Bill Klaproth (Host): This is Check-Up Chat with EvergreenHealth. I'm Bill Klaproth. In this episode, we'll talk about understanding sinus conditions, exploring what your sinuses actually do, common issues, and share expert advice to help you breathe easier with Dr. Galit Almosnino from EvergreenHealth. Dr. Almosnino, welcome.

Dr. Galit Almosnino: Thank you, Bill. It's great to be here.

Host: Great to talk with you. This is a big topic because a lot of people deal with sinuses all the time. So, I'm so happy to talk to you today. So, let's start with the basics. What exactly are the sinuses and what do they do?

Dr. Galit Almosnino: Sure. So, the sinuses are basically just hollow kind of space or air-filled cavities within our face, and within the bones around our nose. And they're lined with soft tissue or mucosa. And they basically produce mucus. They're usually empty. Essentially, air will pass through them on the way to the lungs. And the mucus kind of helps humidify that air. It helps filter and trap bacteria. And then, they also kind of play a role in protecting the brain from trauma and infection. So, they do a lot things.

Host: Okay. So, that mucus actually is something that is good then.

Dr. Galit Almosnino: Absolutely. Sometimes though, as many people know, it can be overproduced and that can be a little problematic.

Host: Right, right. So like I said before, this is a big topic. Why do so many people seem to struggle with sinus problems, especially during certain times of the year?

Dr. Galit Almosnino: Sure. So, kind of as I've described, the other way to think about sinuses is kind of perfect, dark, warm, moist caves in our faces. And as you can imagine, that's just also the perfect environment for bacteria and even fungal spores to thrive in. And so, every person has differences in their immune system, and some people are just more prone to getting more severe and chronic infections as a result.

There's also people that are prone to infections just because of anatomic obstruction within the nasal cavity and within the openings to the sinuses. And then, of course, allergies can contribute to increased inflammation and therefore obstruction of those sinuses as well. For some people, those allergies are year-long, but for many it's seasonal. And that's when we'll see kind of that uptick in nasal congestion and pressure and things like that.

Host: Yes, all of that stuff, that's not very fun. So, sinuses are basically warm, moist cavities where fungus can thrive. So, there's probably a host of sinus conditions out there. Knowing that, what are the most common sinus conditions that you frequently treat?

Dr. Galit Almosnino: Yeah. So, as a subspecialist, I'm seeing usually chronic sinusitis. And that's really just defined as a sinus infection or symptoms of a sinus infection for over three months. And these are usually people that have tried very common medical treatments such as antibiotics, maybe even steroids, saline rinses, nasal decongestion, but are still having those symptoms.

The other thing that I also treat is what's called recurrent acute sinusitis. Those are the people that maybe are relatively okay between infections, but are getting three, four or five infections a year that are requiring antibiotics. And then, like you mentioned, the other thing I'll often see is called fungal sinusitis. And that really is just a fungal infection within the sinuses that needs to be treated.

Host: So then, that brings up the next question. You said you treat basically chronic sinusitis, one of the main things you treat. How do you treat that? What do we need to know about that?

Dr. Galit Almosnino: Yeah. So like I mentioned, that one-off sinus infection once a year, things like that, that you may even need antibiotics for, that doesn't necessarily require much more. But those people that are prone to the chronic infections, that's when we start to think about, once we've kind of maxed out our medical management, do we need to consider surgical options? And the idea there is really, you know, I can't take away the disease process, but we can open up those sinuses widely, allow them to drain and kind of heal and allow to function properly again.

Host: That's really interesting. So, you said some people get the either "Once-a-year, I get this" kind of a thing. People just know it, "Yeah. Every year, I get this." But you're talking about the chronic conditions then.

Dr. Galit Almosnino: Yeah, exactly. Those people, maybe they get some really temporary relief from antibiotics, but their symptoms come back very quickly, or maybe the antibiotics do work, but again, they're taking three, four, or five courses of antibiotics a year. And that can obviously wreak a lot of on our bodies.

Host: Yeah, absolutely. So, is it that point then when someone should come to see you is if it's more than once a year? Like you said, if this is chronic and it's going on for what months at a time, that's when it's time to come see someone like you instead trying to tough it out with over-the-counter medications. Is that right?

Dr. Galit Almosnino: Yeah, absolutely. Sinus infections can really severely affect quality of life. And so, when you're starting to have those symptoms for over three months or those symptoms are persistent, that's a great time to see an ENT. And then, like I said, also those people that are just having those multiple infections a year, that's another great indication to come see us.

