It’s a simple but revealing question: compared to one year ago, how would you rate your health today? I frequently ask this question to patients who have been referred to me with sinusitis, and nearly always their answer is: worse. If you’re struggling with sinus problems, chances are you would say the same.

What’s important about this response is it reflects that sinusitis leads to more than just headaches or nasal drainage or blocked breathing passages. It affects your overall quality of life.

Regardless of your worst symptom whether it’s pain, congestion, a perpetually runny nose, fatigue, or something else you share a common bond with others who have sinusitis: reduced quality of life.

Basic elements of daily living from getting a good night’s sleep to doing your job to enjoying your free time may become difficult or impossible. That’s the bad news. Fortunately, there’s good news about sinusitis, too enough to fill several articles in this blog, and I hope enough to help you find long-lasting relief.

But before you dig in, I’d like to start by raising a few key points. You have plenty of company in experiencing sinus problems. Chronic sinusitis is one of the most commonly diagnosed chronic illnesses in the United States, more prevalent than heart disease and migraine headaches.

More than thirty-five million adult Americans suffered from sinusitis in 2001, according to a 2004 report by the U.S. Centers for Disease Control and Prevention. That’s a whopping 17.4 percent of American adults. Table below shows you where sinusitis fits in among other commonly diagnosed chronic diseases.

Here are some key sinusitis statistics:

• Americans make nearly 800,000 emergency department visits annually for sinusitis.

• Sinusitis causes Americans to miss about twenty-five million workdays a year.

• Americans spend $2 billion annually for over-the-counter medications for nasal and sinus disorders and about $200 million on prescription medications for sinusitis.

• People with sinus problems undergo more than 460,000 sinus surgeries each year in the United States, making it one of the most commonly performed surgical procedures.

Number of Americans with Chronic Diseases

Disease	# in Millions
Lower back pain	63.2
Hypertension	41.8
Arthritis	41.2
Sinusitis	35.5
Neck pain	34.0
Migraines/ severe headaches	33.9
Heart disease	23.5
Asthma	22.2
Hay fever	20.4
Stomach ulcers	18.9
Diabetes	13.0

Source: CDC. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2001. January 2004.

These numbers are up from a decade ago, and health experts expect further increases in the future. Possibly due to pollution and other factors, the prevalence of all breathing-related ailments not just sinusitis, but also allergies and asthma is rising and shows no signs of leveling off.

And not only is chronic sinusitis common, it strikes people during their most productive years. It’s far more likely to occur between the ages of twenty and sixty-five than during childhood or teen years or late in life. And it affects people in all walks of life: teachers, police officers, nurses . . . even U.S. presidents.

Sinusitis keeps a low profile. Despite its prevalence, you don’t often read about it in the newspaper. It’s rarely fatal, so it lacks a dramatic hook for most nightly news programs. Sinusitis is so unfamiliar to the general public that people who talk about their discomfort risk being labeled as complainers.

People with chronic sinusitis reported the highest levels of pain among the diseases we compared, which included heart disease, lower back pain, and chronic lung disease. They also fared the worst on tests of social functioning, a measure of the extent health interferes with normal social activities.

And our study found sinusitis had a significant effect on individuals’ work life, energy, and mental health. Other researchers have since made similar findings. So if you feel like nobody believes you, I want you to know: I believe you, and I’ve written this to help you and millions of others with sinus problems like yours.

Diagnosis and Treatment

Much has happened in recent decades to make it easier to diagnose and treat sinusitis. Until the early 1980s, physicians had a hard time just identifying sinusitis. X-rays, the most common diagnostic tool, were not precise enough to detect small sinus blockages.

Only those people with the most severe obstructions, such as large polyps, had abnormal x-ray findings. So patients with sinusitis often were misdiagnosed as having migraine headaches or were told they had nothing at all, leaving them untreated and extremely frustrated.

Two major technological developments have greatly improved our ability to diagnose sinus disease. First, we now have endoscopes (thin telescopes with high-resolution optics), which a doctor can pass through the nostrils to closely inspect the sinus drainage passages.

Second, old-fashioned x-rays have been supplanted by CT scans, a radiological tool that enables us to get a highly detailed and accurate image of the inside of a patient’s sinuses. Even more significantly, treatments for sinusitis have vastly improved. More options exist and they are easier for patients to obtain.

A large variety of devices for irrigating and cleaning the sinuses are now available in most drugstores. You can order a mist machine called a nebulizer, which delivers medications such as antibiotics or antifungal agents in high concentrations directly into the sinuses, where they can be most effective.

And new and more powerful antibiotics are now available. So when you have a sinus infection, your doctor can choose from an antibiotic arsenal more likely to quickly rid your body of invading bacteria.

For those select people who do not improve with sinus irrigations or medications, developments in sinus surgery over the past two decades have been nothing short of revolutionary.

In years past, sinus surgery was a major ordeal involving incisions on the face or through the gums under the upper lip. The procedures often literally left patients black and blue, and recovery could be prolonged.

Patients’ noses often had to be packed with six-footlong gauze strips, forcing them to breathe exclusively through their mouths for up to a week, and removing the packing was painful.

Thankfully, those days are over. New techniques pioneered in the 1980s and refined in the 1990s allow surgeons to enter the sinuses directly through the nose and remove nasal obstructions with extreme precision, while leaving healthy adjacent tissue untouched.

To do this, we use endoscopes that can be attached to lasers or tiny shavers that rotate several thousand times a minute. And navigational tracking systems in the operating room now work like Global Positioning Systems, allowing surgeons to track the precise location of their surgical instruments within the sinuses on a three-dimensional computer monitor.

This technology helps reduce the risk of a surgical error that might injure the eye or brain, causing blindness or stroke. With computer-assisted technology, sinus surgery is now usually done on an outpatient basis, and packing typically needs to stay in just one night or isn’t necessary at all.

I’ll discuss these treatment options and many others in greater depth later. For now, perhaps you can take comfort in knowing that effective treatment is available when you need it. With some medical conditions, treatment is controlled by the physician, leaving the patient with little to do but take medication and hope for the best.

Chronic sinusitis is not one of those conditions. Numerous treatment options exist, and what works best will depend on your history, symptoms, personality, and lifestyle. I often tell my patients, “You are your own best advocate.” To serve yourself effectively, you need an understanding of the ABCs of sinusitis.

So the first few articles will give you the basics on the anatomy and function of your sinuses, the distinction between acute and chronic sinusitis, and the different factors that might be causing your sinusitis.

You’ll need that fundamental knowledge as we move on in subsequent articles to cover the range of available sinusitis treatments, starting with the simplest and moving to the most advanced, as shown in Figure below.

One final point: these days you see a lot of medical hyperbole in the media. While there is genuine cause for optimism, I cannot promise that you will be cured if you read this blog and follow my recommendations (although some people may be). Unfortunately, sinusitis tends to be a chronic condition.

But here are some realistic improvements you can expect:

• If you’ve averaged five to ten courses of antibiotics each year for your sinusitis, you may find that with proper treatment you’ll only need two or three courses in coming years.

• If you suffer from thick, troublesome postnasal drip, you may discover the drainage is thinner, reducing the need to constantly clear your throat or blow your nose.

• If you have chronic congestion, you may notice yourself breathing easier when you exercise or lie down at night.

Even more important, you’ll see quality of life improvements, such as reduced sick days, higher energy, and better mental health. It’s not uncommon for patients I’ve treated to tell me they feel like a whole new person.