psychology as well. Since allergies, vasomotor rhinitis, and colds are quite common but receive low levels of sympathy, a condition with which others will be more likely to commiserate - in this case sinusitis is preferred by the doctor and patient. Hence, the overuse of the diagnosis.

For nasal congestion the best treatment is precisely what you have been doing, using a decongestant to help reduce the swelling of the nasal tissues and to promote sinus drainage. The oral decongestant pseudoephedrine works quite well as do a number of "nose spray" types of decongestants. Drinking "steaming" hot liquids and vigorous physical exercise accomplish the same thing without the use of medications. In a few days the underlying cause of the nasal congestion usually clears, just as you have noted.

True sinusitis is an infection within the sinus cavities and can be much more serious than simple nasal congestion. At times it is difficult for physicians to distinguish between the two without the use of sophisticated tests such as a CT scan of the sinuses or bacterial cultures. The following are some signs that may indicate a sinus infection and, therefore, the need to see your doctor:

Fever of 100 degrees or more;

Worsening of facial pain when bending over;

Failure to improve with 3 days' use of decongestant;

History of previous sinus infections; and

Diabetes, AIDS or another condition that compromises the immune system.

In addition to the above list, I'd advise you to see your doctor any time your symptoms seem significantly different from your previous episodes of simple nasal congestion. The worst this approach can do is cause a non-essential trip to the doctor. But do understand that I seek the consult of experts whenever I'm unsure. This includes my personal trips to my doctor, consultations with my attorney about legal issues, and with my auto mechanic for those funny sounds my car makes.

Question: I've received conflicting opinions on ingesting dairy products when I have a cold or other respiratory infection. Some physicians have said to avoid all dairy products because they cause phlegm and congestion while others say that reasonable use poses no problems. Who's correct?

Answer: I was taught that milk should be avoided in respiratory infections because it makes the mucus thick and sticky just the conditions one would like to avoid in respiratory infections. Obviously, some of the physicians you have seen were taught this, too. Interestingly, I can find no scientific study that supports this long held "truth" in medicine. I suspect that this bit of medical orthodoxy has been passed from generation to generation without ever being evaluated in a careful scientific manner.

Milk can interfere with the body's absorption of some medications, but other than this concern, I see no reason to avoid its use in reasonable quantities.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.