For weeks you've been suffering with headaches, pressure around your eyes, thick, colored mucus when you blow your nose. Your chronic sinusitis is back.
Chronic sinusitis isn't just one disease. There's a spectrum of disease that require different types of treatment so an accurate diagnosis and evaluation to pinpoint the cause of the inflamed sinus cavities is paramount.
Tune in to SMG Radio as Dr. Giant Lin, an Ear, Nose and Throat specialist with Summit Medical Group, discusses the different types of chronic sinusitis, current treatment protocols, treatments that will soon be available and technology that may help the patient.
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Chronic Sinusitis: Current Treatment Protocols
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Learn more about Dr. Giant Lin
Giant Lin, MD
Dr. Giant Lin is an Ear, Nose and Throat specialist with Summit Medical Group. Dr. Lin's research has focused on the biomarkers for sinonasal and nasal tumors and the advanced resection of these rare tumors. Quality of life and outcome studies in the treatment of chronic sinusitis occupy much of his research time today.Learn more about Dr. Giant Lin
Transcription:
Chronic Sinusitis: Current Treatment Protocols
Melanie Cole (Host): Each year, millions of adults complain of headaches and pressure around the eyes. Could it be chronic sinusitis? My guest today is Dr. Jian Lin. He's a rhinologist specializing in sinus disorders with Summit Medical Group. Welcome to the show, Dr. Lin. What is chronic sinusitis?
Dr. Jian Lin (Guest): First of all, thanks for having me on the show. I've very happy to be here. Chronic sinusitis is really, it's not one, single disorder; it's the end pathway of many types of diseases that can lead to inflammation within your nose or sinuses. Many criteria are out there to diagnose chronic sinusitis, but, basically, if there's any inflammation within your nose, and you're symptomatic from it, that's chronic sinusitis. Generally, you need to have symptoms for 12 weeks for it to be considered chronic, however. It's always good to keep that in mind.
Melanie: So, that would have been my next question, how long does someone have to have these symptoms and what are some red flags you really want them to keep an eye on to send them to an ENT or rhinologist, such as yourself?
Dr. Lin: Well, chronic sinusitis is defined as symptoms for greater than 12 weeks. I think many of us have colds or a much shorter duration symptoms with our nose, but if it’s more than 12 weeks, I think that warrants an ENT evaluation. Chronic sinusitis can be of many types and the symptoms that we usually look for is facial pain/pressure and, more specifically, reduction in the sense of smell. I always say that a loss of sense of smell, even a mild or small of loss in your ability to smell, is a very specific symptom that makes chronic sinusitis a more likely diagnosis.
Melanie: If someone does come to you, how do you diagnose this and then what's the first line of defense?
Dr. Lin: Well, the first part of any good ENT or rhinology evaluation is clinical history, of course. So, I always start with talking to the patient and I see what symptoms they have. I look for, again, loss of smell, facial pain, pressure, trouble breathing from your nose, congestion, nasal blockage, and then, after having obtained a good history, and moving on to a physical exam portion. Oftentimes this includes an endoscopy for me to evaluate whether you have nasal polyps or if you have infection. This leads me to my next point. Sinusitis is many different diseases, so the first step is to tell whether this is sinusitis from nasal polyps, whether it's from allergies, is this infection, and so forth. And, after that, with a good, thorough evaluation, we can come up with a good treatment plan.
Melanie: Many people assume that's it's right away an infection and that they need antibiotics. What do you tell them when they ask you about that?
Dr. Lin: I tell them that in the beginning, I think a lot of it depends on your length of symptoms and duration of symptoms. It's very difficult in the initial phase to tell whether you have a bacterial sinus infection, whether you have allergies, whether you have a cold, or viral rhinosinusitis. That's very difficult to tell. I think anything that's less than 10 days, usually, unless the patient has a strong history of chronic sinusitis, if it's anything less than 10 days, we usually assume that it's viral. If it's more than 10 days, that's when I start to consider antibiotics for use, especially if I see any purulence or any infection on my examination.
Melanie: So, then, you'll consider antibiotics and then what else will go on with the patient? What are some other things that they can try and are there any over-the-counter medications that might work for this, as well?
