Category Archives: Sinusitis

Myth is, after all, the never ending story.

Excuse my ranting and raving about myths in #allergy, but it’s true our minds need to “get in gear” for what we believe. Does it really make sense and does information we believe come from reliable sources? Let’s try and debunk a few myths about allergy while it’s fresh in your mind.

  1.  Once I start allergy shots, I’ll never have any problems. #Allergy immunotherapy or “allergy shots” are very helpful to relieve symptoms of #hay fever such as sneezing, runny nose and even wheezing, but they don’t cure everything. For instance, if you have sinusitis, don’t count on your shots to cure your symptoms–you have to treat the sinuses for relief. This may include antibiotics/prednisone for one month at a time, or even surgical intervention. This is the reason I will often obtain a CT scan of the sinuses before starting allergy shots–to make sure I’m not missing an infection or anatomical obstruction in the sinus cavities. You wouldn’t expect the patient below to improve with allergy shots because they have a concha bullosa on the left side causing obstruction of nasal airflow. Not a good remedy for allergy shots!
  2. Benadryl is the antihistamine of choice–pick an ER and you’re likely to find #benadryl used like candy. Medical conditions like #hives and unknown #allergic reactions should be treated with antihistamines, but benadryl, really? Better antihistamines are available OTC and include Zyrtec and Xyzal.  They’re stronger, more potent and last up to 24 hours instead of 4-6 hours like cousin benadryl. Next time you get benadryl, substitute with a better antihistamine and see what happens. (I think you’ll be pleased).
  3. Nasal spray addiction–Here in America, we don’t like using #nasal sprays. Europe has no problem sticking lots of objects up their nose, but in this country, we’d rather take a pill than use the more effective nose sprays. Every single study that compares nasal sprays with antihistamines, finds that nasal sprays such as corticosteroids work much better for allergies than pills and sometimes even allergy shots. WORD of CAUTION: Nasal sprays such as Afrin or 4-way spray can be addictive and harmful to your health. I’m only comparing nasal sprays with antihistamines and #topical steroids which don’t have addictive potential.
  4. There has to be a cause to my hivesperhaps the most frustrating medical condition of all time is #hives. That pesky rash that can range from a few bumps to your body being covered from head to toe with incredible itch associated with difficulty breathing and swelling. Most patients come in to the office hoping to find a cause or trigger to avoid and thus cure the hives. Unfortunately, the cause for hives is never found in 70% of cases, only leading to more frustration and disgust. I will usually look for allergy, bone marrow problems (tryptase) and alpha gal sensitivity, but that’s about it for finding a cause. Symptom control is key with antihistamines and Xolair, but if you stop your medication, the hives are likely to return. 

No, I’m not done with allergy myths, but part 2 is coming up later. Those topics to include the following:

  1. Can I get over asthma?
  2. Isn’t everyone allergic in Oklahoma? I’ve come to the right state;
  3. Food allergy–https://www.usatoday.com/videos/travel/experience/food-and-wine/2018/07/07/these-foods-can-help-you-feel-cool-heat/36661435/

If you don’t believe me, here’s an hour long lecture on “Allergy myths” given by Dr. Dave Stukus (teaches at Ohio State University) at the following link:

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Natural Home Remedies for Sinusitis

Some great illustrations in this blog. Treating sinus infections has always been a difficult problem.

Monterey Bay Holistic Alliance

SinusitisWhat is Sinusitis?
Sinusitis afflicts millions of Americans each year. According to the National Institute of Allergy and Infectious Diseases, sinusitis “simply means your sinuses are inflamed, red and swollen, because of an infection or another problem.”  Sinusitis can be very irritating to deal with and women are more likely than men to be diagnosed with the infection. Sinusitis affects people from the very young to the very old.

Acute sinusitis can last up to 4 weeks and chronic sinusitis can last more than 12 weeks and persist for months or years after the initial symptoms. The illness can be caused by several factors including viruses, bacteria, allergies, airborne chemicals and a weak immune system.

What are the Symptoms of Sinusitis?
According to the Center of Disease Control and Prevention, those diagnosed with sinusitis usually suffer from the following symptoms:

Sinus infection

• Nasal Congestion
• Headaches
• Earaches
• Fever

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My Sinuses Suck!

Allergy or Irritant--that is the question!
Allergy or Irritant–that is the question!

Sinus pressure can be a real problem during the cold, winter months.  Do I take decongestants or antihistamines?  Sudafed or Zyrtec?  Are my allergies acting up?

