Sinusitis, a chronic inflammatory condition
Nomen Nescio
A Pain in the Face
Millions suffer from a malady in the dark recesses around the eyes
BY JOANNIE FISCHER
'It hurt so much I prayed for death." "The pain was so intense that I
just wept." "I couldn't leave bed for six months." "For two years, I
simply couldn't function."
These are not the words of back pain or heart disease victims but of
sufferers of a condition reported to cause even more pain, depression,
and fatigue: chronic sinusitis, a disease striking more people than
ever before and likely to keep expanding its grip for some time.
Thanks to a proliferating number of triggers, such as pollution and
household chemicals, the persistent inflammation of cavities found
inside the cheeks and forehead and between and behind the eyes is now
the nation's most common chronic disease, affecting as many as 37
million Americans. The rise is especially alarming because the disease
is poorly understood, often misdiagnosed, and notoriously difficult to
treat. And if left to run rampant, it can infect the brain and even
cause blindness. As researchers redouble their efforts to understand
the malady in the dark recesses of the head, whole new theories are
emerging about how our bodies interact with the world.
Nobody knows why the sinuses even exist. The air pockets may lighten
the head's weight, making it less cumbersome. They may also provide a
shock-absorbing cushion for the brain. They definitely help fend off
disease: Each day the sinus linings produce an entire quart of mucus,
the gooey liquid full of immune cells that attack invaders before they
can penetrate the body's walls.
But because of early human beings' determination to stand upright, the
design of the sinuses makes them prone to infection. The tiny drainage
holes are located at the top, not the bottom, of the largest caverns,
so that the liquid they produce must be swept upward to escape. The
minuscule openings are easily blocked (a cold or allergy can do it),
and the sinuses easily become stopped-up dark swamps, what sinus
specialist Wellington Tichenor calls a "perfect petri dish" for the
breeding of nasty microbes that would normally be washed away.
Assault on the senses. Because the infected crevices are nestled right
alongside the eyes, mouth, ears, and nose, all the senses are
assaulted, and a person can be overcome with pain throughout the face
and head. And because the sinuses are separated from the brain by only
an eggshell-thin membrane, says Tichenor, "it's likely that when the
sinuses are inflamed, so is the brain." So all sorts of other
functioning can be impaired. "I could barely open my eyes, was so
dizzy I couldn't stand up, and was full of pain in my face, from my
teeth to my temples," says Salt Lake City's Elyse Mackay of a sinus
attack three years ago. "I finally went to the emergency room when I
suddenly went deaf in one ear."
Most sinus infections start off seeming like a cold that just keeps
getting worse, and if they are caught early they can be conquered in a
month or so. But because many of the bacteria found inside infected
sinuses are the new "supergerms" able to resist antibiotic treatment,
it is getting harder and harder to end sinus problems before they
become chronic. "I never knew they made so many antibiotics," says
Mackay, who was given multiple medications during the five months it
took her to get back to normal.
The danger in these lingering infections is that they make future
infections far more likely, and eventually the sinus linings seem to
permanently change for the worse. "At some point, a line is crossed
and sinusitis transitions from an infectious to an inflammatory
disease," says Harvey Plasse, coauthor of the forthcoming book
Sinusitis Relief. "Then, it's a whole different type of disease
process." For starters, the sinuses seem to become hypersensitive,
responding to substances in the air that were previously regarded as
less dangerous. The inflammation resembles an allergic response. So
not only are there more chemicals throughout daily life, from car
pollution to chemicals in furniture and carpets, says Plasse, but more
people, and especially sinusitis sufferers, are having more extreme
reactions to them than before.
The exact reason for our growing sensitivity still has scientists
stumped, but a couple of theories are gaining ground. One is that we
are inadvertent victims of our own success, that the widespread use of
antibiotics and vaccines and the destruction of parasites have left
our immune systems confused, responding to the wrong things. "To put
it simply, it's as if we haven't been allowed to play in the mud
enough," says Plasse. And after a bad enough infection, the delicate
sinus linings may actually undergo chemical changes, rendering them
hyperreactive to things they happily coexisted with before. For
example, preliminary studies from the Mayo Clinic show that many
chronic sinusitis sufferers release potent immune system warriors to
battle mold-like fungi that normally reside harmlessly in everyone's
sinuses.
Last resort. Whatever the reasons, once chronic sinusitis kicks in, it
is almost impossible to get rid of entirely, despite a battery of
treatments. Indeed, up to a half-million people a year resort to
surgery. The goal is to widen the drainage routes to keep enough air
and mucus flowing through the sinuses so that inflammatory culprits
can't settle in and set up shop.
Techniques perfected in the past five years make surgery a simpler and
safer procedure, but because few surgeons have extensive experience,
the practice is akin to laser eye surgery: It is imperative to seek
out a surgeon with hundreds of procedures under the belt. Because the
sinuses are only a hairbreadth away from the optic nerve, main
arteries to the brain, and the brain itself, it is all too easy to
cause serious complications with the slip of an instrument.
Even when surgery goes perfectly, it is not a sure cure. "I always
explain to patients that I am clearing away blockages, not clearing
away the disease itself," says Texas surgeon Robert Bonham. "It's a
problem that they may have to manage the rest of their life." A
variety of new techniques are being developed to do just that,
including daily nasal "irrigations"–available over the drugstore
counter–and antibiotic and antifungal treatments. But until the true
underlying cause of the problem is better understood, more and more
people are likely to discover what one normally energetic New Yorker
calls "a misery so painful and frightening I thought I would never
recover."