Think twice before using antibiotics for acute maxillary sinusitis ( simple sinusitis )

Even with simple sinusitis, the underlying process is “inflammation” not always infection.


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#infection, #nasal-congestion, #sinusitis

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.

#allergy, #nasal-congestion, #paranasal-sinuses, #sinusitis

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!

#afrin, #health, #nasal-congestion, #nasal-spray, #nose, #paranasal-sinuses, #sinusitis, #x-ray-computed-tomography

I hate my headaches

Did you know that headaches are among the “top 10” reasons for patients to visit the doctor.  Typically, patients will try several over-the-counter preparations and seek information on the Web before visiting a physician.  Am I right?  Patients with allergies are often plagued with the following:

1.  Headaches come from nasal congestion–both allergic and nonallergic nasal inflammation.  I call these nasosinus pressure headaches. 

2.  Allergies increase your risk for migraine headaches.

3.  Migraine headaches are related to food allergies. 

My headache is killing me!

4.  Allergy sufferers are not immune from other common types of headaches such as “tension headaches.”

We’ll help you with treatment of your headaches and in particular, finding out what causes your headache in the first place.  I’ll offer the following links to professional societies whose members are particularly interested in headaches, headache research, and treatment!  Relax and kiss your headache goodbye!

American Headache Society

1.  Extensive information

2.  Childhood headaches through adult problems with an emphasis on migraine.

3.  Professional site for your doctor to review.

4.  Headache diaries found here!

5.  Trigger avoidance worksheet.

6.  School instructions

National Headache Foundation

 1.  Physician finder tool to locate specialists in the Tulsa area

2.  Headache impact test found here.

3.  How do you talk to your doctor about headaches?

 National Library of Medicine

1.  Many hyperlinks to Mayo Clinic and Cleveland Clinic

2.  This site takes more time, so use a weekend afternoon to browse.

3.  Good illustrated medical encyclopedia.

4.  Use MedlinePlus for more research.

#allergy, #headache, #migraine, #nasal-congestion