Here are some pointers on dealing with sinus infections and sinus pressure with some really cool slides at the end:

  1. Most allergens are gone in December-January, so the statement “my allergies are bothering me” is actually misplaced.  You are meaning to say that sinus pressure is causing congestion and runny nose.  Inflammation and swelling definitely exist in your sinuses, it’s just that your symptoms during the winter are not caused by allergy, but rather sinus infection.
  2. Treatment of a sinus infection is “all or nothing”.  In other words, if you only remove 50% of the infection, it is likely your symptoms will quickly recur.  Your body requires a mucociliary blanket in the sinuses to gradually remove bacteria and excessive snot.  This protective blanket is destroyed during any infection, and won’t grow back until the inflammation subsides.  Often it takes 30 days of antibiotics and prednisone to restore the sinuses back to their original condition. 
  3. One of the pictures in your slide set (slide 3 of 15) shows what normal mucociliary blanket looks like under the microscope.  If this giant vacuum sweeper was operating normally all of the time, you wouldn’t have to use all your medication. 

Here are some suggestions on how to treat your sinuses better:

  1. Make sure you eliminate nasal congestion.  For the short term, use Afrin or similar equivalent (OTC) if you limit to < 1 week per month.  This allows the nasal airflow to drive away the excessive mucous in your nose which would otherwise become a great meal for hungry bacteria.  Sick but true!
  2. Find out if you have allergy!  The winter season gives you a reprieve from outdoor allergens, but during the spring, summer, and fall, tree pollen, Bermuda grass, and ragweed are more than willing to invade your sinuses and cause irreparable damage to your mucous membranes and make you always sick. 
  3. Use your prescribed nasal spray EVERYDAY as prescribed by your doctor.  I know, Americans hate to put anything in their nose (except your finger), but regular use of nasal steroids and antihistamines will reduce the swelling in your sinuses and guess what?  You got it, fewer infections. 
  4. Get smart!  Go through the slides below, and if you don’t learn anything new, I’ll buy your favorite drink at Starbucks. 

http://www.medicinenet.com/sinusitis_pictures_slideshow/article.htm

Are CT scans dangerous?

Research does demonstrate that in children, CT scans can lead to a small, but measurable increase in the risk of cancer.  How does one protect your child, yet obtain the x-rays that will give the proper diagnosis and are clinically indicated?

  1. I am of course referring to a CT (coronal) scan of sinuses used to diagnosis infection or anatomical nasal obstruction.  Many patients need CT of sinuses because the underlying cause of their runny nose has never been identified.
  2. Fortunately, coronal CT of sinuses exposes children to very little radiation because the area that is examined is very small (just the face)
  3. Coronal CT of sinuses does not require repeated examinations.  Once is usually enough!
  4. Usefulness of a plain sinus x-ray is questionable.  False negative rates (study is normal, but wrong) can be as high as 30-40% with a plain radiograph.  Take home message: benefit isn’t worth the risk.

Read the article below, but you probably don’t need to worry about CTs of the sinuses. 

http://www.usatoday.com/news/health/story/2012-06-07/childrens-ct-scans-cancer/55439406/1

Cold, Flu, or Allergy–Take the challenge!

At the bottom of this handout from the American Academy of Allergy, Asthma, and Immunology, you’ll find the table that should help you determine if you have a cold or allergies….call me if questions.

Merry Christmas to All, and to All…..

Good Night!  That comes from the Man himself. 

Twas the Night Before Christmas!

You won’t sleep well if you can’t breathe!  Unfortunately, sinusitis is quite common during the Christmas Holidays.

My sinuses are killing me!

Often patients don’t know what can be done about it.  But let’s start from the very beginning…..

What are the signs and symptoms of chronic sinus infection?

1.  Nasal congestion (can’t breathe through my nose) is always present during chronic sinusitis.  No exceptions. I can hear this when you talk to me in the exam room–if you’ve had sinus infections for any length of time, you become accustomed to  hyponasal speech.  You can’t hear it, but I can (and ask your spouse or mother).

2.  Repeated courses of antibiotics that just DON”T work after 10 days. 

3.  If the nasal drainage is clear…can you still have a sinus infection?  YES.  The color of nasal drainage doesn’t predict if you will have chronic sinus infection.  Only a CT scan of your sinuses can show you any inflammation or mucous thickening in the sinuses

4.  Don’t forget that many asthma patients have a flare sending them to the ER because of Sinus infection. 

OK….so now I know what’s going on, but how do I get rid of it?

