Sinus conditions can occur at any time of year.
Learn how you can reduce your risk for sinus infections and other sinus conditions – as well as the treatments available – from Dr. Jose Gurrola, a UVA expert in sinus health.
Selected Podcast
Protecting Against Common Sinus Conditions
Featured Speaker:
Jose Gurrola, MD
Dr. Jose Gurrola is a fellowship-trained otolaryngologist – head and neck surgeon whose specialties include endoscopic sinus surgery. Transcription:
Protecting Against Common Sinus Conditions
Melanie Cole (Host): Sinus conditions can occur any time of the year. How can you reduce your risk for sinus infections and other sinus conditions as well as how do you treat them if they do occur? My guest is Dr. Jose Gurrola. He’s a fellowship trained otolaryngologist, head and neck surgeon whose specialties include endoscopic sinus surgery at UVA. Welcome to the show, Dr. Gurrola. We hear a lot about the sinuses. What do they actually do? And that pain that we sometimes feel on the bridge of our nose, what is that?
Dr. Jose Gurrola (Guest): Thanks, Melanie. There are a number of different theories as to what the sinuses are, why they actually exist, and what they do for us. That includes moisturization of the air as it moves through our bodies, improving the sound and our perception of our voice, as well as protective mechanisms for our brain and other important structures in our head. We don’t clearly know exactly what they’re there for, which makes my job all the more interesting because I like to optimize the health and the normal function of the sinuses for all of our patients. In regard to the various pains, that is a more complex question because it can be a number of different things that are causing a patient’s perception that may or may not actually be related to the sinuses.
Melanie: What are some of the most common conditions that you see?
Dr. Gurrola: On a typical day, we see a number of different people who have what most people would call a running nose but could be related to either allergies; some other non-allergic forms of rhinitis, as we would call it; a lot of upper respiratory infections; and then we see patients with a number of different complexities of sinusitis, which can be both infectiously related; and also a chronic sinusitis, which can be more of an inflammatory condition.
Melanie: People hear about sinus infections, Dr. Gurrola, and they say if you’ve got green goo coming out of your nose, you definitely have a sinus infection. Or if you smell that bad smell into your own mouth, what is that? Does that mean that you’ve got a sinus infection? And how do you treat them? Why are they sometimes so difficult to treat?
Dr. Gurrola: It’s hard to answer that in a blanket statement, but what’s most important isn’t necessarily the initial colors or whether or not the smell is going on, but it’s more the duration. A lot of people will reflexively think that if they have these types of symptoms, they need to be on antibiotics as soon as possible. What we have found out through research over the years is that a good number of patients will in fact have an upper respiratory infection related to viral infection—meaning a virus is causing it—in which case, antibiotics are going to be less effective. Whether or not a patient is on antibiotics, over the course of the first five to seven days, by the end of that time, the patient will typically be better. What this then leads us to is optimizing the treatment of that patient during that time with non-antibiotic related measures. That would include improved nasal hygiene, including saline rinses, saline irrigation, and from my perspective, having them evaluated at the end of that five- to seven-day period. In our office, we typically use an endoscope, which is a small scope that’s attached to a camera and allows us to see inside. If we need to, we are able to take cultures and grow out whatever may be in there to see whether antibiotics are warranted or not.
Melanie: Now, what can people proactively do to keep their sinuses clear? Do you like nasal lavage, neti pots? What about some of these nasal decongestant sprays, antihistamine? People tend to use those things ad nauseam. Sometimes they use them all the time.
Dr. Gurrola: That can be an issue, and it’s one of the things we like to do in our practice is to educate the patient that while they may have an immediate relief from some of these over-the-counter decongestants, long term they can lead to more problems, and they may be masking things that can otherwise be dealt with either through medications, sometimes in-office procedures, and other times, in certain patients, they may need to have an actual surgery where we go to the OR. It’s important to get evaluated if you do find yourself relying more and more on over-the-counter medications or the need for things beyond just nasal saline irrigations. I’m a big proponent of saline lavages or the irrigations and also the nasal saline sprays, and we’re talking just a typical saltwater, not the more medicated treatments that are going to actually have an immediate relief or typically will make a person feel decongested in the short term. The irrigations and the normal sprays that we’re talking about with normal saline are going to help to improve your circulation, going to help to moisturize, particularly during this time of the year, when it’s winter out and you have a heater going on, or even during the summer when it’s hot out and you have a lot of cool air that’s going to be dry. We’re going to like to optimize what you have going on at baseline and, if we need to, intervene and help improve that for you.
