Selected Podcast
What's Sinus Whats Snot? Advances in Sinus Surgery and Other Sinonasal Syndromes
Dr. Adam Coughlin discusses advances in sinus surgery, when to seek help, and what kind of help may be available.
Featured Speaker:
Adam Coughlin, MD
Adam Coughlin is a otolaryngology - head and neck surgery physician. He obtained his undergraduate degree from the University of Notre Dame in Notre Dame, IN and earned his medical degree from the University of Wisconsin School of Medicine and Public Health in Madison, WI. He completed his residency in otolaryngology at the University of Wisconsin Hospital and Clinics-Madison. Coughlin's practice is focused on comprehensive adult and pediatric otolaryngology head and neck surgery including reconstructive facial plastic surgery, functional nasal surgery, thyroid surgery, and sleep surgery. Transcription:
Melanie Cole (Host): Welcome to Stoughton Health Talk. I'm Melanie Cole, and I invite you to listen as we discuss advances in sinus surgery and other sinonasal syndromes. Joining me is Dr. Adam Coughlin. He's an Otolaryngology Head and Neck Surgeon at Stoughton Hospital. Dr. Coughlin, it's a pleasure to have you join us. And this is such a really good topic. Tell us some of the most common sinonasal syndromes that you see.
Adam Coughlin, MD (Guest): By far and away the most common symptom that we see as an Otolaryngologist, as a specialist, is a chronic inflammatory sinusitis, which is the long-term syndrome that you get after having the sinus symptoms for several months. The bacteria kind of set up in place and you have pain and pressure in the face and drainage, and we can get into the details of those, but the chronic problem is what we see. But that's only a very small subset of patients who have sinusitis. By far and away, the most common in the population would be acute sinusitis. So, either bacterial sinusitis or viral sinusitis for much shorter durations
Host: So, I would like to jump right in with busting up a few myths because people wonder about you know, if they have green snot or sputum, they blow their nose a lot. How do you know if it's a sinus infection? Are any of those kinds of myths true?
Dr. Coughlin: Well, some of them are, and some of them aren't. Just because you have green sputum, green mucus coming out of the mouth, doesn't automatically mean it's a bacterial infection. So, that is one myth right there. Green does not automatically mean infection. It often means your white blood cells are responding to it. So, some type of inflammation, but it could very well be viral. So, even a viral sinusitis in the first 10 days or so, can give you a green discharge. So, that's not the only criteria. It might be best to define the sinusitis and that will basically tell you exactly what what's going on. Should we go there or?
Host: Yes, definitely. Why don't you tell us a little bit about how do we know if we do have sinusitis or a sinus infection?
Dr. Coughlin: Well, so, for inflammatory sinusitis. So, this is the generic run of the mill sinus infections, nothing exotic. There are three basic types. One would be acute viral sinusitis, another would be acute bacterial sinusitis and then chronic sinusitis. So, acute viral sinusitis is symptoms lasting up to 10 days. So, it's really a time period. The symptoms would be pus coming out of the nose. So, the green discharge you were talking about, plus one or two symptoms. Pain in the face or pressure in the face or nasal congestion. So, that treatment for that is simply a watchful waiting, treating the symptoms. If it lasts beyond 10 days, then we consider that to be an acute bacterial sinusitis.
So it's really a timeframe, again. Less than 10 days, viral, 10 days to four weeks, bacterial. Same symptoms pus with either pressure or congestion. And then when you get beyond the four weeks, you're kind of in the middle ground and beyond three months, you're talking about chronic sinusitis. So, it's really a time plus symptoms.
Host: So, tell me doctor, why are these so hard to treat sometimes? Some people get them and it's very hard to get them gone. Some people, one course of antibiotics, if it's bacterial and it's gone, why are these sometimes challenging to treat?
