STEVE INSKEEP, Host:

Even if you avoid the flu this season, you might face a cold at some point over the winter. And a common cold can often morph into a stubborn sinus infection. Millions of people wonder what they can do. And so NPR's Richard Knox found some answers.

RALPH METSON: Straight, large Blakeslee forceps, please.

RICHARD KNOX: Dr. Ralph Metson of the Massachusetts Eye and Ear Infirmary is doing surgery on a woman with non-stop sinus pain.

METSON: (unintelligible) forceps once more, please.

KNOX: The woman's under general anesthesia.

METSON: Thank you.

KNOX: Metson's poked an instrument with a light on its tip deep into her nose.

METSON: Looks very good right there.

KNOX: It lights up her face with a weird glow you can see through the bones of her face.

METSON: I'm going to remove the very thin bone and the overlying mucus membrane, which is blocking this sinus.

KNOX: A big video screen shows in amazing detail where his tiny scissors are...

METSON: All right.

KNOX: ...millimeters from the woman's brain.

METSON: We hear a little bit of crunching of bone.

KNOX: After about an hour, Metson has opened up the woman's sinuses so they can drain.

METSON: So the next time she gets a cold, her membranes are not going to swell and block the sinuses the way they have in the past. They're going to stay open.

KNOX: A lot of people get this surgery, about 300,000 a year. Back in the early 80s, it was much more brutal. Surgeons cut through the face and mouth, scraped out the sinuses, and left patients bruised and scarred, and often, no better off. But how good is today's sinus surgery? After the operation, Metson shows me a CAT scan of a woman who had it two years ago.

METSON: See, this is the scan that I actually use in the operating room on her.

KNOX: The black-and-white computer image shows that her forehead and cheek sinuses were blocked by thick fluid.

METSON: That's about as dramatic as you can get. That explains why she was feeling so miserable.

JUDY FOREMAN: I think I was actively kind of battling the sinus problem for 10 years, maybe 15 years.

KNOX: That's the patient, Judy Foreman. She writes a health column for the Boston Globe and other newspapers, so she knows what she's talking about.

FOREMAN: I read this article about people feeling less tired all the time after having had surgery and I thought, boy, I would really like that.

KNOX: Foreman tried everything short of surgery. She rinsed out her sinuses faithfully with salt water. She tried decongestants, antihistamines and steroid sprays. Over and over again, Dr. Metson prescribed antibiotics.

FOREMAN: And finally, I asked him on one of the visits, I said, well, you know, how bad is this? Do other people with this kind of a CAT scan have surgery? And he said, oh yes, they would've had it a long time ago. And I thought, okay, so I'm just being scared.

KNOX: Scared of what?

FOREMAN: The surgery.

(SOUNDBITE OF LAUGHTER)

FOREMAN: It is scary, people poking sharp instruments up your nose.

KNOX: When Foreman finally had the operation, she found it wasn't nearly as bad as she thought it would be.

FOREMAN: It's uncomfortable. Afterwards, you have these cotton wads up your nose and, of course, you can't breathe through all the stuff in your nose.

KNOX: Pain?

FOREMAN: Not bad. I was so glad to get it over with that I would say the pain was not bad at all.

KNOX: Now she has three or four sinus infections a year instead of five or more. But they're not as bad. Even so, she's disappointed.

FOREMAN: I'm not like a person without this problem. You know, I get a cold and I freak out because I know it's going to be there for three weeks. Other people get it and they're done in five days.

KNOX: Foreman wrote a column about her surgery. Two years later, people still email her asking if they should have it.

FOREMAN: I say go for it, because I think it's made enough of a difference that I'm glad I did it.

KNOX: Metson says most of his patients do better than Foreman. But surgery rarely cures them. Surgeons can cut away bone and membranes that block sinuses. But they can't stop the inflammation that causes new obstructions. Scientists have discovered five genes involved in that process. Metson hopes drugs will be developed to regulate those genes.

METSON: And if we can use those as novel targets for, let's say, nasal sprays or medications, we may be able to treat people like Judy without surgery. Or we'll do surgery and then follow it up after surgery with these sprays.

KNOX: That, he says, will be the next big advance in sinus treatment.

Richard Knox, NPR News, Boston.

INSKEEP: And that's Your Health for this Monday morning.

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