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Symptoms

The area over an inflamed sinus may be painful and swollen and you may have a greenish discharge from your nose. As the sinusitis worsens, the passages between your nose and sinuses may close up, preventing the discharge from flowing out of your nose and making your nose even more stuffed up. You may breathe through your mouth, have bad breath, and feel generally ill.

Sites of sinusitis

Inflammation of the frontal sinuses, and sometimes the sphenoidal sinuses, causes a headache or pain over one or both eyes. Pain in the cheeks on either side of the nose and the sensation of a toothache may indicate an infection in the maxillary sinuses. Pain behind or between the eyes usually points to sinusitis of the ethmoid sinuses.

If the sphenoidal sinuses are affected, you may have a headache over one or both of your eyes that is worse when you lie flat or when your head is lower than the rest of your body. If the maxillary sinuses are affected, one or both cheeks may hurt, or the sinusitis pain may feel like a toothache in your upper jaw. If the ethmoid sinuses are affected, one or both lower eyelids may be swollen, especially when you wake up in the morning. See your doctor if your symptoms persist for more than 3 or 4 days.

Diagnosis

Your doctor will examine your nasal passage to look for a discharge and signs of inflammation of the mucous membrane. In severe cases of sinusitis, he or she may order X-rays or a CT scan (see page 112) to confirm the diagnosis. X-rays may also rule out a tooth abscess. A CT scan can help the doctor determine the extent of the inflammation and the severity of the sinusitis.

Treatment

If you have sinusitis, your doctor may recommend inhaling steam to relieve nasal congestion by promoting the drainage of mucus. Add moisture to the air in your home with a vaporizer or humidifier. Blow your nose gently to avoid damaging your sinuses. You will be more comfortable if you keep your head elevated, especially while you sleep. Use decongestant tablets only if your doctor recommends them; although decongestants shrink the swollen mucous membrane (widening the respiratory airways), when used incorrectly they can cause heart problems such as arrhythmias (see page 580).

If your symptoms persist, your doctor may recommend a corticosteroid nasal spray. He or she will prescribe antibiotics only if your sinusitis is caused by a bacterial infection. In rare, severe cases, surgery may be necessary to enlarge the opening of the affected sinus.

Strep Throat

A sore throat is usually a symptom of a viral infection but sometimes can result from a bacterial infection. Strep throat is caused by a streptococcus bacterium that can be contracted when you inhale infected droplets coughed or sneezed into the air or by touching an infected person or contaminated surface. Strep throat is more common in children than in adults.

Symptoms

Symptoms of strep throat vary from person to person. Usually the throat is very red and the tonsils are swollen and have white patches of pus. The throat may be so sore that it is difficult to swallow, although some people have no throat pain. Other symptoms include fever (often higher than 101°F), headache, swollen lymph nodes in the neck, and general body aches. Children may lose their appetite and have abdominal pain and nausea. If you have strep throat, you usually do not have a runny or stuffy nose or a cough.

In rare cases, strep throat infections can lead to infections in the ears, bloodstream, kidneys, or lungs, or to scarlet fever (see page 443) or rheumatic fever (see page 432). Call your doctor immediately if you develop any of the following symptoms: rash; extreme fatigue; bloody nasal discharge; painful, swollen joints; cough; shortness of breath; chest pain; recurring fever; earache; or seizures.

Diagnosis

The only way for your doctor to definitively diagnose strep throat is to take a sample of secretions from your throat, grow the sample (culture) in a laboratory for 2 to 3 days, and examine it under a microscope