Melanie: If someone suffers from allergies or asthma, is there a good relationship there between the sinuses, sinusitis? Does it mean that they’re getting more sinus infections or more sinus problems if they have allergies or asthma?
Dr. Gurrola: The allergies is interesting because in fact, if you are suffering from repeated allergy infection or allergy exposure and exacerbations of that, that can chronically lead to more issues for you, whereby which you may have an increased number of sinus infections. The key to that and just your overall sense of well-being and quality of life is going to be to ensure that you’re doing things to avoid those allergic triggers if there is something that’s going on. In some cases, you may need to actually have further testing done to see what is causing these issues for you. But if you know what your triggers are, if you know it’s going to be early spring when this happens, then towards the end of the winter, it’s a good time to start getting your nasal hygiene improved and talk to your doctor about possible preventative treatments, whether that be nasal steroid sprays or use of oral antihistamines and the patient taking a proactive approach to that. In addition, you could do things like the hypoallergenic beddings. Some of the air filters and whatnot may be of use for some people. And of course, we always recommend avoidance of exposure to smoke or other environmental allergens or irritants that may be causing issues for people.
Melanie: Dr. Gurrola, is there ever time when surgical intervention is considered?
Dr. Gurrola: There absolutely is, but that’s going to be based more on the patient’s history. We take a strong effort to make sure that our patients are medically optimized before we go off to surgery, and in terms of medical optimization, that includes a thorough clinical evaluation, including the endoscopy that I mentioned to you. Where necessary, we will get a CT scan to both evaluate for what’s going on. And if we need to take a patient to the OR, that CT scan can be of use intraoperatively as well. Now, it is worth noting that there are in fact some patients in whom some in-office procedures may be reasonable approaches to treatment with. That doesn’t work for everybody, but there are some patients who may be able to be treated with in-office procedures.
Melanie: In just the last minute or so, Dr. Gurrola, why should patients come to UVA for their treatment of sinus conditions?
Dr. Gurrola: At UVA, we offer evidence-based medicine by fellowship-trained physicians. We are patient oriented and we are interested in ensuring that the patients get an optimal medical assessment, treatment, and experience no matter what time of year, what time of day, or the circumstances notwithstanding. We look forward to seeing any and all patients that we’re able to, and we like to do so with a smile.
Melanie: That is great information. What a nice man you are. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Protecting Against Common Sinus Conditions
Melanie Cole (Host): Sinus conditions can occur any time of the year. How can you reduce your risk for sinus infections and other sinus conditions as well as how do you treat them if they do occur? My guest is Dr. Jose Gurrola. He’s a fellowship trained otolaryngologist, head and neck surgeon whose specialties include endoscopic sinus surgery at UVA. Welcome to the show, Dr. Gurrola. We hear a lot about the sinuses. What do they actually do? And that pain that we sometimes feel on the bridge of our nose, what is that?
Dr. Jose Gurrola (Guest): Thanks, Melanie. There are a number of different theories as to what the sinuses are, why they actually exist, and what they do for us. That includes moisturization of the air as it moves through our bodies, improving the sound and our perception of our voice, as well as protective mechanisms for our brain and other important structures in our head. We don’t clearly know exactly what they’re there for, which makes my job all the more interesting because I like to optimize the health and the normal function of the sinuses for all of our patients. In regard to the various pains, that is a more complex question because it can be a number of different things that are causing a patient’s perception that may or may not actually be related to the sinuses.
Melanie: What are some of the most common conditions that you see?
Dr. Gurrola: On a typical day, we see a number of different people who have what most people would call a running nose but could be related to either allergies; some other non-allergic forms of rhinitis, as we would call it; a lot of upper respiratory infections; and then we see patients with a number of different complexities of sinusitis, which can be both infectiously related; and also a chronic sinusitis, which can be more of an inflammatory condition.
Melanie: People hear about sinus infections, Dr. Gurrola, and they say if you’ve got green goo coming out of your nose, you definitely have a sinus infection. Or if you smell that bad smell into your own mouth, what is that? Does that mean that you’ve got a sinus infection? And how do you treat them? Why are they sometimes so difficult to treat?
