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

Nosebleeds from allergy?

It’ often helpful to review questions that patients will ask, but probably won’t show up in a textbook.  Here’s a little bit about the College of Allergy which can provide you with timely information on topics such as nosebleeds.

Q: My son gets frequent nosebleeds during the late spring. When he wakes up in the morning there is blood on his pillow. We have tried putting Vasoline in his nose but that doesn’t help. What can we do to prevent his nose from bleeding?

A: Nosebleeds are a common problem for children who have allergies. The bleeding happens because there are many blood vessels just inside of the nasal opening on the middle part of the nose (called the nasal septum) that can be damaged with vigorous rubbing, picking the nose or even incorrect use of nasal sprays.

Nosebleeds often happen at night when one is asleep because picking and rubbing can occur without a person being

Most allergy nosebleeds occur at the front of the nose as depicted here.

aware of it. Unfortunately, it always seems like the nose bleeds more than it really does when your pillow is covered with blood.  Ewwww! 

The best way to prevent nosebleeds worsened by allergies is to treat the underlying problem that is resulting in the rubbing and picking. Treatment often involves use of medicines for allergies taken either orally – such as antihistamines – or in the nose, such as nose sprays. You guessed it, antihistamines can dry out the nose  increasing the risk of a nosebleed.  Nose sprays can also increase the risk of a nosebleed and proper technique is very important to prevent this complication.  Spray away from the middle of the nose, up and out towards the ear.

Saltwater (saline) nasal rinses can be very effective for removing nasal secretions and dried up mucous.  The rinses should not be too vigorous and the bulb syringe or Netipot used to do it shouldn’t be inserted very far into the nose to avoid trauma to the blood vessels. Residual or dried blood may come out with these rinses, and that’s OK–much less chance of causing problems in the future.

#allergy, #bleeding, #blood-vessel, #epistaxis, #health, #nasal-irrigation, #nasal-spray, #nose, #nose-picking, #vasoline