Texas Sinus Center Blog

Controlling Inflammation in the Right Places

By | Sinus Problems | No Comments

tsc_inflammationFor those that struggle with sinus problems the use of anti-histamines and other medications is a normal part of each day. Unfortunately, self treatments such as oral medications dispense the medicine throughout the entire body rather than specifically to the affected area. While they certainly help, you end up wasting the medication on areas that do not suffer from allergies such as your legs. The key to controlling sinus disease is controlling inflammation, and one option to do so is through the use of sinus medications delivered through a nebulizer directly into the nose and sinuses.

The nebulizer, is similar to what is used to treat asthma in the chest, and is a portable machine that places the medication directly into the nose. The medicine may be a steroid, an antibiotic, an anti-fungal, or an anti-histamine. Multiple medications can be used at one time. You simply place the medications inside the nebulizer and spray the mist into your nose for thirty seconds on each side. This can be done in addition to taking medications orally.

This inter-nasal, topical spray can be used in patients that have had surgery as well as those that have not had surgery. Sinus problems can be incredibly frustrating and the nebulizer has been the deciding point on whether a patient improves or not. There can be some complications, such as leg cramps or an upset stomach, but those cases are few and far between. If there are complications they usually disappear when the nebulizer is discontinued.

Patients have often tried several other treatments before using the nebulizer. Those who have tried oral or nasal anti-histamines, oral decongestants, nasal steroids and other similar remedies with no improvement are prime candidates. Symptoms including congestion, postnasal drainage, facial pain, and headaches make patients eager to try this method.

Regardless of the condition of the sinus problems, whether the patients require surgery or are just living with the irritation, they are often able to turn things around using this device.

Patients benefit from daily use of the nebulizer and we do frequent checks on all who are using one. Once a patient begins to show improvement, we try to wean them off of the treatment. Sometimes we are able to wean a patient completely off the medication. Other times we are able to wean them down to the least amount possible, such as every other day treatments. More medication is used at the beginning to get the inflammation under control, and once the problem is contained we decrease the amount significantly.

Sinus problems are more than just a nuisance, and sometimes the typical medicating techniques do not offer the relief needed. The nebulizer gives patients a concentrated dose of their medication exactly where they need it, greatly reducing inflammation by directly treating blocked passages in the sinus area of the face. For those that have tried every other method in vain, the nebulized medications can finally provide relief.

- See more at: http://www.texassinuscenter.com/blog/12-07-31/controlling-inflammation-right-places#sthash.FwdFqD1j.dpuf

The Trouble with Silent Reflux

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tssc_gerdMost people recognize when they have heartburn. The stomach acid, known as gastro esophageal reflux disease (GERD), is hard to miss as it burns its way up your esophagus. However, a large number of people experience reflux at night when asleep. While asleep, acid from the stomach rolls into the back of the throat and sometimes into the back of the nose without a patient realizing it. Then, during the day, patients will experience symptoms such as excessive throat clearing, congestion, mucous and phlegm. This is known as silent reflux, also called laryngopharyngeal reflux (LPR). Patients typically do not respond to sinus and allergy treatment because the symptoms are actually caused by a reflux problem.

To diagnose LPR, we perform a fiber optic laryngoscopy. A thin, flexible telescope is used to look through the nose and voice box in search for irritation and inflammation related to silent reflux. This is done in the office and is painless. Once the condition is confirmed, patients are usually placed on medications such as omeprazole (Prilosec). Using the medication, patients usually show considerable improvement, but taking these medications for prolonged periods of time can cause bone loss as well as interfere with other medications.

The preferred treatment is to supplement medications with a change in diet. “Dropping Acid,” by Jamie Kaufman, M.D., is a book explaining silent reflux and outlining the common dietary habits that may have initially caused the reflux to occur. The real problem is pepsin, a protein associated with stomach acid that is left in the throat after refluxing. Normally, pepsin is inactive and does not cause any harm. However, acidic foods or drinks below a certain pH level will activate the pepsin, which will then cause inflammation and damage to the throat.

