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Melanie Cole (Host):  If you’ve ever had inflamed sinuses you, know how uncomfortable that can be. My guest today is Dr. Drew Collins. He is an otolaryngologist with Greenville Health System. Welcome to the show, Dr. Collins. What is sinusitis and how do we know if we have it?

Dr. Drew Collins (Guest):  Well, generally speaking, sinusitis is just any sort of inflammation of the sinuses. That could be anything from allergies to a bacterial infection or even a fungal infection. Sometimes determining whether someone actually has a sinus infection can be somewhat difficult just because of all the symptoms that go along with it can also be signs of other diseases, like allergies or just upper respiratory infections. Probably the most classic sign is actual thick nasal drainage. We’re talking like yellow or green drainage coming from the nose. There are some other factors, too, that we can get into.  

Melanie:  So, let’s get into some of those. People see that green or yellow and right away they think they have this kind of bacterial infection and they head to the antibiotics. Is that always the best course?

Dr. Collins:  No, it’s not, actually. I know a lot of people really suffer with these symptoms so they want something to be done pretty quickly but our academy just recently released some new guidelines for this. Really, we don’t like to prescribe antibiotics unless someone is really getting worse after seven days or their symptoms are extending beyond ten days. The other sign that this may actually be a bacterial infection and not just a viral upper respiratory infection or allergies, is if you have what we call “double worsening”. By double worsening we mean that you get symptoms, you’re doing pretty good for three or four days in the middle there, and then you get worse again. That says to us that you’ve gone from something that started viral, started to get a little bit better and then a bacterial infection hits. Those are signs that you may need antibiotics and where your doctor should really be starting to think about antibiotics.

Melanie:  Sometimes sinusitis or severe sinus infections are hard to even treat and you have to be on an antibiotic for a long time to kind of get in there. So, why is that? Why are sometimes these hard to treat?

Dr. Collins:  Well, that can have multiple reasons behind it. Some people may have allergies that just keep everything so inflamed that their sinuses never get out of that inflammatory state. Some people with allergies develop something called “allergic polyps.” These polyps actually are physical lumps and they are caused by allergies and they block the outflow tracts of the sinuses. So, it doesn’t matter how much you treat the infection, those sinuses can’t drain like they normally should. Some people have things like diabetes that makes them just naturally harder to fight off any sort of infection, whatever that may be. Other people have anatomic problems such as a deviated nasal septum which is that middle wall in between your left and right nostril. That can be bent over and, again, pushing against one of the outflow tracks of the sinuses. Sometimes we are up against some of these anatomic or other health problems that cause these sinus infections to just keep coming back or persist.

Melanie:  Is there anything we can do to prevent them? We’ve heard about nasal lavage, irrigation and taking note of the triggers that are out there. What’s your best advice for preventive measures for sinusitis?

Dr. Collins:  Well, probably the best thing is if you get an upper respiratory infection just go ahead and get one of the over-the-counter nasal saline rinses. These cause almost no harm. They are very benign to use. They help you symptomatically, even with an upper respiratory infection and they really can improve the clearance from an upper respiratory infection and may help prevent actually conversion to a bacterial infection or sinusitis. The data on that is somewhat sparse but it’s a good idea and just in my practice, I have seen that be helpful. Another thing is if you are an allergy patient, is to actually work with your doctor to stay on top of your allergies. Once you get behind the eight ball, so to speak, with allergies that can be a very difficult situation to get back out of. So, getting on a regiment that really keeps your allergy symptoms at bay is a great idea. Oftentimes, people with allergies are the people that are getting recurrent sinusitis or sinusitis that won’t clear.

Melanie:  Tell us a little bit about decongestants because some of the ones that are on the market I have even heard that you shouldn’t use for more than a day or two. When people are really stuffed up, Dr. Collins, they are just looking for anything and certain products, maybe like Afrin, can actually aggravate the sinuses much less de-inflame them, correct?