Dr. Lin: Yes, that is a very good question. Antibiotics is definitely a mainstay of treatment for bacterial sinusitis, meaning that sinus infection is coming from bacteria that's invading or present or brewing inside of the sinuses. Oftentimes, the bacteria will cause inflammation within the nose and swelling within the mucosa that makes the sinuses unable to drain. Oftentimes, we give steroids which is a very powerful decongestant in the short-term to help your sinuses drain. In addition, we give saline rinses to your nose so that you can help your nose along with in regards to this drainage pathway. Some of the over-the-counter medicines are very helpful as well. In recent years, many of the nasal steroid, topical steroids, have become over-the-counter. In fact Flonase, Rhinocort, and Nasacort, which all used to be prescription, only those are all over-the-counter. Those can all be helpful as a decongestant and to decrease inflammation in your nose when you have any sinus infection. And, the other medicines such as Mucinex and allergy medicine can also be of health and benefit for any sinus infection, depending on the etiology of your sinusitis.
Melanie: And, you mentioned nasal irrigation. What do you want people to know about that? Neti pots--they see a lot of things in the media or, you know, the pharmacy. What are they supposed to do with those? How often? It's not a very comfortable thing to do.
Dr. Lin: No, it is not very comfortable. Initially, I think, there's always some reticence to get started, but I would say that many of the patients that start using it tell me that it actually is very comfortable and is very soothing to use, once you get used to it. The trick is to make sure that what you're irrigating with is the same salt concentration as your body. So, we call that “isotonic”. Remember, let's say you put your eyes in regular water, now that's going to sting, but there are these things called “saline pools”, or pools where the water is the same salt concentration as your blood, and in these pools, you can actually open your eyes wide open without any pain. Same thing goes with your sinuses. If you're able to irrigate and rinse with water that's the same concentration of salt as your body, then that doesn't sting or hurt at all. In fact, many people find it soothing, and I feel it helps patients along by helping rinse out or remove any irritants, allergens, infection, or purulence that may be in the nose because we do know from studies that when you have an infection, whether that be viral or bacterial, your body and your sinus’ ability to clear the mucus out of itself is much decreased.
Melanie: So, it's sort of like giving your sinuses a shower, as it were?
Dr. Lin: Yes. I think that's a great way to look at it. You're kind of helping it along because it can't. It's kind of you're converting a slow-flowing river into a fast-flowing river and we know that, from experience, that slow-flowing rivers tend to be mucky and dirty. But, if you think about the rivers that you see, fast-flowing rivers tend to be very clean.
Melanie: Dr. Lin, if allergies are contributing to your sinusitis, is immunotherapy something that you may look at?
Dr. Lin: Absolutely. Now not everybody is an immunotherapy candidate. That requires a thorough exam and visit with one of our allergists but immunotherapy can definitely be helpful if allergy is found to be a significant or the main cause of your sinus infections because we do know that allergies can cause mucosal swelling and if this is the driver of your sinus inflammation, it can definitely be of benefit. Now, we can talk about nasal polyps as well. Oftentimes patients with nasal polyps will have immune or immunologic drivers that are contributing to nasal polyp formation and there's a specific allergic inflammatory type pathway that drives this type of inflammation and nasal polyp growth. Studies show that with appropriate patients and appropriate immunotherapy, you can reverse that pathway and, hopefully, decrease the chances of the nasal polyps in chronic sinusitis.
Melanie: If it's a recurrent infection, then what do you tell people about dealing with that?
Dr. Lin: Recurrent infections can be of many etiologies. I think that patients with recurrent infections warrant a thorough examination both by endoscopy, clinical history, and sometimes a CAT scan. Recurrent infections can from anatomic factors. Oftentimes, we need a CAT scan or a good physical exam to diagnose what type of anatomic factors or narrowing of the sinuses that's leading to the recurrent infection. Recurrent infection can be also from nasal polyps and these polyps block the drainage pathway of the sinuses and treating the nasal polyps in that case is really the mainstay of therapy for these patients with nasal polyps in recurrent infections. And, there are some patients with immunologic disorders or immunodeficiencies that can have recurrent infections. So, in this case, really increasing your immune defense system and finding out why you have immunodeficiency is the mainstay of the treatment. So, many types of inflammation can occur and I think the key is to find out the etiology of the underlying inflammation of your sinuses.
Melanie: Might there ever be a time when surgical intervention is necessary?
