Joey Wahler: It's a condition that causes a variety of uncomfortable symptoms sometimes including facial pain. So we're discussing the treatment of sinusitis. Our guest, Dr. Mariah, Pate an otolaryngologist specializing in head and neck surgery. This is BayCare Health Chat. Thanks for listening. I'm Joey Wahler. Dr. Pate, thanks for joining us.

Dr. Mariah Pate: Thank you for having me.

Joey Wahler: Great to have you with us. So first, naturally I have to start by asking what exactly is an otolaryngologist?

Dr. Mariah Pate: Well, that's a great question. A lot of people ask me that question when I tell them my title. So otolaryngology is the study of the ear, nose, and throat. So I'm also known as an ear, nose and throat doctor, and we also are known as ENT physicians, so a lot of people will call me an ENT versus an otolaryngologist.

Joey Wahler: Gotcha. Now you see, I considered just saying you're an ear, nose and throat doctor, but I didn't want to take the easy way out. I wanted to make sure I had the right pronunciation.

Dr. Mariah Pate: Right.

Joey Wahler: And then a natural second question here would be, what exactly is sinusitis?

Dr. Mariah Pate: So you have sinuses in yourface that are air filled spaces around the nose, and these cells are lined with mucus cells and Celia that help the drainage flow through your nose. And so sinusitis is a condition where the sinuses become inflamed and it can be both short-term and long-term, and can cause lots of different symptoms.

Joey Wahler: And do those with it usually already have an underlying condition?

Dr. Mariah Pate: So many people with sinusitis can have other conditions that can make it worse. And so one can be nasal obstruction, either enlarged tissues inside the nose. We call those turbinates so those can get really enlarged. Or sometimes people have what we call a septal deviation where the dividing part of the nose or the septum goes to one side. So it blocks some of the drainage pathways that are supposed to be open. Additionally conditions like allergies, either seasonal or perennial meaning all year long can cause the sinusitis to come on more often. Also, patients who have asthma are more susceptible. Those who have eczema are more susceptible because they have more allergic characteristics in their body.

Joey Wahler: And what are the typical sinusitis symptoms?

Dr. Mariah Pate: So there's different types of sinusitis. The first type is what we call acute sinusitis, and that's what most people think of as a sinus infection. And so people who have acute sinusitis will have thick drainage from the nose. It will go down the back of the throat, or they'll blow it out the front. They'll have worsening nasal congestion. They'll feel facial tenderness, especially around the cheeks and they can also experience some teeth pain. People will have ear pressure, headache, loss of smell. They can have cough, fatigue, fever. So just overall, feeling pretty crummy, kind of like an upper respiratory infection, but more severe. And that lasts more than just a few days.

Joey Wahler: And then other types of sinusitis.

Dr. Mariah Pate: So there's also what we call chronic sinusitis. So chronic sinusitis is also inflammation of the sinuses. Similar symptoms, but it lasts for a longer amount of time. So patients who have sinus symptoms for more than 12 weeks or have more than four infections a year are considered to have chronic sinusitis. And so these symptoms are very similar. You'll find that patients have facial pressure, congestion, drainage they'll also have a loss of smell more chronic headaches, many times in the frontal region, right at the forehead or under the cheeks. They can also have fever, but it's not as common. Also, bad breath can occur. People can have worsening fatigue, cough, and then ear pain as well, or sometimes ear full where they can't pop their ears. And these symptoms, just happen every day, all day. And they interfere with patient's lives.

Joey Wahler: And this facial pain or pressure, as you called it. Tell us a little bit more about what exactly that feels like.

Dr. Mariah Pate: So people who have more of a sinus infection, they'll find that if they touch their face, they'll have kind of point tenderness. They have that kind of sharp pain when they touch their face. And they can also feel, obviously the pressure and it can bring, headaches on that can, worsen throughout the day. Those patients who have chronic sinusitis, sometimes it can feel a little bit different. It almost feels like the atmosphere is changing or the pressure is changing and you have that kind of dull ache either in the forehead or the cheeks. And many people who have chronic headaches or migraines, sinus problems or chronic sinusitis, can also bring those headaches on. And so those headaches can be caused by the sinusitis as well.

Joey Wahler: Gotcha. So some may be wondering at this point, how does sinusitis differ from, say, the common cold?

Dr. Mariah Pate: Yeah, and that's a very important question because, deciding if you need to go to the doctor is difficult for some people. So many people who have upper respiratory infections have similar symptoms to what I described earlier, the drainage, the congestion, headaches, sometimes fever, fatigue. So we find that people who have sinus infections, the drainage typically becomes thicker and sometimes changes colors to yellow or green. That's not an absolute, but it's a good indicator that things may be getting worse and turning into a bacterial infection.

And if the symptoms last for more than a week, then you know that, it's not a typical upper respiratory infection. So upper respiratory infections, or the common cold is generally caused by a virus, and so that is usually a shorter time period, and once that has gone longer, it turns into more of a bacterial infection, which requires different treatments such as antibiotics.

Joey Wahler: And the week timeframe. The one-week timeframe that you just mentioned, doctor, is that about the point where someone should see a doctor if they're having these symptoms?