Host: Absolutely. So, like I said, this is a big topic. What's one piece of advice you wish more people knew when it comes to taking care of their sinuses?

Dr. Galit Almosnino: Yeah, it's a hard one. The first one I want to say is, I wish people were more aware of kind of what to do when they get a cold so that it doesn't always become a sinus infection. Because for many people, just using saline sprays daily, using decongestants like Flonase can be really beneficial in just reducing that inflammation during a cold and allowing the sinuses to continue to drain.

But like I said, sinus disease can really impact quality of life. And so, what I would say is if you're listening to this and you're like, "Wow, I always have facial pressure or headaches or pain or congestion," that's not normal. And again, your quality of life can be significantly improved if we try and address those problems. So, don't be afraid to talk to your primary care doctor, or come to an ENT to at least have those symptoms evaluated.

Host: Yeah, that makes a lot of sense. You said something there that just really caught my ear where you said things people can do when they get a cold so it doesn't progress into a sinus infection. What are some of those things?

Dr. Galit Almosnino: Yeah. So, I'd say, again, the big one is, like I said, saline spray is great and it's very safe. You can use it two, even three times a day in your nose. Topical sprays like Flonase, I think there's a common misconception because they're often steroid sprays, and there's a misconception that there's going to be a lot of absorption and side effects.

But the nice thing about topical steroid sprays is they have very, very, very low systemic absorption. So, they're super safe to use for the most part in the nasal cavity. And again, they can really help reduce that inflammation and just provide some symptom relief during the common cold.

Host: All right. So if you have the common cold or the runny nose, the blowing, right, stuffiness, that's when it's time to use something like you just mentioned?

Dr. Galit Almosnino: Absolutely. And kind of our official definition of sinusitis is that if those symptoms are lasting greater than seven days, we start to become a little more suspicious that it might be bacterial in nature rather than just the common virus causing a cold. And that's also a good time to maybe consider seeing your primary care, because at least there should be that discussion of if you need antibiotics or not.

Host: And is that the usual course of treatment? If someone comes to you with chronic sinusitis, is it usually antibiotics? Is that the general treatment?

Dr. Galit Almosnino: It's a great question. Oftentimes patients are coming to me when they've already been on multiple rounds of antibiotics. And so, at that point we're talking about getting a culture if possible, maybe getting some imaging to see what the state of the sinuses is. So, I'm usually seeing patients a little bit kind of down the line at that point. But antibiotics can be a possibility depending on the patient.

Host: And then, generally, the outcomes after seeing an ENT like yourself, generally I would imagine are good with professional treatment. People can more better, if that's a phrase, manage their sinus conditions. Would that be right?

Dr. Galit Almosnino: Absolutely. Again, the immune system here plays a very significant role as well. And sometimes we need to do further evaluation, kind of maybe address allergies, so on and so forth. But overall, I'd like to think that we definitely give more direction for improved outcome for patients with chronic sinusitis.

Host: Absolutely. And the question I had earlier, you know, people just tough it out. "I'm going to just get through it. I don't want to go see the doctor." You're saying, "Hey, if it's really bothering you, if it's affecting your quality of life, come see us. We will be able to help you with this."

Dr. Galit Almosnino: Exactly. Absolutely. That's exactly it.

Host: I love it. That's so good. Well, Dr. Almosnino, thank you so much. This has really been interesting. Anything else you want to add? Anything we missed at all?

Dr. Galit Almosnino: I don't think so. I think that's a pretty good coverage of, like you said, a very large topic. So, thank you so much for having me on here, Bill.

Host: Absolutely. Well, I'd love to have you on again. I know there's more ground to cover when it comes to sinuses. We're just kind of giving the brief overview, but we'd love to have you on again. This has really been great. Thank you again.

Dr. Galit Almosnino: Thank you.

Host: And once again, that is Dr. Galit Almosnino. Our experts at EvergreenHealth ENT plus Head and Neck Surgical Care have advanced training and years of experience treating conditions in the ear, nose, and throat. Schedule your appointment at one of our convenient locations in Kirkland and Monroe by visiting evergreenhealth.com/ent. And this wraps up another episode of Check-Up Chat with EvergreenHealth. And please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. And for more health tips and updates, follow us on your social channels. Thanks for listening.