Prakash Chandran: It seems like right now, sniffy noses and sore throats are more common than ever. But how do you know if you have a simple case of allergies versus something potentially more serious? We're going to talk about it today with Dr. Haidy Marzouk, a full-time physician at St. Joseph's Hospital and Associate Professor at SUNY Upstate Medical Center.

This is St. Joseph's Health MedCast, the podcast from St. Joseph's Health. My name is Prakash Chandran. So Dr. Marzouk, really great to have you here today. Thank you so much for your time. I just touched on some of the symptoms that people experience during this time of year. And in trying to figure out if it's something more than just allergies, I'd love to start by asking how common is it to have sinus issues?

Dr. Haidy Marzouk: Well, thank you so much for having me. It's a pleasure. Sinusitis is one of the most common things seen in the US population with regards to frequency. Most of us know someone if we have in ourselves had a sinus infection at some point. Chronic sinusitis, which is where the symptoms are a little bit more prolonged. It affects actually over 10% of the US population, and about close to 30 million people. So, it is extremely common.

Prakash Chandran: Okay. And when you say chronic sinusitis, can you talk a little bit about the symptoms of when someone has this?

Dr. Haidy Marzouk: Sure. So, chronic sinusitis is a chronic infection within the sinus cavity. So as you can imagine, people typically will have nasal congestion, drainage from the nose, facial pressure, or pain. Sometimes it can lead to sore throat, bad breath and other symptoms related to facial pain.

Prakash Chandran: Okay. Understood. And because it kind of expresses in the same way that allergies do sometimes, how do you know that you actually have sinusitis versus allergies?

Dr. Haidy Marzouk: Sure. That's a really common question I face on a day-to-day basis, and it's really not straightforward because a lot of times people have chronic allergies and that inflammation from the allergies will predispose them to more frequent or more persistent infections. So, the line can be fuzzy sometimes. But ways that we can differentiate sometimes is when symptoms come on quickly and more severely. We tend to think that there might be an infection going on. Forty percent of allergy sufferers will feel facial pressure. But when the pain becomes more severe, we tend to think that there might be an infectious exacerbation.

The other thing is the nature of the drainage. Typically with a bacterial sinus infection, the drainage will change to be colored and more thick and not see through and clear. With allergies, there tends to be congestion and pressure, but there is usually some associated itching, sneezing, or the drainage tends to be more clear. Allergies are not associated with fever or other body symptoms such as muscle pain and things that kind of go with a more infectious cause of the nasal symptoms.

Prakash Chandran: Okay. That's really helpful. So if someone is experiencing the symptoms that you're mentioning, things are getting a little bit more severe, but perhaps the drainage is colored, do they just kind of suffer through it and hope that it goes away? Or is there something that they can do to find relief?

Dr. Haidy Marzouk: Sure. So, the question that all physicians ask ourselves is, does somebody have to have antibiotics? Does there have to be involvement? Not every sinus infection has to receive antibiotics. But typically, our kind of guidelines that we've established through a lot of research tell us that if the symptoms are severe or prolonged or outside of the straightforward symptoms I mentioned, those are times where you want to consider antibiotics for your infection.

Things outside of antibiotics that you can do in the short term to kind of give some relief are saline rinses and washes, which are available over-the-counter. Anti-inflammatory nasal sprays such as nasal steroid sprays are also really helpful. Decongestants, whether they be in spray form or pill form, are also helpful.

So, a lot of my patients before or during their antibiotic course, we usually want to get the inflammation and the congestion down a little bit to give room for the infection to drain. And then, we mechanically help that infection drain with salent rinses.

Prakash Chandran: Okay. Understood. And you mentioned before if the pain that people are experiencing or the symptoms are severe or prolonged, then it might be time to, for example, consider antibiotics. But what does severe and prolonged mean? Is that like a week long, two weeks, a month?

Dr. Haidy Marzouk: So typically, if it's a short virus that won't respond to antibiotics, you're talking under a week. Usually, those sorts of things can pass it in three to five days. Sometimes it'll stretch just a touch longer. However, once it's kind of past the seven to 10-day mark, it probably might help facilitate getting better by being on antibiotics.