Dr. Mariah Pate: So at about the week time point, I have patients really kind of pay attention to what's going on. They can check in with their physician. But generally, you know, at 10 days, that's the point where you should definitely make an appointment. And for children, it's a little bit different. Children, usually we can go a couple more weeks, sometimes up to three weeks before we are concerned about sinusitis in that age group.

Joey Wahler: So what at-home treatments are available to address this condition?

Dr. Mariah Pate: So I'm sure if you go to any drugstore, you'll find a whole aisle of cold and cough and sinus remedies. So some things that I recommend; these treatments can help with both an upper respiratory infection and sinusitis. The first thing is of course getting plenty of rest and hydrating. You can also use nasal saline in the nose. That can either be a spray or an irrigation. Patients can also use a nasal steroid in the nose. This is also called Flonase or fluticasone, and that can be bought over the counter. Many patients find that doing steam showers can help. Of course, if they have headaches or they're fatigued, there's over the counter pain relievers like Tylenol and Motrin.

And there's some other treatments that are a little short term, more short term such as Sudafed. So that helps a lot with the pressure and the congestion that many patients have. And then nasal sprays like Afrin can be used to temporarily relieve the congestion. One note, the Afrin is something that is readily available over the counter, but if you use it for more than three days, your nose actually gets used to it and you can have pretty severe rebound congestion. So it's something to use just very short term if you're having symptoms.

Joey Wahler: Yeah, as you mentioned, there certainly are a wide variety of choices. Anytime you go to the store for these meds, I think maybe you and I need to FaceTime in the aisle the next time I need to make a decision, right?

Dr. Mariah Pate: Absolutely.

Joey Wahler: Couple of other things. So let's talk now about surgery, if that's needed. What are those options?

Dr. Mariah Pate: Right. So, sinus surgery is needed for some patients. If you're having that, long-term infection or if you're getting multiple infections per year. It gets to the point where the sinuses are so inflamed that they can't drain the way they're supposed to, and so mucus gets backed up. Infections become more common and people's symptoms worsen. And so first sinus surgery, there's different types of surgery. So the first type of sinus procedure can be done in the operating room, and we call that surgery functional endoscopic sinus surgery. And so a lot of people will hear this is kind of like the rotor rooter the clean out.

And so those are some things patients will say to friends and family. And so this procedure is actually done in the operating room under general anesthesia, so you're completely asleep during the procedure. As a surgeon, I use scopes and long tools to go in through the nose to manually cut open the sinus cavities. And so this allows the sinuses to drain. I'm able to remove any type of debris or mucus out of the sinuses. And surgery usually takes about two hours. Sometimes we use tools that help with safety and image guidance for more severe cases. And most patients can expect recovery of about five to seven days after a sinus procedure.

Sometimes if the septum, which is again the middle part of the nose that divides the two nasal cavities, sometimes if that's deviated, it also has to be corrected to allow the sinus surgery to be performed. And so that can also lengthen recovery. So a patient who also has a septoplasty, they're looking at a probably a full seven days of recovery. So I usually tell my patients to take about five to seven days off after sinus surgery. So some patients are also candidates for sinus procedures in the office setting. These are less invasive procedures. In this procedure, same scopes and tools are used to open the sinuses and instead of sharp tools, we use dilators that gently dilate the sinus.

So the opening is enlarged and the sinus can drain and become healthy. So this procedure is minimally invasive and it does not require the patient to go under general anesthesia. It's local anesthesia. So the patient is numb topically in the nose to allow a good pain control during the procedure. And so for those patients, the procedure generally takes about 30 to 45 minutes, and the recovery is generally about 24 hours. Sometimes as long as 48 hours for more complicated cases. So there's many options. So it just depends on the severity and the patient in order to decide which avenue is the best type of treatment for that patient.

Joey Wahler: And in any case, if there is surgery performed In terms of benefits patients can expect, do these procedures typically hold for a lifetime or no?

Dr. Mariah Pate: So that's a good question that a lot of people are curious about. It all depends on the patient themselves. So some people have severe inflammation that goes along with their sinus problems, and depending on the severity, it can sometimes lead to future procedures. But most patients do well with sinus surgery at least for a couple years. And it's the same thing with the in-office dilation. There is a small percentage of patients that need revision surgery. And so most patients will find that after sinus surgery, after their initial recovery, that they breathe much better, they have less pressure, they have less drainage, and they overall have less fatigue.

Over time sometimes if the inflammation continues, it can lead the passageways to close back up leading to the need for revision surgery. So it's a small amount of patients and it depends on. How patients are and how severe they are before the surgery is performed. There is a certain condition called nasal polyps that can happen in the nose, and those patients with nasal polyps, many of them have longer term problems even with surgery. So we make sure to counsel the patient and let them know they may need additional procedures in the future and may need other medications to help manage their condition.

Joey Wahler: Well certainly sounds as though there are many options depending upon each patient's particular situation. Folks, we trust you're now more familiar with treatment of sinusitis, Dr. Mariah Pate. Thanks so much again.

Dr. Mariah Pate: Thank you so much for having me.

Joey Wahler: And for more information, please visit BayCare.org. Again, that's BayCare.org. If you found this podcast helpful, please do share it on your social media, and thanks again for listening to BayCare HealthChat, hoping your health is good health. I'm Joey Wahler.