When It’s More than a Stuffy Nose

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell and today we will be talking about ear, nose and throat care. You know, for those times when it's more than just a stuffy nose. Our guest today is Dr. Kathy Yu-Syken, an otolaryngologist and head and neck surgeon at MemorialCare Orange Coast Medical Center and MemorialCare Long Beach Medical Center. Welcome, Dr. Yu-Syken.

Kathy Yu-Syken, MD: Hi there. Good morning. Glad to be here.

Deborah Howell (Host): Awesome to have you on the show. According to the CDC, more than 26 million adults in the US suffer from painful chronic sinusitis. So since so many of us suffer from sinus issues, especially during cold and flu season and also in association of course with allergies, what are some signs and symptoms that a stuffy nose may be something more serious?

Kathy Yu-Syken, MD: Well, it depends on the duration of symptoms most of the time. If symptoms last more than seven to 10 days without any improvement in the symptoms, it may not just be a viral infection like a cold. Some of the symptoms you may experience could be nasal stuffiness, some drainage from the nose, and it doesn't really matter if it's colored or clear, sinus pressure, sinus headaches, that post-nasal drip, annoying drip that goes down the back of the throat, and loss of smell could be some of the symptoms if the symptoms last beyond the seven to 10 days after initial start of the cold.

Deborah Howell (Host): Got it. And then what exactly is a sinus infection?

Kathy Yu-Syken, MD: So a sinus infection involves inflammation in the sinus cavities from either viral, bacterial, or fungal infections. This can occur from either anatomical blockage due to obstructed or narrow sinus openings or chronic biofilms in the sinuses. These conditions predispose a person to sinus infections. So in terms of the bacterial biofilms, it can accumulate over time and in a blocked sinus can end up chronically infecting the sinuses.

Deborah Howell (Host): Got it. Never pleasant. Okay, and then again while I'm asking questions, what are chronic sinusitis and recurrent acute rhinosinusitis?

Kathy Yu-Syken, MD: So these are two separate conditions. Patients with chronic sinusitis usually have chronic inflammation in the lining of the sinuses from bacterial biofilms or obstructed sinuses. And these symptoms are ongoing for at least three months and may be low-grade. They may be only feeling some congestion, maybe some fatigue, some post-nasal drip. Symptoms can be vague at times, but the real criteria is it has to last beyond three months. For recurrent acute sinusitis, these are the patients who come back every couple months or so for antibiotics, clear up with antibiotics, then usually get another infection within another three to four months. So when a patient gets an active sinus infection of four episodes or more per year requiring antibiotic treatment, that qualifies as recurrent acute rhinosinusitis.

Deborah Howell (Host): Okay, got it.

Kathy Yu-Syken, MD: So for recurrent acute rhinosinusitis, the episodes usually last less than three months, versus chronic sinusitis which is ongoing for longer than three months.

Deborah Howell (Host): Got it. Now are there some ways that someone prone to sinus infections can help prevent them from occurring?

Kathy Yu-Syken, MD: Of course. There are a lot of over-the-counter remedies you can try, such as a sinus saline lavage, which is what we call a sinus rinse. They sell them over the counter and we use it to flush out the nose. And it's hypertonic saline, which usually helps rinse out and wash out the nose and decrease some of the congestion in the nose. There are a variety of over-the-counter nasal steroid sprays. Some of the common names would be Flonase or Rhinocort. And those topical steroids also decrease inflammation inside the nasal cavity and sinus cavities. Other sprays such as Xlear are emollients and moisturizing, and they have natural ingredients that are antibacterial. For people who have allergies, the symptoms of the allergies must be controlled with either over-the-counter prescription medications versus allergy shots so that the allergies don't contribute to the development of a sinus infection.

Deborah Howell (Host): Got it. Okay, and what are some common and effective medical treatment options for chronic sinusitis?

Kathy Yu-Syken, MD: So some of the common effective medical treatments could be the same that are things that patients would usually do to prevent a sinus infection, such as the sinus rinses, a nasal steroid spray, or Xlear nasal spray. However, for chronic sinusitis, antibiotic duration of at least three to four weeks is necessary to eliminate all of the bacterial biofilms that may be causing the infection. So this would be an extended course, much longer than most primary care doctors would prescribe. However, if it does not work, then we can always try a different antibiotic or there are other options such as procedures that can help. A common antibiotic that I prescribe is Ceftin, which is broad spectrum. And another one is called Bactrim, which also covers resistant organisms like MRSA, which is methicillin-resistant staph aureus.

