It seems that for some people, every time they get a cold, a sinus infection follows.
Seasonal allergies also get the blame for causing sinus headaches and infections.
Are some people just prone to getting sinus infections?
Is there anything they can do to prevent them?
Joining the show is Dr. Bruce Dennison, Otolaryngologist with Allina Health. He shares the best advice on preventing sinus infections and dealing with them if they occur.
Selected Podcast
Chronic Sinus Infections: Not Just In Your Head
Featured Speaker:
Learn more about Bruce Dennison, MD
Bruce Dennison, MD
Bruce Dennison, MD, is board-certified in Ear, Nose and Throat (Otolaryngology). He enjoys travel, and participates in outdoor activities such as hunting, fishing and scuba diving.Learn more about Bruce Dennison, MD
Transcription:
Melanie Cole (Host): It seems that for some people every time they get a cold a sinus infection follows. Seasonal allergies also get the blame sometimes for causing sinus headaches and infections. Are some people just more prone to getting sinus infections and is there anything that they can do to prevent them? My guest today is Dr. Bruce Dennison. He’s board certified in ear, nose and throat otolaryngology at Allina Medical Clinic in Woodbury, Minnesota. Welcome to the show, Dr. Dennison. So, tell us a little bit about the sinuses and what they do and how they get, for some people, so easily infected.
Dr. Bruce Dennison (Guest): Well, that’s an interesting question. First of all, with the sinuses, there are four separate sinus areas--that would be the frontal, maxillary, sphenoid and ethmoid sinuses. Because one’s infected doesn’t necessarily mean that the other one can be infected. It can be rather complicated in terms of which sinus is a problem but, eventually, that would be something we could discuss further in this conversation. Frequently, patients will ask the question, “Doctor, what do the sinuses do?” and to be honest we don’t quite know why they exist. Some anthropologists might suggest that it’s for phonation related to our earlier ancestors, if you believe in evolution. Others might suggest that it actually lightens the head but we really don’t know why sinuses exist. They certainly can cause problems as they have a tendency to become infected in certain categories where we describe patients that would be prone to sinus infections.
Melanie: So, tell us a little bit about the infection itself. People, Dr. Dennison, think every time that if they blow their nose and there’s yellow or green, they right away assume that they’ve got a sinus infection. That’s not necessarily the case, yes?
Dr. Dennison: You’re absolutely correct. Most individuals will assume they have a sinus infection and, in fact, what they probably are suffering from is an acute viral infection. In general, we’d like to think of a sinus infection as being caused by, in many cases, a viral infection but time becomes a factor. Usually, most colds or viral infections will resolve within a week to 10 days. If your symptoms of purulent drainage, facial pressure, pain, dental pain, post-nasal drip, and cough persists or actually gets worse at the tail end of a cold, it’s likely that you’ve handed off that virus to a bacterial infection and that, officially, would be a sinus infection. The other issue is why do certain people, certain individuals, more prone to sinus infections? That, frequently, is where an ear, nose and throat physician can play a role in managing and trying to minimize the number of infections or the complications or symptoms related to sinus infections. So, when I’m seeing someone for the first time, it’s typical they’ve been seen by their primary care physician on a number of occasions, been provided with antibiotics and maybe a saline wash with the hopes that their symptoms will go away. I think it’s imperative on the physician’s part to look at the issue of not do they have a sinus infection but why is this individual prone to sinus infection. So, in my practice, I will typically look at more common causes such as underlying allergies and immunosuppression. Is there an anatomical issue that may be predisposing the individual to infections? Typically, the investigation will involve an excellent or in-depth nasal exam or sinus exam coupled with possibly a sinus CT and, if symptoms suggest, having the patient undergo allergy testing. At least in my view, if you do a good job controlling allergies, you’re less likely to become infected over and over and over again. One issue that can come up during the exam can be the presence of polyps. If there’s polyps, that generally suggests there may be underlying allergies but it’s a different issue because the polyps will predispose you to recurring sinus infections simply by obstructing the sinus openings. So, I look at that scenario like how can we control polyp formation or do we need, at some point, to remove the polyps? Again a lot of that is based on our physical exam, assessment radiographically and, if need be, getting our allergy colleagues to take a look at the patient.
Melanie: Dr. Dennison, what’s the first line of defense? If you determine somebody does have a sinus infection, are antibiotics the first thing and why do they sometimes not work as well?
