Sinusitis for Patients

What Exactly is Sinusitis? Healthy sinuses are covered with mucous membrane, moist, delicate tissue with microscopic moving hairs called cilia, covered by thin mucous. The nasal and sinus cilia move back and forth like tiny oars, constantly moving the mucous to flush the sinuses and nasal passages. The body is defended against foreign particles and pathogens in the air we breathe by this constant flushing. When there is a blockage of the sinuses, or when the cilia fail to move the mucus, then an infection can occur. The cilia do not move the bacteria out of your body so they can multiply and make you sick. In sinusitis, the sinus tissue is infected and inflamed. Bacteria are present. The tissues look swollen in the nose and in the sinuses on examination. The patient will have trouble breathing because of the blockage. Usually there is mild pain, fever and yellow or green discharge. Often the throat and chest are affected — with sore throat and cough. Acute or Chronic? Acute Sinusitis Essentially in acute sinusitis you get over the attack fully. Might take a month but then you are clear. If we take an X ray at the start of the blockage, fever and pain, we generally see fluid in the sinus cavity, membranes are swollen, and there is severe swelling at the opening of the sinus cavities. If we take a repeat X ray later, the sinuses are now free of fluid, the swollen membranes are back to normal and the openings are no longer swollen and blocked. There is pain, nasal congestion, fever, and patient feels sick. Symptoms...

Empty Nose Syndrome

What Is Empty Nose Syndrome? What are Turbinates? Turbinate Surgeries How do you prevent ENS? Treatment What Is Empty Nose Syndrome? The nasal turbinates are shelf-like structures in the nasal cavity (which begins where the inside of your nose enters your head). They serve to provide moisture, warmth, and airflow for breathing, and many of the body’s natural defenses against infection. There are a variety of different problems associated with the turbinates. Sometimes the turbinates themselves are damaged by disease, and can shrivel and no longer function. In other cases the turbinates can swell and block breathing. There are journal articles recommending surgical removal of diseased turbinates in order to provide adequate airflow for breathing. After such a surgery, however, the turbinates can no longer provide mucus, cilia, and enzymes to protect against infection, and secondary infections can occur regularly and in turn may require additional surgery to clear the infection. Often patients will have 3 or 4 subsequent surgeries. There can be dryness, burning, crusting, and sometimes pain. The pain associated with this syndrome may come from the raw surface or the exposure of nerve endings or infection. All this adds up to the “Empty Nose Syndrome” as a side effect of surgery. In patients with removed turbinates, the X-ray of the the nose looks empty to your doctor, hence the term, “Empty Nose Syndrome” (ENS). The worst symptom, in my opinion, is the feeling of not getting enough air. The turbinates acts like a pressure valve in the nose; they change the air pressure of the air you breathe much like using your thumb on the end...

Nosebleeds

Do you get Nosebleeds? When the nose is dry and crusted, it may bleed, especially if one goes to a dry or cold area at high altitude. For the acute nose bleed try nose drops, such as Neosynephrine 1/4% . Place on cotton, place the cotton in the nose and press gently from the outside. Sitting up is best. Ice to the face may help. Try to stay calm, the more the excitement to more the blood pressure the more the bleeding. For chronic nose bleeds, Use lots of saline nose spray and an antibiotic ointment such as Neosporin Ointment in a 15 gram tube. This has a pointed tip you can insert into the nose, the soft part, then squeeze the nose from the outside to spread it around. Do this 2 or 3 times a day. In most cases of bleeding the nose is infected and the antibiotic ointment helps. If you are taking aspirin or aspirin substitutes, including non steroidal anti-inflammatory medication, this may cause you to bleed. Dry climates are a frequent cause of bleeding; in this case, use lots of saline nose spray. Most important, keep the bedroom moist at night. Hang a wet towel, put water in a bowl, have a plant that takes lots of water. If you need to pick your nose for crusts, your nose is too dry – use an enhanced nasal moisturizing spray and/or gel, whatever works best for you. Absolutely avoid any preparations with additives or preservatives – these usually cause more problems than they solve. Nosebleeds are seldom fatal. It looks bad and it feels bad...

