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Excessive mucous production - especially mucous that is greenish or brownish in color - is indicative of a purulent sinus infection. A long-standing infection can be extremely troublesome to the patient, bringing about symptoms like heaviness of the head, a feeling of tiredness, a change in the voice and even a recurrent fever.

The most common cause of this kind of problem is a bacterial infection. These infections often have few symptoms, however there has been a recent emergence of more resistant strains of bacteria that last longer and produce more of a reaction from the immune system.

Commonly talked-about home "treatments" like increased humidity, air conditioning or even dryness will not help relieve the symptoms of these infections, as the cause is not environmental in origin. A differential diagnosis of allergic rhinitis should also be considered as that has some symptoms which overlap with bacterial infection. The pus seen in that case is however clear and thin in nature, as it uninfected.

Underlying Pathology

The basic reaction of the body that brings about the above mentioned symptoms is relatively straightforward. The infection causes an over production of mucous from the epithelium lining the sinuses. This, if coupled with a certain anatomic predisposition like insufficient opening of the sinuses, will lead to what is commonly known as a sinus block.

The natural flow of mucus is obstructed. This block can also be caused by a polyp formed as the result of the proliferation of the nasal mucosa.

Another thing that commonly occurs is a secondary infection in addition to the primary infection. This is sure to lead to a worsening of the symptoms. Smoking is one habit that is to be absolutely avoided as it irritates the nasal mucosa further and can dramatically increase the severity of the problem.

Investigations

The doctor will require a good quality sinus X-ray (PNS view) and maybe even a CT scan coronal view. If an examination by the ENT specialist has not been done then that is a must as well. Thorough investigations will help the doctors decide on whether non invasive treatment is sufficient or whether other treatment options are to be considered.

Treatment

The treatment options will vary as per the final diagnosis however they include the use of antibiotics, possible endoscopic surgery to evacuate the pus. This is known as Fiber optic endoscopic sinus surgery. The symptoms associated with problem are relieved absolutely after surgery bringing about a stark increase in the quality of life of the patient.

There is a chance of recurrence of symptoms if an adequate sinus opening is not done during surgery.

Post operative care

This part of the treatment is as important as the treatment itself. Long term post operative care and medication is common in such cases. This will include nasal sprays, antihistamine medication as well as a regular follow up (every 3-6 months) under the ENT surgeon.

The antihistamine medication may have to be continued life long in some cases.

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