Prakash Chandran: So, at what point should someone seek a specialist or the help of a specialist like an ENT?

Dr. Haidy Marzouk: Sure. I would say that most of our primary care doctors are really excellent when it comes to treating acute sinus infections. Urgent cares also are able to treat sinus infections. Things that might require subspecialty care are if you have allergies that are not fully diagnosed and treated by your PCP that you're looking to kind of take care of, so that your less predisposed to sinus infections is one reason. Another reason is if you're having recurrent sinus infections. You know, if we're having one sinus infection a year, the PCP is great. But if you're having more than four acute sinus infections in a year, that's typically a sign that you might need a specialist to see if there's something structural or underlying allergies that's predisposing you to this.

And lastly, we talk about chronic sinusitis, which is when the symptoms are present for more than 12 weeks. At that point, if with antibiotics and you're having 12 weeks of symptoms with the things we mentioned, subspecialty care is usually indicated at that point.

Now, when it comes to severe symptom, Of course, if you have severe headache, vision change, anything that's outside of the spectrum of symptoms that I mentioned, that's definitely a sign that you want to see emergency care with potentially a subspecialty physician seeing you at that point.

Prakash Chandran: Let me ask a more general question. Even before someone starts to experience some of these symptoms, is there a way to proactively prevent or fix sinus issues altogether?

Dr. Haidy Marzouk: Well, to prophylactically fix the common cold would be wonderful, and sinusitis would be wonderful. I would say it's the same thing that all of our primary doctors and even our moms and grandmoms used to tell us, which is general health and immunity support, and especially if there's big changes in the weather, saline, and sometimes just keeping the immune system boosted is a great way to kind of help you fight off or prevent sickness in general. And if you have allergies, keep them well controlled. Because definitely when the allergies are not well controlled, you are predisposed to getting more sinus infections.

Prakash Chandran: And when you say well controlled, is that taking over-the-counter medicine? Is it kind of taking that saline rinse? What do you mean by that?

Dr. Haidy Marzouk: So when allergies are well controlled, the wonderful thing is it depends on you because everyone is different. Some people are well controlled with just the over-the-counter antihistamine and some people need more. So, a lot of times we treat that based on symptoms and symptoms score as well as kind of what we see on our physical exam.

Prakash Chandran: Okay. Understood. And Dr. Marzouk, just as we close, I wanted to ask if there's anything else that you wanted to share with the audience.

Dr. Haidy Marzouk: So, there are a couple of great resources online for patients to get more information about allergies and sinusitis that are available through some national academies. The first one is the American Academy of Otolaryngology and Head and Neck Surgery. But I'll make that short for everyone, it's entnet.org. And the second one is the American Academy of Otolaryngologic Allergy. Again, I'll make it quick, aaoallergy.org. So, two nice websites with patient information is entnet.org, and the other is aaoallergy.org.

Prakash Chandran: Okay. Wonderful. And one final, final question that I always like to ask. In all of the patients that you've seen and everyone that you've helped, what is one thing that you know to be true that you wish more patients knew before they came to see you?

Dr. Haidy Marzouk: That's a very good question. So, the one thing I wish patients would know when they come to see me is that I am there for their help and comfort. I think a lot of people go to the physician very vulnerable and sometimes can be anxious, it can be anxiety-provoking. But I wish all my patients would walk through the door knowing that my sole purpose is to make their experience a good one and to make it to their benefit, even though not everything we do is comfortable. And I think if all my patients walked through the door with that mindset, it would make me very happy.

Prakash Chandran: I love that, and I think that's the perfect place to end. Dr. Marzouk, thank you so much for your time today.

Dr. Haidy Marzouk: I appreciate it. Thank you for having me.

Prakash Chandran: That was Dr. Haidy Marzouk, a full-time physician at St. Joseph's Hospital and Associate Professor at SUNY Upstate Medical Center. To make an ENT appointment, you can call 315-744-1505. For more information you can visit sjhsyr.org. That is sjhsyr.org. Or Dr. Marzouk mentioned two websites that you might be interested in. That is entnet.org or aaoallergy.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been St. Joseph's Health MedCast from St. Joseph's Health. My name is Prakash Chandran. Thank you so much for listening and be well.