A simple change in diet can help minimize silent reflux immensely, but not every healthy diet is good for preventing reflux. Certain diets for weight loss include lots of foods that promote reflux.

It is not always easy to recognize LPR, but it is important that it is treated to prevent sinus congestion, sinus infections and throat problems. Ineffectiveness of sinus treatments may be a signal that reflux is the underlying issue.

Snoring May Be A Health Risk As Well As A Nuisance

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Snoring is a common occurrence in the daily lives of many. We often hear stories of a significant other’s snores reverberating through the home – but what people do not realize is that snoring can be more than a social problem. Although it can certainly be an annoyance to family members, snoring can transition into a serious health risk that requires medical attention.

Snoring can frequently be a symptom of sleep apnea – a condition wherein a person quits breathing for a few moments as they sleep. A machine designed to aid in breathing, the CPAP, is universally effective in correcting sleep apnea. Unfortunately there are disadvantages to using this device: The mask and strap over the head, required to keep the CPAP in place, can be uncomfortable and hard to get used to at first. And, like snoring itself, the CPAP can be a social nuisance. Those who have been married for a great length of time tend not to mind the mechanism, but newlyweds are less likely to choose its benefits over its inconveniences.

Snoring does not guarantee a need for a CPAP. There are several causes of apnea: septal deviation, severe allergies, sinus infection, and obesity. The CPAP indiscriminately treats all of these – but there may be other treatment options aside from reliance on a breathing machine. The best way to ascertain what treatment is needed is to have an examination by someone who specializes in sleep apnea.

You may find that you need to undergo a sleep study. During the study, “events” will be recorded. Events are times that you quit breathing for a period of ten seconds. They demonstrate the incredible amount of strain being put on the heart and lungs. The number of events recorded indicates the severity of apnea and establish the proper treatments.

Pulse-ox is an indicator of oxygen levels and the negative effects sleep apnea can have. A finger monitor records oxygen levels, which are typically at 98%. By holding their breath an individual may reduce that level a percent or two. What is frightening is that the same individual may be reaching oxygen levels of 60-70% as they sleep. That is a level unobtainable by holding one’s breath.

Without an evaluation it is not possible to know what is going to need to be done to correct the problem. But whatever treatment is deemed necessary, it is important to address the issue of snoring. Snoring can be an indication of a sleep apnea and the right evaluation will determine the appropriate course of action.

Choosing Over-the-Counter Allergy Medicines

By | Allergies | No Comments

Many people welcome the colorful blossoms of spring. Our patients, however, experience the season from a different point of view: with their heads down. Pollen counts are through the roof this time of year. We can almost hear people who suffer from allergies quickening their pace to the drug store. Now is the perfect time to take a close look at over-the-counter allergy medicines.

In Texas, recent rains, following almost two years of drought, are causing an increase in mold and pollen. The drought affected a lot of our patients, with many of them exhibiting symptoms such as dryness, irritation and cracking in the nose, which led to infections and nosebleeds. We are seeing the opposite problems now. Our typical allergy patients today have a very distinct onset of symptoms that correlate with a sudden increase in mold and pollen. Those who have had pollen problems in the past may be unable to control them now with the usual kind of medication, because their tolerance is down.

For the most part, over-the-counter allergy medications are no problem at all. This includes former prescription antihistamines Claritin, Zyrtec and Allegra. The antihistamines you should be careful with are those associated with the indicator for pseudoephedrine, “D,” such as in Zyrtec-D and Allegra-D. The potential problem with using pseudoephedrine is that it can raise blood pressure, which can lead to urinary symptoms for people prone to prostate enlargement. You can also get rebound congestion when you stop taking pseudoephedrine. Combination products with “D” are best suited for young people who don’t have prostate or heart problems, and they should only be taken when symptoms are at their worst.

Other over-the-counter medicines that we recommend are mucus thinners such as Mucinex. Again, Mucinex-D has the same warnings as we mentioned above. The products we suggest you use sparingly are nasal decongestant sprays such as Afrin, Dristan and Mucinex. Patients should limit their use to two or three days at a time during severe congestion problems, to avoid physiological addiction.

