My Doctor Online The Permanente Medical Group

Symptoms

The symptoms of sinusitis may include:

• Nasal congestion
• Yellow or green nasal discharge
• Pain in the teeth of the upper jaw
• Decreased ability to smell
• Facial pain that is worse when bending forward
• Headache
• Fever
• Bad breath
• Ear fullness
• Fatigue

Causes

More than 37 million Americans suffer from at least one episode of sinusitis a year. The occurrence of sinusitis has increased over the last decade, possibly due to increases in air pollution and antibiotic resistance. The most common causes of sinusitis are:

• Viruses. These are the usual cause of sinus infections. As the body's immune response fights the virus, it causes the mucous cells to produce more mucus, which builds up in the sinuses. The mucous membranes swell and the openings narrow. This prevents proper drainage and causes congestion.
• Bacteria. If symptoms persist for more than 7 to 10 days it is likely that you have a bacterial infection, a frequent complication of viral sinusitis.
• Allergies or hay fever. If you have severe allergies to pollen or pollution, you may be at more risk of sinus infection. Inflammation occurs in the sinuses because of the immune response to the presence of pollen or irritants in the sinuses. Increased mucus and swelling of the membranes may cause more fluid to build up in the sinuses.

Additional causes are rare and can include a dental root infection that spreads into the sinus cavity, getting water into the nasal cavity through swimming, intranasal cocaine use, nasal polyps (growths), foreign bodies, fungi, or tumors.

Screening and Diagnosis

Diagnosis depends on the type of symptoms you have. We will ask you about your symptoms and evaluate the cause of your illness. There are 2 basic types of sinusitis:

• Viral sinusitis is often associated with colds and flu due to viruses. 
• Bacterial sinusitis causes common symptoms, such as facial pain or tenderness, pressure in the face or teeth, postnasal discharge, or chronic cough. These symptoms can last 7 to 10 days.

If you do not respond to several courses of antibiotics, we might order a CT scan of the sinuses. If you have a chronic condition such as diabetes or hypertension, it is important to check with us before using any over-the-counter medications.

Treatments

It’s important to get treatment for sinusitis. Left untreated, sinus infections can cause unnecessary pain and discomfort. The type of treatment we recommend will depend on the type of sinus infection you have.

• Viral sinusitis. To treat viral sinusitis related to common colds and flu we focus on relieving the symptoms due to mucus buildup in the sinuses. Over-the-counter medications like ibuprofen (Motrin) or naproxen (Aleve) relieve pain, headache, and muscle aches. You can use them in combination every 12 hours on a regular basis for several days. A decongestant like pseudoephedrine (Sudafed) can be added for nasal congestion or cough.
• Bacterial Sinusitis. We typically use antibiotics to treat bacterial sinusitis. We will prescribe an antibiotic that should be effective against the likely kinds of bacteria that cause sinusitis. You will usually be asked to take it for 7 to 10 days to eradicate the bacteria in the sinuses. If you don't respond to one course of a specific antibiotic medication, we will discuss the possibility of a stronger antibiotic, as well as oral steroids.
• Chronic Sinusitis. Usually after 12 consecutive weeks, sinusitis that persists is considered chronic. If you are not better after taking 3 courses of antibiotics, we will consider referring you to a specialist.

Surgery

In about 10 percent of cases, medical treatment with multiple courses of antibiotics may not be effective. If that occurs in your case, we may recommend surgery.

What to expect

We will give you a thorough ear, nose and throat examination. We will also explore your facial features to determine where swelling and redness exist, as well as feel and press your sinuses for tenderness. Additionally, we may tap your teeth to help identify an inflamed sinus. We may insert a small scope to examine the inside of your nose.

We may prescribe medications such as antibiotics, decongestants or nasal steroid inhalers. If you have not responded to medications, we may recommend the option of surgery to enlarge the openings to drain your sinuses. This is necessary for only a few patients.

Endoscopic surgery

Sinus surgery has been revolutionized by the nasal endoscope, a special instrument to help evaluate and treat chronic sinusitis. Endoscopic surgery will open the natural pathways in the sinuses to improve drainage. If this is successful, the affected sinus membranes often return to normal.

During surgery, we may insert a very small scope into your nose while you are under local or general anesthesia. The surgeon can see into your sinuses with the endoscope. With state-of-the-art microsurgical instruments, the abnormal tissues that are obstructing your sinuses can be removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

After the procedure, you may have nasal packing, a type of dressing to absorb drainage. A few days after the procedure, nasal irrigation with a mild saline solution will be recommended to decrease crusting as the surgery site heals.

Home Remedies

Some steps you can take to care for yourself at home include:

• Use a humidifier during the winter, when the heat is on, and summer, when air conditioners are in use. You should also try to place a moisturizer, such as Vaseline or Bacitracin in your nose, or take a steam shower.
• Use a saline solution to wash out the mucus, bacteria, pollen or irritants from your sinuses. You can do this 2 to 4 times a day. You can buy saline irrigation at the pharmacy or make your own by putting half a teaspoon of sea salt, and 1/8 of a teaspoon of baking soda in 12 ounces of distilled water. Spray the saline into your nose, sniff it from your palm, or irrigate your nose with a large syringe.
• Use steroid nasal sprays that we can prescribe to prevent mucous membrane swelling due to nasal allergies.
• Use an over-the-counter decongestant. Check with us first if you have any chronic conditions like diabetes or asthma.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. I may recommend other diagnostic studies as needed, such as a sinus CT scan, if you have not had one prior to your visit. We will discuss treatment options, such as endoscopic sinus surgery, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the Radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.