Stuffy nose? Headache? Don't feel good? "Not another sinus infection!" 30 million Americans will suffer this year with sinusitis, and the treatment is becoming more and more difficult.

There are four pairs of sinus cavities in the head. The frontal sinuses are located behind the forehead while the ethmoid sinuses are located along side the bridge of the nose. The maxillary sinuses are behind the cheeks, and the sphenoid sinuses are in the middle of the head. Nobody is quite sure of the function of the sinuses. They may give some resonance to sound, but in general, they serve no specific function. On the other hand, the sinuses are susceptible to infection, and resistant bacteria are creating more and more problems in treatment.

Each sinus communicates with the outside atmosphere through tiny openings from the sinus cavity into the nose. If the small openings are blocked by swelling in the nose, the sinus cavity may fill with mucus and become infected.

Symptoms of a sinus infection include headache or pressure, nasal congestion, sometimes a low grade temperature elevation, and yellow or green nasal exudates. Fatigue and malaise make the problem more severe.

Treatment can be simple or may become complicated. Most physicians recommend a nasal decongestant such as Sudafed or even a decongestant nasal spray (no more than three days or a "rebound congestion" may make things worse). Saline irrigation, three or four times a day, seems to "soothe" the lining of the nose. Frequently the sinus infection will "cure" itself with these simple measures. On the other hand, if symptoms persist for longer than 7-10 days, an antibiotic may be needed. The selection of the antibiotic is difficult because the site of the infection is frequently contaminated with other bacteria in the same area-making a culture for the appropriate bacteria almost impossible. Antibiotics are frequently prescribed for three or four weeks.

If the first antibiotic doesn't work, then a second or even third antibiotic may be needed. (Caution: the overuse of antibiotics is causing resistant strains to become more common)

What happens if the antibiotics don't work? Sometimes sinus surgery is needed to solve the problem. No one likes the thought of having to have surgery, but new techniques are allowing chronic sinus suffers to have better drainage and less resistant infections. FESS (functional endoscopic sinus surgery) is done under anesthesia with a small instrument that re-establishes proper drainage from the sinus cavity.

"Here comes another cold!" Start treatment early and give your body a little extra rest. Hopefully your sinus infection will go away quickly and there will be relief at the end of the nose.

If you have a question for Dr. Bob, write "The Dr. Bob Show" at 6700 Baum Drive, Suite 1, Knoxville, TN 37919 or send your e-mail to letters@drbobshow.com.