Dr. Lin: Absolutely. Surgical intervention is probably the best treatment options for patients with severe disease, but it is not for everyone. Usually, surgery is offered only after medical therapy has failed. And, when I said failed, I mean, you have to have failed multiple rounds of maximum medical management. This includes steroids, whether that be oral, topical, nasal, antibiotics, treatment or evaluation of allergies. Surgery, in my opinion, is very helpful in severe cases because it gives both the surgeon, the physician, as well as the patient a new treatment modality. In addition to removal of any disease, clearing of any infection, surgery lets us open up the sinuses in such a way that your nasal irrigations can really reach the sinuses and reach where the inflammation and polyps are forming. So, it gives us the ability to use topical irrigations and medicated irrigations to treat your sinus infection or sinus polyps or inflammation--whatever may be the cause or driver of your chronic sinusitis.
Melanie: So, in just the last few minutes, give your best advice for people that have some of these symptoms and red flags we've been discussing, what you really want them to know about chronic sinusitis and why they should come to Summit Medical Group for their care.
Dr. Lin: Well, I think chronic sinusitis is a very complex disease. Again, there is not a single, common path of physiology for chronic sinusitis. Thus, I think an accurate treatment and diagnosis is paramount and we know that leads to better outcomes. For patients, I would say that if you have symptoms for more than three months that seems to not get better with antibiotics, if you have trouble breathing from your nose, or if you have trouble with your sense of smell, then I think those are very specific signs that I think you may benefit from evaluation from an ear, nose, and throat physician or rhinologist, like myself. Here at Summit Medical Group, we've really combined the treatment of chronic sinusitis kind of bringing in the best of both worlds. The allergist and the ear, nose, and throat doctor work hand-in-hand and I think, as physicians, allergists are better at treating medical things, and as ENT surgeons, we're better treating surgical things, and here we really combine the best of both worlds by having the patients oftentimes see both the allergist and the ear, nose, and throat doctor, if that's what they need. We're at the cutting edge of using the newest technology to treat chronic sinusitis. We use image guided surgery or a GPS of your head to do surgery, if that's decided to be the best mode of treatment. We're also involved in clinical research. We're very active in new studies of using drug eluting stents to shrink polyps and in-office treatment of sinusitis using new technology and I think down the line, it's going to bring us to the point where we have to do surgery less frequently, which is going to be our goal. Our allergy colleagues also are very active in doing research in using anti-IL4, IL5, IL13 agents as well as treatment of patients with high levels of allergies and immunoglobulin type E. We are very active in clinical studies to improve patient care and, you know, I think we approach things from a comprehensive standpoint and that's going to lead to better patient outcomes.
Melanie: Thank you so much for being with us today. It's great information. You're listening to SMG Radio and for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Chronic Sinusitis: Current Treatment Protocols
Melanie Cole (Host): Each year, millions of adults complain of headaches and pressure around the eyes. Could it be chronic sinusitis? My guest today is Dr. Jian Lin. He's a rhinologist specializing in sinus disorders with Summit Medical Group. Welcome to the show, Dr. Lin. What is chronic sinusitis?
Dr. Jian Lin (Guest): First of all, thanks for having me on the show. I've very happy to be here. Chronic sinusitis is really, it's not one, single disorder; it's the end pathway of many types of diseases that can lead to inflammation within your nose or sinuses. Many criteria are out there to diagnose chronic sinusitis, but, basically, if there's any inflammation within your nose, and you're symptomatic from it, that's chronic sinusitis. Generally, you need to have symptoms for 12 weeks for it to be considered chronic, however. It's always good to keep that in mind.
Melanie: So, that would have been my next question, how long does someone have to have these symptoms and what are some red flags you really want them to keep an eye on to send them to an ENT or rhinologist, such as yourself?
Dr. Lin: Well, chronic sinusitis is defined as symptoms for greater than 12 weeks. I think many of us have colds or a much shorter duration symptoms with our nose, but if it’s more than 12 weeks, I think that warrants an ENT evaluation. Chronic sinusitis can be of many types and the symptoms that we usually look for is facial pain/pressure and, more specifically, reduction in the sense of smell. I always say that a loss of sense of smell, even a mild or small of loss in your ability to smell, is a very specific symptom that makes chronic sinusitis a more likely diagnosis.
Melanie: If someone does come to you, how do you diagnose this and then what's the first line of defense?
