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.

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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.