Dr. Coughlin: One of two reasons. Either because it's a persistent infection that really needs a stronger, longer course of antibiotics. So, usually for a typical course of acute bacterial sinusitis, we'll do a fairly short duration of antibiotics, five or seven days, but once it's persistent and recurrent, sometimes you need to actually a quite prolonged course. So, for some of our chronic sinusitis patients, we will treat them for three weeks with antibiotics and steroids. So, a much longer course. The other scenario is, you could be, just have the wrong diagnosis. And we see that a lot as well. It might not be a sinus infection. That's kind of the other half of the whole investigation into sinusitis is, is it actually sinus, or is it something else?
Host: So, now things that people try at home, Dr. Coughlin. Nasal saline, there's anti-histamines and decongestants, and, you know, nasal steroids and things like Afrin. We're told not necessarily to use these things. And certainly not very often. Can you tell us why or if any of these are really good to use or not great to use? Tell us what to make of all of the things that we see on the pharmacy shelves?
Dr. Coughlin: Actually many of them are fantastic, especially the saline rinses, the Neti pot rinses, NeilMed irrigation, some of the powered ones, Nuvage, is basically moving the pus, the mucus around is great. You can do it two or three times a day and really very little downside. So, that one's fantastic. I also put almost every patient on nasal steroids as well. As long as you're using them appropriately, delivering the device and following the recommendations on the box it's very safe. Yeah. The one that you can get into a little bit of trouble with is Afrin, which is oxymetazoline also Vicks Sinex.
They're very potent nasal decongestants, so they're not steroids. They constrict the blood vessels in the nose. Excellent for short term, two or three days, if you are feeling really stuffed up. Fantastic. But you got to make sure to stop it. If you continue to use some of those medications beyond five, seven days, you can really actually cause some damage to the nose and your nose was basically becomes addicted to it. So, that's the one we really caution long-term consequences about.
Host: When does chronic sinusitis require some sort of a procedural intervention Doctor? Tell us like how long you'll try or what you tell your patients when this is something that, that really affects quality of life, doesn't go away very easily. What's next?
Dr. Coughlin: First is a course of complete medical management. So, that would include, as I alluded to before, a longer course of steroids, a longer course of antibiotics. So, oral steroids, something like prednisone, methylprednisolone, dexamethazone and then a longer three weeks, two- or three-week course of antibiotics, so something fairly strong. At the same time, doing your topical rinses, doing the nasal steroid sprays and then seeing how that does. There are some patients who you do that, and they feel wonderfully. You don't need to do any surgery. If they're still having symptoms and still on exam, have polyps or pus in the nose, then kind of stepping up the intensity of investigation and maybe getting a CAT scan of the sinuses and thinking about sinus surgery, if they are very symptomatic. That's kind the role of the Otolaryngologist in the management of sinusitis.
Host: Wow. There's so many people that really suffer with this. I'd like for you, and before we wrap up, tell us some exciting things in your field, tell us about what you're doing every single day Doctor, and also kind of reinforce some of the home treatments that you might recommend that I don't know if they can possibly prevent, but certainly help to prevent some of the sinus conditions that you see.
Dr. Coughlin: Absolutely. Yeah. Well, there are actually a fair number of technological advances that have come out over the past 10 years for sinusitis. So, industry has really kind of brought this to the forefront. There are steroid dissolving stents that we can place in the nose at the time of sinus surgery or for people with recurrent problems in the office. So, that is one major advantage that's relatively new and about a year and a half ago, the FDA approved a biologic agent. So, some of those types of medicines that you're seeing more and more of in the realm of Rheumatology and Dermatology are making their way into our field as well.
And this one is called DUPIXENT. And it is it injection that really does a very nice job for making nasal polyps smaller. So, those are two kind of advanced technologies that are coming into the field that are very promising and we're seeing excellent results with them. So, as far as what you can do for at home I would say the best thing you can do is very simple over the counter things which is topical treatment of your nose, using nasal steroid sprays, which is things like Flonase, Nasocort, Nasonex, all available over the counter.