Saline rinses for the nose offer a huge benefit for allergy patients. The key to selecting a good saline rinse is to choose one without preservatives. Beyond that, it doesn’t matter whether you use a bottle, Neti pot or other applicator. Choose the one you’re most likely to use on a daily basis. If you use nasal wash to flush 30% of the pollen out of your nose in a given day, your nose is going to be 30% better because it’ll have 30% less pollen to react to.

Unfortunately, nothing you can take over the counter is going to fix a chronic sinus infection. In these cases, the first thing we do is a CT scan of the sinuses. (As we explain in this video on our YouTube channel, our in-office CT scanner is very low in radiation.) Next we do allergy testing to see if the patient’s allergies are so severe that they need a stronger medication. The third thing we look at is the shape and size of the patient’s nose. Sometimes the sinuses are so small that even a slight allergy and mild swelling will create the blockage that leads to headaches and congestion. When the CT scan shows that a patient’s nose is not large enough to handle the allergy problem, we start considering surgery. While surgery isn’t a cure, making the sinuses slightly bigger combined with medication often yields a much better result.

Allergies change with every season, and their severity is often as extreme as the weather. At the Texas Sinus Center, we’re here to test and recommend the best treatment for you.

 

How to Treat a Vitamin D Deficiency

By | Allergies, Supplements | No Comments

This is the third post in our three-part series on Vitamin D. In this post, we recap the important points of our first two posts and look at methods of treating a Vitamin D deficiency.

A few recent studies have shown that Vitamin D has a significant impact on patients with sinus problems. This past February doctors looked at the effect of Vitamin D on chronic sinus infections. They felt that treating patients with Vitamin D may provide a potential way to control inflammation of the sinuses. This is something we’re extremely excited about at the Texas Sinus Center.

A recent study recently reported that patients who add oral Vitamin D supplementation while taking nasal steroids to control their allergies and nasal inflammation showed about a 50% improvement over patients using only the nasal steroids.

When you look at how people get Vitamin D, it’s no surprise so many of us are deficient. You get Vitamin D from some foods, including cod liver oil, salmon, sardine, mackerel, tuna and egg yolk. The main source of Vitamin D, however, is the sun, which most of us don’t get nearly enough of. People who are older, who live in northern latitudes or who have a darker pigment tend to produce less Vitamin D overall. Even when you do go outside in the summer time, SPF 8 reduces your Vitamin D production by about 95%. Considering these factors, it makes sense for many of us to take a Vitamin D supplement with a doctor’s supervision.

Years ago the common belief was that people with sinus problems needed to control their allergies and possibly have surgery. We have learned that while these things are critically important, the real thing these patients need is inflammation control in their sinuses. Most of our patients with chronic sinus problems have a sinus inflammation problem as well. Those we’ve tested recently have all shown a Vitamin D deficiency. The American Endocrine Society says that it’s probably safe to take up to 4,000 units a day unsupervised. However, if you are Vitamin D deficient, 4,000 units a day may not make up your deficiency. You will be much better served by seeing your doctor and working together on supplementation. It is important to know that over supplementing can elevate your calcium levels, which can lead to kidney stones.

Past studies have focused on the impact a Vitamin D deficiency has on diabetics and obese patients, but none have isolated the benefit Vitamin D can have on patients with chronic sinusitis until now. Paying attention to medical trends is a great way to find new solutions to old problems, like allergies and chronic sinus infections. Controlling inflammation is the key to the whole problem.

Vitamin D Deficiency Part Two

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The concerns associated with sun exposure have caused quite a stir. People are spending less time outdoors, and those who do partake in the summer rays lather themselves with layers of sunscreen. Although intentions may be good, people may be so anxious about protecting their skin that they neglect their body’s need for Vitamin D. There are certainly risks attributed to an excess of sun exposure, but there are also risks that can be just as severe stemming from a lack of sun exposure.

There are several consequences of being Vitamin D deficient. The most obvious is the affect it can have on your bones, making them brittle and more susceptible to fractures. A Vitamin D deficiency can cause hypertension and increase your risk of cardiac disease. Interestingly, it has been found that Vitamin D deficiency is linked to a decreased resistance to infections as well, and with a low immune system, you are opening your body up to a variety of health issues. These few examples exemplify the importance of Vitamin D and how it can affect your overall health.