Dr. Lin: Well, the first part of any good ENT or rhinology evaluation is clinical history, of course. So, I always start with talking to the patient and I see what symptoms they have. I look for, again, loss of smell, facial pain, pressure, trouble breathing from your nose, congestion, nasal blockage, and then, after having obtained a good history, and moving on to a physical exam portion. Oftentimes this includes an endoscopy for me to evaluate whether you have nasal polyps or if you have infection. This leads me to my next point. Sinusitis is many different diseases, so the first step is to tell whether this is sinusitis from nasal polyps, whether it's from allergies, is this infection, and so forth. And, after that, with a good, thorough evaluation, we can come up with a good treatment plan.
Melanie: Many people assume that's it's right away an infection and that they need antibiotics. What do you tell them when they ask you about that?
Dr. Lin: I tell them that in the beginning, I think a lot of it depends on your length of symptoms and duration of symptoms. It's very difficult in the initial phase to tell whether you have a bacterial sinus infection, whether you have allergies, whether you have a cold, or viral rhinosinusitis. That's very difficult to tell. I think anything that's less than 10 days, usually, unless the patient has a strong history of chronic sinusitis, if it's anything less than 10 days, we usually assume that it's viral. If it's more than 10 days, that's when I start to consider antibiotics for use, especially if I see any purulence or any infection on my examination.
Melanie: So, then, you'll consider antibiotics and then what else will go on with the patient? What are some other things that they can try and are there any over-the-counter medications that might work for this, as well?
Dr. Lin: Yes, that is a very good question. Antibiotics is definitely a mainstay of treatment for bacterial sinusitis, meaning that sinus infection is coming from bacteria that's invading or present or brewing inside of the sinuses. Oftentimes, the bacteria will cause inflammation within the nose and swelling within the mucosa that makes the sinuses unable to drain. Oftentimes, we give steroids which is a very powerful decongestant in the short-term to help your sinuses drain. In addition, we give saline rinses to your nose so that you can help your nose along with in regards to this drainage pathway. Some of the over-the-counter medicines are very helpful as well. In recent years, many of the nasal steroid, topical steroids, have become over-the-counter. In fact Flonase, Rhinocort, and Nasacort, which all used to be prescription, only those are all over-the-counter. Those can all be helpful as a decongestant and to decrease inflammation in your nose when you have any sinus infection. And, the other medicines such as Mucinex and allergy medicine can also be of health and benefit for any sinus infection, depending on the etiology of your sinusitis.
Melanie: And, you mentioned nasal irrigation. What do you want people to know about that? Neti pots--they see a lot of things in the media or, you know, the pharmacy. What are they supposed to do with those? How often? It's not a very comfortable thing to do.
Dr. Lin: No, it is not very comfortable. Initially, I think, there's always some reticence to get started, but I would say that many of the patients that start using it tell me that it actually is very comfortable and is very soothing to use, once you get used to it. The trick is to make sure that what you're irrigating with is the same salt concentration as your body. So, we call that “isotonic”. Remember, let's say you put your eyes in regular water, now that's going to sting, but there are these things called “saline pools”, or pools where the water is the same salt concentration as your blood, and in these pools, you can actually open your eyes wide open without any pain. Same thing goes with your sinuses. If you're able to irrigate and rinse with water that's the same concentration of salt as your body, then that doesn't sting or hurt at all. In fact, many people find it soothing, and I feel it helps patients along by helping rinse out or remove any irritants, allergens, infection, or purulence that may be in the nose because we do know from studies that when you have an infection, whether that be viral or bacterial, your body and your sinus’ ability to clear the mucus out of itself is much decreased.
Melanie: So, it's sort of like giving your sinuses a shower, as it were?
Dr. Lin: Yes. I think that's a great way to look at it. You're kind of helping it along because it can't. It's kind of you're converting a slow-flowing river into a fast-flowing river and we know that, from experience, that slow-flowing rivers tend to be mucky and dirty. But, if you think about the rivers that you see, fast-flowing rivers tend to be very clean.
Melanie: Dr. Lin, if allergies are contributing to your sinusitis, is immunotherapy something that you may look at?