And then using a nasal saline rinse. The NeilMed rinse bottle system is very economical and very easy to use and you can use it once or twice a day. And those two things, if you are already doing, you will be well ahead of most people in treating their sinuses and their nose.
Host: What great information. Such usable, informative episode. Thank you so much, Doctor for joining us today. And for more information, head over to our This email address is being protected from spambots. You need JavaScript enabled to view it. to get connected with one of our providers. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Melanie Cole.
Melanie Cole (Host): Welcome to Stoughton Health Talk. I'm Melanie Cole, and I invite you to listen as we discuss advances in sinus surgery and other sinonasal syndromes. Joining me is Dr. Adam Coughlin. He's an Otolaryngology Head and Neck Surgeon at Stoughton Hospital. Dr. Coughlin, it's a pleasure to have you join us. And this is such a really good topic. Tell us some of the most common sinonasal syndromes that you see.
Adam Coughlin, MD (Guest): By far and away the most common symptom that we see as an Otolaryngologist, as a specialist, is a chronic inflammatory sinusitis, which is the long-term syndrome that you get after having the sinus symptoms for several months. The bacteria kind of set up in place and you have pain and pressure in the face and drainage, and we can get into the details of those, but the chronic problem is what we see. But that's only a very small subset of patients who have sinusitis. By far and away, the most common in the population would be acute sinusitis. So, either bacterial sinusitis or viral sinusitis for much shorter durations
Host: So, I would like to jump right in with busting up a few myths because people wonder about you know, if they have green snot or sputum, they blow their nose a lot. How do you know if it's a sinus infection? Are any of those kinds of myths true?
Dr. Coughlin: Well, some of them are, and some of them aren't. Just because you have green sputum, green mucus coming out of the mouth, doesn't automatically mean it's a bacterial infection. So, that is one myth right there. Green does not automatically mean infection. It often means your white blood cells are responding to it. So, some type of inflammation, but it could very well be viral. So, even a viral sinusitis in the first 10 days or so, can give you a green discharge. So, that's not the only criteria. It might be best to define the sinusitis and that will basically tell you exactly what what's going on. Should we go there or?
Host: Yes, definitely. Why don't you tell us a little bit about how do we know if we do have sinusitis or a sinus infection?
Dr. Coughlin: Well, so, for inflammatory sinusitis. So, this is the generic run of the mill sinus infections, nothing exotic. There are three basic types. One would be acute viral sinusitis, another would be acute bacterial sinusitis and then chronic sinusitis. So, acute viral sinusitis is symptoms lasting up to 10 days. So, it's really a time period. The symptoms would be pus coming out of the nose. So, the green discharge you were talking about, plus one or two symptoms. Pain in the face or pressure in the face or nasal congestion. So, that treatment for that is simply a watchful waiting, treating the symptoms. If it lasts beyond 10 days, then we consider that to be an acute bacterial sinusitis.
So it's really a timeframe, again. Less than 10 days, viral, 10 days to four weeks, bacterial. Same symptoms pus with either pressure or congestion. And then when you get beyond the four weeks, you're kind of in the middle ground and beyond three months, you're talking about chronic sinusitis. So, it's really a time plus symptoms.
Host: So, tell me doctor, why are these so hard to treat sometimes? Some people get them and it's very hard to get them gone. Some people, one course of antibiotics, if it's bacterial and it's gone, why are these sometimes challenging to treat?
Dr. Coughlin: One of two reasons. Either because it's a persistent infection that really needs a stronger, longer course of antibiotics. So, usually for a typical course of acute bacterial sinusitis, we'll do a fairly short duration of antibiotics, five or seven days, but once it's persistent and recurrent, sometimes you need to actually a quite prolonged course. So, for some of our chronic sinusitis patients, we will treat them for three weeks with antibiotics and steroids. So, a much longer course. The other scenario is, you could be, just have the wrong diagnosis. And we see that a lot as well. It might not be a sinus infection. That's kind of the other half of the whole investigation into sinusitis is, is it actually sinus, or is it something else?