Dr. Gurrola: It’s hard to answer that in a blanket statement, but what’s most important isn’t necessarily the initial colors or whether or not the smell is going on, but it’s more the duration. A lot of people will reflexively think that if they have these types of symptoms, they need to be on antibiotics as soon as possible. What we have found out through research over the years is that a good number of patients will in fact have an upper respiratory infection related to viral infection—meaning a virus is causing it—in which case, antibiotics are going to be less effective. Whether or not a patient is on antibiotics, over the course of the first five to seven days, by the end of that time, the patient will typically be better. What this then leads us to is optimizing the treatment of that patient during that time with non-antibiotic related measures. That would include improved nasal hygiene, including saline rinses, saline irrigation, and from my perspective, having them evaluated at the end of that five- to seven-day period. In our office, we typically use an endoscope, which is a small scope that’s attached to a camera and allows us to see inside. If we need to, we are able to take cultures and grow out whatever may be in there to see whether antibiotics are warranted or not.
Melanie: Now, what can people proactively do to keep their sinuses clear? Do you like nasal lavage, neti pots? What about some of these nasal decongestant sprays, antihistamine? People tend to use those things ad nauseam. Sometimes they use them all the time.
Dr. Gurrola: That can be an issue, and it’s one of the things we like to do in our practice is to educate the patient that while they may have an immediate relief from some of these over-the-counter decongestants, long term they can lead to more problems, and they may be masking things that can otherwise be dealt with either through medications, sometimes in-office procedures, and other times, in certain patients, they may need to have an actual surgery where we go to the OR. It’s important to get evaluated if you do find yourself relying more and more on over-the-counter medications or the need for things beyond just nasal saline irrigations. I’m a big proponent of saline lavages or the irrigations and also the nasal saline sprays, and we’re talking just a typical saltwater, not the more medicated treatments that are going to actually have an immediate relief or typically will make a person feel decongested in the short term. The irrigations and the normal sprays that we’re talking about with normal saline are going to help to improve your circulation, going to help to moisturize, particularly during this time of the year, when it’s winter out and you have a heater going on, or even during the summer when it’s hot out and you have a lot of cool air that’s going to be dry. We’re going to like to optimize what you have going on at baseline and, if we need to, intervene and help improve that for you.
Melanie: If someone suffers from allergies or asthma, is there a good relationship there between the sinuses, sinusitis? Does it mean that they’re getting more sinus infections or more sinus problems if they have allergies or asthma?
Dr. Gurrola: The allergies is interesting because in fact, if you are suffering from repeated allergy infection or allergy exposure and exacerbations of that, that can chronically lead to more issues for you, whereby which you may have an increased number of sinus infections. The key to that and just your overall sense of well-being and quality of life is going to be to ensure that you’re doing things to avoid those allergic triggers if there is something that’s going on. In some cases, you may need to actually have further testing done to see what is causing these issues for you. But if you know what your triggers are, if you know it’s going to be early spring when this happens, then towards the end of the winter, it’s a good time to start getting your nasal hygiene improved and talk to your doctor about possible preventative treatments, whether that be nasal steroid sprays or use of oral antihistamines and the patient taking a proactive approach to that. In addition, you could do things like the hypoallergenic beddings. Some of the air filters and whatnot may be of use for some people. And of course, we always recommend avoidance of exposure to smoke or other environmental allergens or irritants that may be causing issues for people.
Melanie: Dr. Gurrola, is there ever time when surgical intervention is considered?
Dr. Gurrola: There absolutely is, but that’s going to be based more on the patient’s history. We take a strong effort to make sure that our patients are medically optimized before we go off to surgery, and in terms of medical optimization, that includes a thorough clinical evaluation, including the endoscopy that I mentioned to you. Where necessary, we will get a CT scan to both evaluate for what’s going on. And if we need to take a patient to the OR, that CT scan can be of use intraoperatively as well. Now, it is worth noting that there are in fact some patients in whom some in-office procedures may be reasonable approaches to treatment with. That doesn’t work for everybody, but there are some patients who may be able to be treated with in-office procedures.
Melanie: In just the last minute or so, Dr. Gurrola, why should patients come to UVA for their treatment of sinus conditions?
Dr. Gurrola: At UVA, we offer evidence-based medicine by fellowship-trained physicians. We are patient oriented and we are interested in ensuring that the patients get an optimal medical assessment, treatment, and experience no matter what time of year, what time of day, or the circumstances notwithstanding. We look forward to seeing any and all patients that we’re able to, and we like to do so with a smile.
Melanie: That is great information. What a nice man you are. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.