Q: I have problems with my sinuses.  I usually get a few sinus infections per year. But for the last few months, I have had a lot of drainage in my throat, and have had a sore throat because of it. I have visited my family physician, but am just wondering if I should see a specialist, and if so, what type of specialist?

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A: The cause of sinus problems including pressure, pain, or drainage is most often due to a common cold. Your symptoms are classic for the common cold.

A common cold is an illness caused by a viral infection located in the nose. There are over 100 different cold viruses. Rhinoviruses are the most important and cause at least one-half of colds. Colds also involve the sinuses, ears, and bronchial tubes. The symptoms of a common cold include sneezing, runny nose, nasal obstruction, drainage down the throat, sore or scratchy throat, cough, hoarseness, and mild general symptoms like headache, feverishness, chilliness, and not feeling well in general. Colds last on average for 7-10 days. Mild colds may last only 2-3 days while severe colds may last for up to 2-3 weeks. Adults average 2-3 colds per year and children 6-10, depending on their age and exposure (sometimes more). Children's noses are the major source of cold viruses.

The highest concentration of cold virus in nasal secretions occurs during the first three days of infection. This is when infected persons are most contagious. Cold viruses may at times be present in the droplets that are expelled in coughs and sneezes. Nasal secretions containing cold viruses contaminate the hands of people with colds as a result of nose blowing, covering sneezes, and touching the nose. Cold viruses may contaminate objects and surfaces in the environment of a cold sufferer. Also, cold viruses readily transfer to the hands as a result of touching contaminated objects and surfaces. Young children are the major reservoir of cold viruses and a particularly good source of virus containing nasal secretions.

Experiments have demonstrated that a cold virus easily transfers from the skin and hands of a cold sufferer to the hands and fingers of another person during periods of brief contact. Virus on the fingers is transferred into the nose and eye by finger-to-nose and finger-to-eye contact. Once in the nose, a cold virus is transported to the back of the nose where it starts a cold. In some instances, cold virus, which is expelled into the air in coughs and sneezes, may land in the nose or eye and cause infection. Acute bacterial sinusitis complicates colds in both adults and children. Only 1% to 5% of all colds (adult & children) have this complication of sinusitis (i.e. very rarely). When a common cold has lasted for 7-10 days and is no better or worse, acute bacterial sinusitis may have developed and additional medical care may be required. The recommended course of antibody treatment for acute bacterial sinusitis is 10-14 days. With proper antibiotic treatment, over 90% of cases of acute bacterial sinusitis are cured.

Decongestants may make the symptom of sinus pressure and pain worse by thickening the nasal secretions which then can block the openings to the sinuses. The pressure can build in the blocked sinus causing face pain and headaches. Sinus pressure can also develop from chronic seasonal allergies. To overcome these symptoms a nasal saline wash can be used to clean and open the sinuses.

Nasal Saline Wash

• Place 1 quart (4 cups) of boiled tap water or Distilled Water into a clean glass jar or other clean container.
• Add 2-3 teaspoon of Pickling salt, Canning salt, Sea salt, or Kosher salt to the water. (Do Not Use Table Salt or salt substitutes -- the iodine and additives are not good for your nose.)
• Add ½ teaspoon of baking soda (pure bicarbonate).
• Stir or shake the solution to mix the salts well before each use. (you may also warm in microwave 30-40 seconds)
• While bending over a sink use a bulb syringe to flush each nostril 2-3 times per day. (be sure to aim toward back of your head)
• Store unused solution at room temperature.
• Use for no longer than one week. After one week, pour out any leftover mixture and make a new batch.
  
  Why Saline in the Nose?
  The nasal cavity functions as a filter by removing pollutants, dust, pollen, allergens and infectious materials from the air and preventing these contaminants from entering the lungs. These contaminants may cause inflammation and swelling of the nasal membranes. If inflammation does occur, symptoms such as facial pain and pressure may occur and thick nasal secretions may develop. If the sinus openings become clogged from these secretions, pain, pressure, and headaches will follow.

• Nasal saline is a simple, effective method of reducing physical symptoms that are associated with many types of nasal problems.
• Nasal saline moisturizes the nasal cavity and reduces the thickness of the secretions, allowing the secretions to drain more effectively.
• Nasal saline decongests the nose. Because of the high salt concentration, fluid is pulled out of the membrane. This shrinks the membrane, which improves nasal airflow and opens sinus passages.
• Nasal saline also can assist with normal nasal function by washing out the allergens, pollutants and infectious organisms that are deposited in the nasal cavity.
• Best of all, nasal saline can be made at home for very little cost and because there are no addictive risks or serious side effects, it can be used for as long as necessary.
  

Note: the above recipe comes from an Ear, Nose & Throat specialist.

When these remedies do not work your family physician may need to obtain a CT scan or x-ray of the sinuses or have you see and ENT specialist for further evaluation. In your case I would not recommend a specialist at this time.