Wayne Kronstadt can describe the past decade as a series of sinus problems: One infection after another left him struggling through his 10-hour days as general manager for the Fox automobile dealership on U.S. 40.
"I never seemed to get a normal cold. I'd get tremendous blockages and headaches, sinus infections that would be with me two weeks at a time," recalls the 37-year-old manager. "I'd have a hoarseness in my throat. I'd be loaded up with congestion that wouldn't drain. It would feel like my eyes were being pushed out of my head."
The typical case of sinusitis -- an infection or inflammation of air pockets that lead into the nose -- begins with a cold, flu or allergy that swells the nasal membranes and increases mucus production. Swollen membranes block sinus openings, preventing them from draining while creating a good environment for bacteria to grow. Sinusitis can lead to bronchitis, asthma and chronic coughing.
Mr. Kronstadt recently had surgery to allow his sinuses to drain more easily to relieve his sinusitis, an affliction that bedevils many.
The National Center for Health Statis tics says more than 33 million Americans suffer from sinus disease, making it the nation's most common chronic ailment. Some of the most familiar complaints: pressure or pain over the area of the sinuses, sinus headaches, postnasal drainage, pain in the upper teeth when eating, a low-grade fever, fatigue due to poor sleep, bad breath, coughing, a poor sense of taste and smell, a congested nose and general feelings of grogginess and malaise.
At least half of the cases of chronic sinusitis comes from allergies, says Alkis Togias, assistant professor in medicine at the Johns Hopkins Asthma and Allergy Center. And when it comes to allergens, Maryland is well-endowed. The state's suitability to Northeastern and Southern plant life presents allergy sufferers with a variety of pollens, he says. And the humidity encourages a stunning growth of fungi, molds and dust mites, microscopic insects often found in homes.
Then, there's air pollution: Baltimore ranks sixth among the cities with the worst air quality in the nation, according to the Environmental Protection Agency. Although no studies have proved definitively that smog and air inside "sick buildings" -- structures that harbor indoor air pollutants -- contribute to sinus problems, most people believe there is a correlation.
And let's not forget the weather:
"In people that clearly have no allergies, the most common problems of sinus are exposure to cold and dry air, exposure to very humid environment or sudden changes in the barometric pressure," says Dr. Togias. "The weather in Baltimore changes constantly and that could be a factor."
Sinus problems also trail the flu season. One of the most common triggers in winter is a viral infection; teachers and health care workers are particularly susceptible, according to the American Academy of Otolaryngology -- Head and Neck Surgery Inc.
People with allergies can decrease their sinus infections by avoiding the allergens that may stimulate them. In winter, for instance, keeping dust mites under control means removing any feather-filled material on the bed and keeping the humidity in the bedroom low -- between 30 percent and 50 percent -- so the mites don't flourish.
However, don't let the bedroom air get too dry. Low humidity leads to more sinus infections because the nose has trouble adapting to very dry air, says Dr. William Gray, head of the division of otolaryngology at the University of Maryland Medical Center. If the nose dries out, normal mucus secretions will thicken and increase the risk of sinus infection. In the winter, the most common type of postnasal drip is caused by low humidity.
The first step toward curing a sinus infection is to allow the sinuses to ventilate and drain, says otolaryngologist George Alderman of GBMC. Those chronic cases of sinusitis, which are exacerbated by the structure of the nose or by swellings from repeated infections, are often best treated by surgery. With the help of a new endoscopic technique, this treatment is usually considered outpatient.
Most people, however, rush to the drugstore. According to the American Academy of Otolaryngology, Americans purchase more than $1.5 billion worth of "sinus" medication every year.
Standard over-the-counter remedies don't work for everyone.
"It's very difficult to define who will and who will not get relief from various medications," says Dr. Togias. "Some contain a Tylenol or equivalent aspirin to work against pain, some have decongestants and some have antihistamines which work against sneezing and itching but can cause drowsiness as well as dryness."
Sinus infections often require antibiotics. If sinusitis becomes a chronic problem, he recommends consulting a physician.
* People with allergies should avoid the allergens that may stimulate them. In winter, people who are allergic to dust mites should remove feather-filled material from the bed and keep the humidity in the bedroom low.
* Don't smoke . . . and stay away from smokers. "Is the sky blue? Cigarette smoke is the No. 1 sinus irritant," says Dr. Bacon. "It's bad. The smoke from one cigarette will paralyze the cilia [tiny hairs in the nose] which move the mucus out of the sinus."
* Limit your exposure to kerosene heaters and wood-burning fires -- the smoke may also impede the ability of the cilia.
* Be cautious about indoor swimming programs because of irritation to the sinuses and possible bacteria in the pool.
* Limit your use of over-the-counter nose sprays. They will worsen nasal congestion if they are used too often.
* If you are not suffering from allergies, avoid antihistamines which dry up the sinuses more than necessary and may prevent them from draining.
* Sleep with the head of your bed elevated.
* Consider salt water washes that irrigate the nasal passages to help dry excess secretions and decrease postnasal drip.