Host: So, now things that people try at home, Dr. Coughlin. Nasal saline, there's anti-histamines and decongestants, and, you know, nasal steroids and things like Afrin. We're told not necessarily to use these things. And certainly not very often. Can you tell us why or if any of these are really good to use or not great to use? Tell us what to make of all of the things that we see on the pharmacy shelves?
Dr. Coughlin: Actually many of them are fantastic, especially the saline rinses, the Neti pot rinses, NeilMed irrigation, some of the powered ones, Nuvage, is basically moving the pus, the mucus around is great. You can do it two or three times a day and really very little downside. So, that one's fantastic. I also put almost every patient on nasal steroids as well. As long as you're using them appropriately, delivering the device and following the recommendations on the box it's very safe. Yeah. The one that you can get into a little bit of trouble with is Afrin, which is oxymetazoline also Vicks Sinex.
They're very potent nasal decongestants, so they're not steroids. They constrict the blood vessels in the nose. Excellent for short term, two or three days, if you are feeling really stuffed up. Fantastic. But you got to make sure to stop it. If you continue to use some of those medications beyond five, seven days, you can really actually cause some damage to the nose and your nose was basically becomes addicted to it. So, that's the one we really caution long-term consequences about.
Host: When does chronic sinusitis require some sort of a procedural intervention Doctor? Tell us like how long you'll try or what you tell your patients when this is something that, that really affects quality of life, doesn't go away very easily. What's next?
Dr. Coughlin: First is a course of complete medical management. So, that would include, as I alluded to before, a longer course of steroids, a longer course of antibiotics. So, oral steroids, something like prednisone, methylprednisolone, dexamethazone and then a longer three weeks, two- or three-week course of antibiotics, so something fairly strong. At the same time, doing your topical rinses, doing the nasal steroid sprays and then seeing how that does. There are some patients who you do that, and they feel wonderfully. You don't need to do any surgery. If they're still having symptoms and still on exam, have polyps or pus in the nose, then kind of stepping up the intensity of investigation and maybe getting a CAT scan of the sinuses and thinking about sinus surgery, if they are very symptomatic. That's kind the role of the Otolaryngologist in the management of sinusitis.
Host: Wow. There's so many people that really suffer with this. I'd like for you, and before we wrap up, tell us some exciting things in your field, tell us about what you're doing every single day Doctor, and also kind of reinforce some of the home treatments that you might recommend that I don't know if they can possibly prevent, but certainly help to prevent some of the sinus conditions that you see.
Dr. Coughlin: Absolutely. Yeah. Well, there are actually a fair number of technological advances that have come out over the past 10 years for sinusitis. So, industry has really kind of brought this to the forefront. There are steroid dissolving stents that we can place in the nose at the time of sinus surgery or for people with recurrent problems in the office. So, that is one major advantage that's relatively new and about a year and a half ago, the FDA approved a biologic agent. So, some of those types of medicines that you're seeing more and more of in the realm of Rheumatology and Dermatology are making their way into our field as well.
And this one is called DUPIXENT. And it is it injection that really does a very nice job for making nasal polyps smaller. So, those are two kind of advanced technologies that are coming into the field that are very promising and we're seeing excellent results with them. So, as far as what you can do for at home I would say the best thing you can do is very simple over the counter things which is topical treatment of your nose, using nasal steroid sprays, which is things like Flonase, Nasocort, Nasonex, all available over the counter.
And then using a nasal saline rinse. The NeilMed rinse bottle system is very economical and very easy to use and you can use it once or twice a day. And those two things, if you are already doing, you will be well ahead of most people in treating their sinuses and their nose.
Host: What great information. Such usable, informative episode. Thank you so much, Doctor for joining us today. And for more information, head over to our This email address is being protected from spambots. You need JavaScript enabled to view it. to get connected with one of our providers. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Melanie Cole.