Dr. Collins:  Correct. I do agree that in the acute setting, when you are miserable, some decongestants can be great. They help open your nose up. You breathe better. You feel a little bit better. People definitely with high blood pressure should be very cautious about using any of those products--whether its pills like Sudafed or Afrin, or any of the decongestant sprays because they can affect your blood pressure. If you are on blood pressure medication, you should talk to your doctor before using any of them for any reason. For the average person, just two or three days is sufficient. With particularly the nasal sprays, if you use them for more than about four to six days, they actually start to have a reverse affect. It’s called a rebound affect and what used to decongest you, now will cause you to become more congested. This is how people get “hooked” on these medications. They get to the point that they need them to breathe at all. So, that’s why we say just a short-term course of them.  

Melanie:  Are there any surgical treatments for sinusitis? Chronic sinusitis that just doesn’t seem to go away?

Dr. Collins:  Absolutely. Here at GHS, at Mountain Lakes Ear, Nose and Throat, we perform surgery several times a week for sinusitis. It’s certainly not the first line treatment for sinusitis, but if you’re having recurrent infections or ones that won’t go away, your primary care doctor may refer you to us. This is where we analyze the anatomic factors that may be going on--whether you have polyps or that sort of thing. We’ll then get a CT Scan of your sinuses and that will show us if there are any anatomic things that we can do something about to help these sinuses function better. There are multiple different surgical techniques that we have to treat sinusitis in the patient who can’t get over it medically.  

Melanie:  So, is this endoscopic-type surgery? Is it not very invasive? What can people expect if they do have to have it?

Dr. Collins:  Actually, over the last 30 years we have seen this incredible evolution of sinus surgery. What used to be open technique, where we actually had to make some external incisions, then went to endoscopic sinus surgery where we can actually use a small endoscope and just go through the natural openings of the nostril. That allowed us to be much less invasive and get people back to work and life a lot quicker. We’ve also have had some advances in our guidance systems. Literally, I can get a CT scan of you, be operating in your nose while you are under anesthesia, touch an area in your nose and see right where I am on the CT scan. This also allowed us to be less invasive, go right to where the anatomic problem is and solve it. More recently, we’ve had the exciting advance of what is called “balloon sinuplasty”. This is a devise similar to what cardiologists use to balloon open clogged blood vessels. We use a small catheter that slides into the natural opening of the sinus. We then expand the balloon and that actually opens that area allowing better drainage. This can often be done even in the office under topical and injectable anesthesia. I, myself, actually had it done by my colleague here in the office and it’s actually quite tolerable.

Melanie:  With the balloon sinuplasty or the image-guided surgery, how long can you expect them to last?

Dr. Collins:  It just depends on some of the other factors that you have going on. If you are someone with severe allergies, if you have other immune issues, if you are diabetic, you may be in that 10-15% of unfortunate patients where even with sinus surgery you may still need to be on medical treatment. But for about 80-85% of people when we do surgery, we can theoretically get them life-long improvement. If we can go in there and solve some of the anatomic problems that were part of their problem in the first place, then theoretically that anatomic problem is gone and their sinusitis is much better, or at least much easier to get rid of if you do occasionally get one.

Melanie:  Dr. Collins, in just the last minute or two if you would, give listeners your best advice for those suffering with inflamed sinuses, sinusitis and why they should come to Greenville Health System for their care.

Dr. Collins:  Sure. You don’t have to suffer with this. That is my first message to people.  They think this is just a normal course of things and, “Oh, it’s just sinusitis.” We actually know that the impact of sinusitis is huge. Some quality of life studies have shown that people have worse quality of life scores than people with chronic back pain, congestive heart failure and even chronic obstructive pulmonary disease. So, this disease can really impact you. So, seek treatment early and if you’re having more than, I would say, even one a year, then let your doctor know about it. Let them know that you have symptoms so that they can actually work with you to try to get rid of this disease. Now, here at GHS we have the full range of sinus surgery available. Here at Mountain Lakes EMT in Seneca, we perform sinus surgery every day and we have all of the latest techniques as do they at the Greenville Center as well.

Melanie:  Thank you so much. That's great information. You're listening to Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks so much for listening.