Dr. Dennison: There can be several reasons why they don’t work but let me touch first upon the first part of your question—antibiotic. I think more recently, at least, the data and the sense is that antibiotics should be something that you hold in reserve and waiting for that 10-day period is a reasonably good first approach, using a saline wash – not necessarily jumping to an antibiotic. But, if you choose an antibiotic and you assume that there’s a bacterial infection, there’s always a possibility that they type of organism that resides in the sinuses is not sensitive to the antibiotic that’s been prescribed, i.e. resistance. Frequently that’s the case when individuals have received multiple courses of antibiotics in their past because you will select out for more resistant organisms. So, the idea that an antibiotic will work every time would mimic or would suggest that the model for sinus infection is overgrowth of bacteria, antibiotic, resolution of infection and that really may not be the correct model. The model might be better promoted as follows: This patient has a sinus infection because… and it can be poorly controlled allergies, nasal polyps, septal deviation. If we can eliminate or control that underlying cause, we’re more likely to have a more positive outcome rather than repeating antibiotic after antibiotic after antibiotic. In many cases, in my practice, I will find that if we look at a sinus CT, the poor patients receive three or four antibiotics and yet the sinus film looks entirely normal and what we’ve been treating is poorly controlled allergies. That both is a disservice to the patient and prolongs the level of symptoms or the time the symptoms have been inadequately treated. So, I like to get a baseline and, again, going back to my original comments. Let’s figure out why this patient is having a problem rather than just always assume it’s bacterial and that an antibiotic would be the first choice. I don’t necessarily find that to be the case.
Melanie: Are there certain things that you like to recommend that people can do at home? Giving your sinuses a bath, as it were, nasal lavage, any over the counter products that you like?
Dr. Dennison: Absolutely. The idea of using a saline wash and frequently that’s done under the guise of a Neti pot. The Neti pot assumes that you are going to create a vacuum to pull mucus and debris out of the sinus. That actually would be incorrect on an individual whose sinuses haven’t been opened surgically. If they’ve been opened surgically, a Neti pot is fantastic way to flush the sinuses. Also, if you’re using a Neti pot or a saline wash, essentially, what you’re doing is facilitating the movement of mucus out of the nose, you’re eliminating bacteria, and you’re also flushing out pollen--all of which will help the hygiene of the nose which indirectly can help the sinuses. So, the idea of using a saline wash is a great idea. Absolutely great idea. Of course, if you live in the cold climates up in the Twin Cities in the middle of winter, any moisture in the nose when it’s cold and dry out certainly can benefit the function of the nose and indirectly the sinuses and may actually help to prevent viral infections or colds. So, saline wash you can’t go wrong. It’s cheap, it’s easy to use and it has very little side effects, so I would be a proponent of that.
Melanie: We don’t have a lot of time, Dr. Dennison, but is there any truth to the myth that some of the over-the-counter, Sudaphedrine and nasal sprays can actually exacerbate a sinus infection?
Dr. Dennison: I’m not so sure. Assuming when you say over the counter spray, you’re talking about decongestant spray, that would be a separate condition that may be the result of the spray and, unfortunately for many individuals, they use a decongestant spray and often it results in just the opposite condition that the patient is trying to treat. In fact, it will eventually lead to swelling inside the nose. Sudafed, at least in my view, I try not to use a great deal of it. I think its side effects of increasing the viscosity of mucus may actually predispose one to lack of drainage of the sinus but if you’re complaint is the inability to breathe through your nose, Sudafed acts by shrinking the lining of the nose--not the sinuses. It may help to facilitate the opening of the sinus but I’m not a big fan of Sudafed. Unless you have severe allergies, I don’t think I would use it on a regular basis to treat a chronic sinus condition. I would tend to shy away from that but that’s my opinion. I think others in my field would have a different viewpoint but Sudafed increases your heart rate, can make you jittery, keep you up at night and if you tend to be a little bit older, it may actually have some ill effects on your cardiovascular systems. Again, I tend to shy away from it.
Melanie: No, that was a great answer and great information. In just the last minute, please give your best advice for those that suffer from chronic sinus infections and what they can do about them or possibly prevent them.