Deborah Howell (Host): Got it. Now let's talk about prevention a little bit. Are there some ways that someone prone to sinus infection can help prevent them from occurring?

Kathy Yu-Syken, MD: Yes. Make sure that the allergies or any underlying condition that would aggravate the sinuses to be congested, such as acid reflux, a cold, allergies, to have the congestion from those conditions to be under control because that could be the underlying reason why a patient would be continuing to develop sinus infections. Another reason would be if there is a blocked sinus and there is no aeration of the sinus and no outflow tract for the mucus stream. In that case, you know, products like sinus rinses, nasal steroid sprays, allergy medications, and acid reflux medications, if the patient has symptoms of allergies, would be very helpful to help prevent these sinus infections.

Deborah Howell (Host): Okay. Now, when the first attempts at treating chronic sinusitis, they're not effective. What are some other treatment options to consider?

Kathy Yu-Syken, MD: So the next treatment option that I usually recommend when patients fail adequate medical management regimen is a procedure that's easily done in the office. It's called in-office sinus balloon dilation or also known as balloon sinuplasty. And what this does is it alleviates the obstruction of block sinus openings and restores normal ventilation and airflow and function of the sinuses. The mucus that build up in the sinuses can then drain through the enlarged opening made by a balloon dilation. And so therefore it helps the function of the sinuses. So balloon sinuplasty is a minimally invasive procedure and it helps widen the sinus pathways and improves breathing and reduces the risk and recurrence of sinus infection. This type of procedure can mostly be performed under local anesthesia in the office, sometimes in more complex cases on an outpatient basis in the operating room, but it both means that the patient goes home pretty soon afterwards. During this procedure, a thin probe or catheter is inserted through the nostril into the sinus cavities. Once in the correct position and confirmed, a tiny balloon at the end of the catheter is gently inflated and thus widens the sinus pathway. Once the obstructed and narrowed region has been opened, the balloon is then deflated and removed along with the catheter, thus restoring normal breathing and sinus function.

Deborah Howell (Host): That sounds like a dream. Now what's the typical recovery time after a balloon sinuplasty?

Kathy Yu-Syken, MD: Since it is a minimally invasive procedure, most patients only need a few days, such as a weekend, to recover. In addition, most patients do not end up needing much prescription pain meds at all. They usually take over-the-counter Tylenol, which is sufficient. Post-procedure symptoms would resemble that of a cold and would include things like nasal stuffiness, some nasal discharge, or even some sinus pressure. But usually the recovery is not bad. It's similar to having symptoms of a cold for about three to five days.

Deborah Howell (Host): Wow, that sounds wonderful. Now what steps would you recommend someone take if they feel like they may have a chronic sinus condition?

Kathy Yu-Syken, MD: So first off, I think they should seek the advice of a specialist or their primary medical doctor. Some of the over-the-counter meds that they can try prior to doing so would be a sinus rinse, a saline sinus lavage, and there are multiple brands out there. A nasal steroid spray such as Flonase or Rhinocort or Sensimist, those are available over the counter and can be used after the sinus rinse. And for those with allergy symptoms, which include sneezing, runny nose, or itchy watery eyes, they should try over-the-counter allergy medications. Some of the popular ones are Zyrtec or Allegra or the newest one out there on the market, which I think to be very effective, is called Xyzal. If there is no improvement with the over-the-counter treatment methods, then definitely consult with an ENT specialist specializing in sinus disorders.

Deborah Howell (Host): Thank you so much, Dr. Yu-Syken, for being on our show and for all the good work you do. We learned a lot today.

Kathy Yu-Syken, MD: Thank you so much for having me.

Deborah Howell (Host): It's been a pleasure. For more information or to listen to a podcast of this show, go to MemorialCare.org. That's MemorialCare.org. That's all for this time. Thank you so much for listening and have yourself a fantastic day.