Dr. Lin: Absolutely. Now not everybody is an immunotherapy candidate. That requires a thorough exam and visit with one of our allergists but immunotherapy can definitely be helpful if allergy is found to be a significant or the main cause of your sinus infections because we do know that allergies can cause mucosal swelling and if this is the driver of your sinus inflammation, it can definitely be of benefit. Now, we can talk about nasal polyps as well. Oftentimes patients with nasal polyps will have immune or immunologic drivers that are contributing to nasal polyp formation and there's a specific allergic inflammatory type pathway that drives this type of inflammation and nasal polyp growth. Studies show that with appropriate patients and appropriate immunotherapy, you can reverse that pathway and, hopefully, decrease the chances of the nasal polyps in chronic sinusitis.
Melanie: If it's a recurrent infection, then what do you tell people about dealing with that?
Dr. Lin: Recurrent infections can be of many etiologies. I think that patients with recurrent infections warrant a thorough examination both by endoscopy, clinical history, and sometimes a CAT scan. Recurrent infections can from anatomic factors. Oftentimes, we need a CAT scan or a good physical exam to diagnose what type of anatomic factors or narrowing of the sinuses that's leading to the recurrent infection. Recurrent infection can be also from nasal polyps and these polyps block the drainage pathway of the sinuses and treating the nasal polyps in that case is really the mainstay of therapy for these patients with nasal polyps in recurrent infections. And, there are some patients with immunologic disorders or immunodeficiencies that can have recurrent infections. So, in this case, really increasing your immune defense system and finding out why you have immunodeficiency is the mainstay of the treatment. So, many types of inflammation can occur and I think the key is to find out the etiology of the underlying inflammation of your sinuses.
Melanie: Might there ever be a time when surgical intervention is necessary?
Dr. Lin: Absolutely. Surgical intervention is probably the best treatment options for patients with severe disease, but it is not for everyone. Usually, surgery is offered only after medical therapy has failed. And, when I said failed, I mean, you have to have failed multiple rounds of maximum medical management. This includes steroids, whether that be oral, topical, nasal, antibiotics, treatment or evaluation of allergies. Surgery, in my opinion, is very helpful in severe cases because it gives both the surgeon, the physician, as well as the patient a new treatment modality. In addition to removal of any disease, clearing of any infection, surgery lets us open up the sinuses in such a way that your nasal irrigations can really reach the sinuses and reach where the inflammation and polyps are forming. So, it gives us the ability to use topical irrigations and medicated irrigations to treat your sinus infection or sinus polyps or inflammation--whatever may be the cause or driver of your chronic sinusitis.
Melanie: So, in just the last few minutes, give your best advice for people that have some of these symptoms and red flags we've been discussing, what you really want them to know about chronic sinusitis and why they should come to Summit Medical Group for their care.
Dr. Lin: Well, I think chronic sinusitis is a very complex disease. Again, there is not a single, common path of physiology for chronic sinusitis. Thus, I think an accurate treatment and diagnosis is paramount and we know that leads to better outcomes. For patients, I would say that if you have symptoms for more than three months that seems to not get better with antibiotics, if you have trouble breathing from your nose, or if you have trouble with your sense of smell, then I think those are very specific signs that I think you may benefit from evaluation from an ear, nose, and throat physician or rhinologist, like myself. Here at Summit Medical Group, we've really combined the treatment of chronic sinusitis kind of bringing in the best of both worlds. The allergist and the ear, nose, and throat doctor work hand-in-hand and I think, as physicians, allergists are better at treating medical things, and as ENT surgeons, we're better treating surgical things, and here we really combine the best of both worlds by having the patients oftentimes see both the allergist and the ear, nose, and throat doctor, if that's what they need. We're at the cutting edge of using the newest technology to treat chronic sinusitis. We use image guided surgery or a GPS of your head to do surgery, if that's decided to be the best mode of treatment. We're also involved in clinical research. We're very active in new studies of using drug eluting stents to shrink polyps and in-office treatment of sinusitis using new technology and I think down the line, it's going to bring us to the point where we have to do surgery less frequently, which is going to be our goal. Our allergy colleagues also are very active in doing research in using anti-IL4, IL5, IL13 agents as well as treatment of patients with high levels of allergies and immunoglobulin type E. We are very active in clinical studies to improve patient care and, you know, I think we approach things from a comprehensive standpoint and that's going to lead to better patient outcomes.
Melanie: Thank you so much for being with us today. It's great information. You're listening to SMG Radio and for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.