DEAR DOCTOR: Just how risky are sinus infections? I read about a teenager who died recently after a sinus infection spread to his brain. Is this common? How do you prevent a sinus infection?
DEAR READER: We hadn't heard about this before we received your letter, but we did a search and found the incident you're referring to.
A 13-year-old boy in Michigan who had been diagnosed with a sinus infection went on to develop migraine-like headaches. The severe headaches worsened over the course of several weeks and an MRI was performed. It was discovered that a viral infection had spread to his brain and caused blood clots, which led to a series of strokes, according to his family members. Despite emergency surgery, the boy passed away. It's a tragic story and, considering that sinus infections are common -- an estimated 31 million are diagnosed in the United States every year -- it's an alarming one. However, the fact is that these types of complications are rare.
The sinuses are pairs of air-filled cavities located behind the lower forehead, behind the nose, on either side of the bridge of the nose, and within the bony structures of the cheeks. In a heathy sinus, a thin layer of mucus catches dust, dirt or debris and, with the aid of tiny hairlike structures, clears it away. That mucus then drains into the nasal passage and winds up in the nasopharynx, which is where the very back of the nose and the throat converge. At that point, the mucus continues its journey down the esophagus and into the stomach.
A sinus infection occurs when a virus, bacterium or fungus causes the tissues that line these cavities to become inflamed. When this happens, the flow of mucus is blocked and it begins to collect in the sinus cavity. This can cause symptoms like congestion, postnasal drip, excess and sometimes discolored (usually greenish) mucus, tooth pain, a feeling of pressure, frontal headache, fatigue and even bad breath. In rare cases, the pathogens causing a sinus infection can cross the blood brain barrier, which is a filtering mechanism that protects brain tissues, and cause an abscess.
Conditions with similar symptoms, like colds or allergies, can be mistaken for a sinus infection. An accurate diagnosis requires an examination of the throat, nose and sinuses. This can include a physical examination with an endoscope, X-rays or a CT scan, and a mucus culture to pinpoint the cause of infection. Antibiotics may be used when the infection is bacterial but will not help with a viral infection. Symptoms can be eased with over-the-counter antihistamines, nasal decongestant sprays and nasal saline washes. Patients are often counseled to drink plenty of fluids to help thin the mucus.
Prevention consists of the same steps you take to avoid catching a cold or the flu. The Centers for Disease Control and Prevention suggest:
-- Practice good hand hygiene.
-- Keep the family up-to-date with immunizations.
-- Steer clear of individuals with upper respiratory infections.
-- Avoid exposure to tobacco smoke.
-- Use a humidifier -- and be sure to keep it clean.
Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.