Dr. Dennison: In general, I think if it gets to the point where it’s adversely affecting the quality of your life, you’ve seen a number of primary care physicians or you’ve sought the counseling of providers who treat sinus infections, at some point rather than treat the symptoms, try to determine what the underlying cause is. I think, in the long run you’d be well served to take that approach. Really, you’re dealing with the root cause rather than treating the symptoms as they occur. You’re being proactive and in the long run, it will serve the patient better.
Melanie: Thank you so much for great information. You’re listening to the WELLcast with Allina Health. And for more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): It seems that for some people every time they get a cold a sinus infection follows. Seasonal allergies also get the blame sometimes for causing sinus headaches and infections. Are some people just more prone to getting sinus infections and is there anything that they can do to prevent them? My guest today is Dr. Bruce Dennison. He’s board certified in ear, nose and throat otolaryngology at Allina Medical Clinic in Woodbury, Minnesota. Welcome to the show, Dr. Dennison. So, tell us a little bit about the sinuses and what they do and how they get, for some people, so easily infected.
Dr. Bruce Dennison (Guest): Well, that’s an interesting question. First of all, with the sinuses, there are four separate sinus areas--that would be the frontal, maxillary, sphenoid and ethmoid sinuses. Because one’s infected doesn’t necessarily mean that the other one can be infected. It can be rather complicated in terms of which sinus is a problem but, eventually, that would be something we could discuss further in this conversation. Frequently, patients will ask the question, “Doctor, what do the sinuses do?” and to be honest we don’t quite know why they exist. Some anthropologists might suggest that it’s for phonation related to our earlier ancestors, if you believe in evolution. Others might suggest that it actually lightens the head but we really don’t know why sinuses exist. They certainly can cause problems as they have a tendency to become infected in certain categories where we describe patients that would be prone to sinus infections.
Melanie: So, tell us a little bit about the infection itself. People, Dr. Dennison, think every time that if they blow their nose and there’s yellow or green, they right away assume that they’ve got a sinus infection. That’s not necessarily the case, yes?
Dr. Dennison: You’re absolutely correct. Most individuals will assume they have a sinus infection and, in fact, what they probably are suffering from is an acute viral infection. In general, we’d like to think of a sinus infection as being caused by, in many cases, a viral infection but time becomes a factor. Usually, most colds or viral infections will resolve within a week to 10 days. If your symptoms of purulent drainage, facial pressure, pain, dental pain, post-nasal drip, and cough persists or actually gets worse at the tail end of a cold, it’s likely that you’ve handed off that virus to a bacterial infection and that, officially, would be a sinus infection. The other issue is why do certain people, certain individuals, more prone to sinus infections? That, frequently, is where an ear, nose and throat physician can play a role in managing and trying to minimize the number of infections or the complications or symptoms related to sinus infections. So, when I’m seeing someone for the first time, it’s typical they’ve been seen by their primary care physician on a number of occasions, been provided with antibiotics and maybe a saline wash with the hopes that their symptoms will go away. I think it’s imperative on the physician’s part to look at the issue of not do they have a sinus infection but why is this individual prone to sinus infection. So, in my practice, I will typically look at more common causes such as underlying allergies and immunosuppression. Is there an anatomical issue that may be predisposing the individual to infections? Typically, the investigation will involve an excellent or in-depth nasal exam or sinus exam coupled with possibly a sinus CT and, if symptoms suggest, having the patient undergo allergy testing. At least in my view, if you do a good job controlling allergies, you’re less likely to become infected over and over and over again. One issue that can come up during the exam can be the presence of polyps. If there’s polyps, that generally suggests there may be underlying allergies but it’s a different issue because the polyps will predispose you to recurring sinus infections simply by obstructing the sinus openings. So, I look at that scenario like how can we control polyp formation or do we need, at some point, to remove the polyps? Again a lot of that is based on our physical exam, assessment radiographically and, if need be, getting our allergy colleagues to take a look at the patient.
Melanie: Dr. Dennison, what’s the first line of defense? If you determine somebody does have a sinus infection, are antibiotics the first thing and why do they sometimes not work as well?