On the positive side, we have realized that Vitamin D can aid in controlling diabetes. As well, we have found that maintaining a healthy level of Vitamin D is also important to ward off nasal problems. It is a safe, natural way to help control sinus inflammation, and a Vitamin D deficiency can explain why treatments are not working the way they should. Usual nasal treatments consist of steroid sprays, antihistamines and even surgery. However, if patients are Vitamin D deficient, the desired results are a lot harder to achieve through standard therapy. By identifying people who are Vitamin D deficient and then correcting that deficiency, traditional treatments have the opportunity to be much more effective. Correcting the Vitamin D deficiency corrects the patient’s low immune system, allowing them to respond better to treatment

Frequent allergy problems and chronic sinus infections combined with little to no sun exposure can be related to a Vitamin D deficiency. You may not be sleeping well, or you may be feeling run down. These are potential warning signs that you may need to be tested. It is important to note that age increases the risk of a deficiency as well. As you age, your capacity to produce Vitamin D is reduced. Add to that the changes in diet as you get older. Many people develop lactose intolerance, so they drink less milk, and let’s face it; we’re just not outside in the sun as much as we were when we were young. For those who have tested every traditional method and are still suffering from sinus problems, testing for a Vitamin D deficiency is something to be considered. It is a simple blood test, and if your level is low, we can talk about starting supplementation. In our next post, we’ll talk about how you can treat a Vitamin D deficiency – using methods other than sunbathing non-stop.

Vitamin D: The Sinus Relief Vitamin?

By | Sinus Home Remedies | No Comments

Vitamin D, commonly known as the “sunshine vitamin,” has been getting a lot of attention in recent years for its role in maintaining bone health and mood. What you may not know is that Vitamin D also helps control inflammation and can be beneficial for those suffering from chronic sinus problems. Let’s take a closer look at what Vitamin D is and how your body obtains it.

Vitamin D, like most vitamins, is defined as a vital nutrient that helps your body function properly. Vitamin D is slightly different from most other vitamins (that are consumed through diet exclusively) because it can be made in our body from exposure to sunshine.

Most people do not produce enough or consume enough Vitamin D. At our clinic, we often test our clients’ Vitamin D levels and everyone we have tested has had insufficient amounts of this nutrient. Significant sun exposure is required to produce adequate amounts of Vitamin D. If you are relying on sun exposure as your primary source for Vitamin D, it can be nearly impossible to meet your needs.

It can be challenging for most people to obtain Vitamin D through sun exposure when they spend the majority of their day inside and apply sunscreen to protect their skin when they are outside. Using SPF 8 sunscreen results in a 95% reduction in Vitamin D; and as you age it becomes even more difficult for your body to make Vitamin D. Also, a person with a naturally dark skin tone requires at least three to four times longer sun exposure to synthesize the same amount of Vitamin D as someone with a lighter skin tone.

Another factor that affects Vitamin D production is location. People who live north of 33 degrees latitude have a reduced ability (or sometimes no ability) to synthesize Vitamin D during the winter. This has an effect on nearly everyone living in the United States. The 33rd parallel runs from Long Beach, CA, through Phoenix and Atlanta to the southern tip of North Carolina. Everyone living north of those places is at risk for inadequate Vitamin D production. With all these factors working against you, chances are slim that you are getting enough Vitamin D from the sun alone.

Many foods can boost your levels of Vitamin D, such as cod liver oils, salmons, sardines, mackerel, tuna, egg yolks and Vitamin D fortified milk. However, most people require a supplement to get the required amount. If you are Vitamin D deficient, you will need to intake a much higher amount than normal to re-establish the proper level of Vitamin D in your body; the maximum recommended amount is 4,000 units daily without doctor supervision.

At the Texas Sinus Surgery Center we can determine your level of Vitamin D deficiency from a simple blood test and start you on a supplementation regime if needed.