Snoring and What to do About it

Why do we snore? In deep sleep the muscles of the tongue, throat and roof of mouth relax and allow the tongue and soft palate and uvula to fall backward. The heavier the person is, the more overweight, the more this backward fall can close the breathing passage. In a recent study it was shown that by correcting the nasal condition and shrinking the tonsils, even sleep apnea can be corrected. Did you know there are doctors who specialize in snoring? And no wonder, snoring can destroy a relationship ! It can also change you from a pep and energy person to one who drags himself around all day half asleep. Normal Sleep Normally the person breathes openly and there is no alteration of sound such as snoring. If the nose is congested, if there is post-nasal drip or sinus or allergy, the reduced airway can produce sounds, which the partner doesn’t care for. However, a second change takes place. When there is drainage from the nose, this can affect the soft tissues of the throat. The tonsils may enlarge, there may be swelling of the back of the throat or the top of the throat too. Even the tongue may be affected. This enlargement acts as a stop valve to create the obstructive aspects of snoring called sleep apnea. Social Snoring Socially, snoring can be a true handicap. No question that snoring severely bothers the partner’s sleep, and earplugs may not be a sufficient answer. A separate bedroom is not a happy answer. Social snoring may be defined as loud noises made in sleep that doesn’t affect the...

Cystic Fibrosis and Sinusitis

Medicine has advanced the treatment of Cystic Fibrosis and sinusitis (CF) significantly in the past 10 years. Various measures that clear the lungs are becoming standardized. The Cystic Fibrosis Foundation as well as other support groups have been contributing not only to uncovering a cure but in helping the patient and their families as well. In 1989 the gene etiology of this condition was recognized and gene therapy is now being actively pursued. The CF patient fails to have normal mucus clearance. Thick tenacious mucus keeps bacteria from being cleared and prevents antibiotics from being effective. Clearance of mucus from the chest therefore is a paramount treatment objective. Various physical therapy methods include chest percussion, forceful exhalation, various dilators, postural drainage. The flutter device uses sound vibration to help reduce the thickness of the mucus. Inhalation of drugs that break down the structure of the mucus are in use. A similar thick fluid causes sinus infections. Nasal polyps are common. This is a type of bag of water where the liquid is maintained within the cell so that the cell expands and blocks the nose. A mucocele can develop, often in the frontal sinus. This is a similar bag of water within a membrane that expands and puts pressure on the sinus wall. Headaches in the frontal sinus area – above the eyes – is a common sign. Pulsatile irrigation is useful in several ways. First it can remove thick secretions from the nose and sinus. This is important because removal of thick secretions helps to restore regular methods of body resistance. Pulsatile irrigation helps remove bacteria. Any reduction of...

Do I need sinus surgery?

I get a lot of questions asking about having surgery of the turbinates. Here are some answers. What are turbinates? The turbinates are shelves on the side of the nose. The main ones are the middle and the inferior. They normally enlarge and shrink. They especially enlarge with a cold or infection because blood is coming to the area to fight infection. They enlarge with allergy, and become pale and swollen. Sometimes they happen to be swollen on the day you see the doctor, and if you are complaining that your breathing feels blocked, it makes sense to reduce their size. Enlargement of the turbinates can, at times, be seen on an X- ray. BUT What Do Turbinates Do? The turbinates serve a major function. They warm inhaled air before it enters the lungs. They are covered by millions of cilia which defend the body against contaigons and irritants in the inhaled air. They provide an environment for the good white blood cells, and a bacteria-fighting enzyme called lysozyme, to gather and fight infection. They act as a baffle to better direct the flow of air. No matter how much your turbinates seem to cause you trouble, you don’t want to just remove them. If you did, you would have dryness, crusting and sensations of burning pain. Doctors have therefore come up with various ways to reduce the blockage of your nasal passages without removing your turbinates and their cilia. Surgery Methods One technique is to just remove a small amount, not enough to take away too much cilia. In certain cases the position of the turbinates is such...