Dr. Dennison: There can be several reasons why they don’t work but let me touch first upon the first part of your question—antibiotic. I think more recently, at least, the data and the sense is that antibiotics should be something that you hold in reserve and waiting for that 10-day period is a reasonably good first approach, using a saline wash – not necessarily jumping to an antibiotic. But, if you choose an antibiotic and you assume that there’s a bacterial infection, there’s always a possibility that they type of organism that resides in the sinuses is not sensitive to the antibiotic that’s been prescribed, i.e. resistance. Frequently that’s the case when individuals have received multiple courses of antibiotics in their past because you will select out for more resistant organisms. So, the idea that an antibiotic will work every time would mimic or would suggest that the model for sinus infection is overgrowth of bacteria, antibiotic, resolution of infection and that really may not be the correct model. The model might be better promoted as follows: This patient has a sinus infection because… and it can be poorly controlled allergies, nasal polyps, septal deviation. If we can eliminate or control that underlying cause, we’re more likely to have a more positive outcome rather than repeating antibiotic after antibiotic after antibiotic. In many cases, in my practice, I will find that if we look at a sinus CT, the poor patients receive three or four antibiotics and yet the sinus film looks entirely normal and what we’ve been treating is poorly controlled allergies. That both is a disservice to the patient and prolongs the level of symptoms or the time the symptoms have been inadequately treated. So, I like to get a baseline and, again, going back to my original comments. Let’s figure out why this patient is having a problem rather than just always assume it’s bacterial and that an antibiotic would be the first choice. I don’t necessarily find that to be the case.
Melanie: Are there certain things that you like to recommend that people can do at home? Giving your sinuses a bath, as it were, nasal lavage, any over the counter products that you like?
Dr. Dennison: Absolutely. The idea of using a saline wash and frequently that’s done under the guise of a Neti pot. The Neti pot assumes that you are going to create a vacuum to pull mucus and debris out of the sinus. That actually would be incorrect on an individual whose sinuses haven’t been opened surgically. If they’ve been opened surgically, a Neti pot is fantastic way to flush the sinuses. Also, if you’re using a Neti pot or a saline wash, essentially, what you’re doing is facilitating the movement of mucus out of the nose, you’re eliminating bacteria, and you’re also flushing out pollen--all of which will help the hygiene of the nose which indirectly can help the sinuses. So, the idea of using a saline wash is a great idea. Absolutely great idea. Of course, if you live in the cold climates up in the Twin Cities in the middle of winter, any moisture in the nose when it’s cold and dry out certainly can benefit the function of the nose and indirectly the sinuses and may actually help to prevent viral infections or colds. So, saline wash you can’t go wrong. It’s cheap, it’s easy to use and it has very little side effects, so I would be a proponent of that.
Melanie: We don’t have a lot of time, Dr. Dennison, but is there any truth to the myth that some of the over-the-counter, Sudaphedrine and nasal sprays can actually exacerbate a sinus infection?
Dr. Dennison: I’m not so sure. Assuming when you say over the counter spray, you’re talking about decongestant spray, that would be a separate condition that may be the result of the spray and, unfortunately for many individuals, they use a decongestant spray and often it results in just the opposite condition that the patient is trying to treat. In fact, it will eventually lead to swelling inside the nose. Sudafed, at least in my view, I try not to use a great deal of it. I think its side effects of increasing the viscosity of mucus may actually predispose one to lack of drainage of the sinus but if you’re complaint is the inability to breathe through your nose, Sudafed acts by shrinking the lining of the nose--not the sinuses. It may help to facilitate the opening of the sinus but I’m not a big fan of Sudafed. Unless you have severe allergies, I don’t think I would use it on a regular basis to treat a chronic sinus condition. I would tend to shy away from that but that’s my opinion. I think others in my field would have a different viewpoint but Sudafed increases your heart rate, can make you jittery, keep you up at night and if you tend to be a little bit older, it may actually have some ill effects on your cardiovascular systems. Again, I tend to shy away from it.
Melanie: No, that was a great answer and great information. In just the last minute, please give your best advice for those that suffer from chronic sinus infections and what they can do about them or possibly prevent them.
Dr. Dennison: In general, I think if it gets to the point where it’s adversely affecting the quality of your life, you’ve seen a number of primary care physicians or you’ve sought the counseling of providers who treat sinus infections, at some point rather than treat the symptoms, try to determine what the underlying cause is. I think, in the long run you’d be well served to take that approach. Really, you’re dealing with the root cause rather than treating the symptoms as they occur. You’re being proactive and in the long run, it will serve the patient better.
Melanie: Thank you so much for great information. You’re listening to the WELLcast with Allina Health. And for more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.