- See more at: http://www.texassinuscenter.com/blog/12-04-18/vitamin-d-sinus-relief-vitamin#sthash.TmZqzq8I.dpuf

Predict your sinus headaches with Texas Sinus Center & Accuweather

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Many of our sinus patients get headaches and facial pain when the weather changes. This is due to changes in barometric pressure. We are now monitoring a service Accuweather offers that predicts the likelihood of sinus headaches based on pending changes in the weather.

When there is a significant chance of a weather related headache we will be sending a link to the Accuweather page via TSC’s Twitter account and Facebook page. If you would like to get these updates just click one or both of the links below to follow us on Twitter or Like us on Facebook.

We will be sending out occasional pollen updates too.

Sinus headache preventions tips

If you are prone to sinus headaches, here are some tips you can use to try and prevent a flare up when you get one of our alerts.

  1. If you have prescription sinus medicines, but have not been faithful taking them, get back on them as soon as possible.
  2. Over the counter medications with Sudafed can help prevent/treat the symptoms. These include Sudafed alone or any sinus product that ends in “D”, such as Mucinex – D, or Allegra-D, etc.
  3. If you start getting a sinus headache you can use Afrin two squirts in each nostril twice a day. Don’t use this for more than three days or you will get addicted to it.
  4. If you find that you need Afrin several times a month for sinus headaches you need to see us.
  5. If you find that none of the above is controlling your sinus headaches you need to see us.

If any of your friends or family living in the San Antonio area suffer from sinus headaches feel free to let them know about this service.

We’re also working on getting the Texas Sinus Center Facebook page running smoothly — please hang in there until we get things finalized.

Best of luck with your sinus health!!

James Atkins, M.D. and the staff of the Texas Sinus Center

- See more at: http://www.texassinuscenter.com/blog/12-02-13/predict-your-sinus-headaches-texas-sinus-center-accuweather#sthash.NXoLY12S.dpuf

Deaths Linked to Nasal Irrigation with Tap Water

By | Allergies, Sinus Home Remedies | No Comments

At the Texas Sinus Center we are big fans of using nasal rinses. Recently, though, there have been several deaths in Louisiana linked to doing nasal irrigations with tap water instead of distilled water like the instructions say.

You can read the full article here, but the basic summary is that a certain amoeba sometimes found in tap water can be harmful if forcefully irrigated in the nose. You don’t have to stop doing your irrigations, but please follow the instructions and use distilled water. If you’re traveling, pick up one or two bottles of water to use.

Everything You Ever Wanted to Know About Nasal Irrigation

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Short Version: Use any product that does not have a preservative in it. Irrigate when you feel congested or a cold coming on.

Long Version: I am going to summarize the major types of delivery systems available and videos showing how to use the products.

Type 1 – Pre-mixed Saline.

This is saline that is misted or squirted from a bottle that is pre-filled and does not require any mixing. There are several brands available. Simply Saline is readily available at HEB and local drugstores. The advantage of pre-mixed solutions is convenience. Their disadvantage is that the amount of saline irrigated is less than the techniques shown below and since it is pre-packaged is usually a little more expensive. They are great to carry with you, have at work or use while traveling.

Type 2 – Neti-Pot:

Neti-pots are a way of irrigating your nose with a plastic or ceramic pot that allows irrigation to flow in one nostril and out the other. It is best to use pre-packaged salt that you mix with water and put in the Neti-pot. These are available at any pharmacy. Mixing your own salt combination at home is not a good idea. If the concentration is not right you will do more harm than good. The advantage of a Neti-pot is that it allows for a large volume of irrigation, but is gentle. The disadvantage of a Neti-Pot is that it is sometimes hard for people to get the hang of.

This is the best video I found. Ignore the part about mixing you own salt water and buy the packages mentioned above.

Type 3 – Nasal flush bottles:

This method also involves using pre-packaged salt mixed with water. However in this method the water is put in a squeeze bottle and flushed a little more vigorously than with a Neti-pot. The advantages are that you can flush a little bit harder. The disadvantages are that some patients flush too hard and end up with clogged up ears or a headache.