1.  Remember, the engine that drives movement of mucous in the sinuses is nasal airflow.  Without nasal airflow, secretions accumulate and you can’t blow your nose enough to get rid of the SNOT.  I know it’s gross, but this is the key to keeping your sinuses open.

2.  The purpose of nasal sprays (steroids/antihistamines) is to reduce the size of enlarged turbinates and allow nasal airflow. 

Nasal airflow is crucial to clean the sinuses

3.  Don’t worry about the side effects of nasal steroids.  Exposure is very low and often not detectable in the bloodstream.  And besides, the clinical researchers trying to find side effects of nasal steroids put themselves and their own kids on this type of medicine.

4.  Persistence is the key!  Use at least one spray in each nostril per day (the rest is gravy)….up to 4 sprays per day may be needed during colds or upper respiratory infections.

5.  Tilt your head forward to use the spray and avoid “snorting” the spray down the back of your throat. 

6.  If nasal sprays don’t work because of your congestion, I recommend using NasoNeb II from ASL pharmacy.  Any nose spray works better if you “pretreat” with Afrin™ or other 4-way spray, simply because you open the nose for better penetration.  Your limit on use of Afrin or similar OTC nose spray is < 1 week per month–don’t worry about addiction if you stay within these boundaries.

  •  So there you have it….no one should suffer from sinus headaches during the Christmas holidays if you follow some simple steps:
  • Find out if you have sinus infection–CT is best
  • Use your nasal spray (from the doctor, not OTC) everyday as prescribed!
  • Put your money where your mouth is and use correct technique with any nasal inhaler…what goes down the back of your throat can’t help.

Want to know more on this subject?  The link below will take you to the most recent guidelines on treatment and management of sinusitis.  In the meantime, sleep tight and enjoy the Holidays!

Enjoy the Holidays!

http://allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005%20Sinusitis

Does it Help to Irrigate My Sinuses?

Example of nasal flush

Chronic RhinoSinusitis (CRS) is a source of increased medical costs and decreased quality of life for many adult & pediatric patients each year. Evidence-based, clinical practice guidelines include recommendations for the use of nasal saline irrigation (NSI) as a significant treatment component or effective adjunct therapy for CRS; however, the research reviewed did not clearly support or refute it. Currently, saline irrigations are being used as a treatment for CRS and you can find many formulations and products OTC. Until further research is conducted to refute this practice, this treatment modality provides a safe and economically astute alternative to the costly conventional treatments available for CRS.

Are Saline Irrigations Effective in Relieving Chronic Rhinosinusitis Symptoms: A Review of the Evidence

Thornton A, Alston M, Dye H, Williamson S
J Nurse Pract. 2011;7:680-686

Study Summary

Background. Chronic rhinosinusitis (CRS) is a common disorder that affects 14% of the adult population of the United States and has been estimated to account for more than $3 billion in healthcare expenditures. Yes, that’s 3 BILLION! Furthermore, CRS, typically caused by a virus, is frequently treated with antibiotics, contributing to the growing problem of antibiotic resistance. For this reason, both patients and healthcare providers have increasingly turned to alternative therapies including nasal saline irrigation. For this study, the researchers defined CRS as symptoms persisting for 12 weeks or longer. The purpose of this study was to examine the evidence for efficacy of this therapy.

Methodology. Numerous databases, including Cochrane, MEDLINE, and CINAHL, were searched for studies that answered the research question: In adult primary care patients, does the use of saline irrigations (compared with no treatment) improve the symptoms of CRS? Overall a good search of the literature on this topic.  Unfortunately, no big studies are available to compare.

Results. The investigators concluded that the evidence for efficacy of saline irrigations was contradictory. No conclusion could be drawn as to type of solution (isotonic, hypotonic, or hypertonic) that produced consistently positive results or was best tolerated, which may indicate that patient preference is the best indication of appropriate solution. No serious adverse effects were found and the treatment appeared to pose no significant health risks, but data were insufficient to support a conclusion that irrigation was of some benefit with minimal side effects.

Viewpoint

Not everyone will agree on the use of nasal irrigation. Clearly, an alternative to the widespread use of antibiotics to treat this predominantly viral condition must be found. The investigators do an admirable job of synthesizing the literature and examining the limited data available in support of this cheap and safe therapy. Saline irrigation fulfills the mandate to “first, do no harm,” so it should be included in the armamentarium of therapies for this common condition.

If you’re looking for alternatives, check out this nebulizer (atomizer) from ASL Pharmacy

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