Online Health Chat with Raj Sindwani, MD

August 16, 2012


Cleveland_Clinic_Host: More than 30 million adults are diagnosed with sinusitis in the United States each year, due to allergies, common cold or mucus blockage. People who suffer from sinus infections are often uncomfortable and experience painful symptoms (facial pain and pressure, nasal congestion, and cough) on a daily basis, which has a significant impact on their overall health and quality of life

Whether you suffer from acute sinusitis that lasts a short time or chronic sinusitis (lasting for longer than 12 weeks), many treatment options are available.

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About the Speakers

Raj Sindwani, MD is Section Head of Rhinology for Cleveland Clinic’s Head & Neck Institute. He specializes in sinus disorders, skull base surgery for tumors and cerebrospinal fluid leaks, and endoscopic orbital surgery for Grave’s disease and blocked tear ducts. Dr. Sindwani is one of the most experienced rhinologists in the state, and one of only a few fellowship-trained rhinologists, having obtained subspecialized fellowship training at Harvard Medical School, Cambridge, Mass.

Let’s Chat About Early Childhood Nutrition

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic expert Dr. Raj Sindwani. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.

baglady: Are sinus disorders hereditary?
Dr__Sindwani: As far as we know, most common sinus disorders—like chronic sinusitis—are not hereditary.

hedlok: Can sinus problems cause a loss of the senses of taste and smell?
Dr__Sindwani: Yes, you can definitely have a loss of smell with sinus problems. As you would imagine, it is one of the more concerning symptoms to patients with sinus problems. Acute sinus infections, even viral ones, can affect smell as can chronic sinus infections. Smell is especially poor in people with chronic sinusitis with nasal polyps. Polyps are grape-like clusters that grow in the nasal cavity and block smells from reaching the smell centers high in the nose.

Curly: I am having chronic sinus problems. When I am on an antibiotic, I feel better. Just as soon as I am done with the treatment, it comes back. My physician has sent me to an ENT (ear, nose and throat specialist), who ordered a CT of the sinuses. I have an appointment tomorrow to get the results. The physician who I saw at the urgent care center thinks I have eustachian tube dysfunction. Will this show up on the CT scan? If not, how can this be detected? Thanks for your time.
Dr__Sindwani: The possibilities of your chronic sinus problems are that you may not be completely clearing your infections; they may be viral, or you could be undertreated for the infection (not long enough or wrong antibiotic choice).

A CT scan, usually performed after medical treatment with antibiotics, sprays, etc., is the gold standard way of diagnosing chronic sinusitis.

We can see the eustachian tube (ET) on a CT, but the best way to examine for ET dysfunction is physical examination (of the ear and the back of the nose).

Yram22: My 21-year-old daughter has had ongoing face pain and pressure, dry eyes, and left sided paresthesias ever since she had her wisdom teeth out three years ago. She had gum infections, and treatment with clindamycin led to c. difficile infection. She was then treated with two rounds of metronidazole. Her physicians did a CT (computed tomographic) scan, an MRI (magnetic resonance imaging), and an MRA (magnetic resonance angiography) of her head and neck, and only found an ethmoid cyst. The ENT doesn't think the ethmoid cyst or polyp is causing the pain, but do you think it could be causing her face pain? Also, is it possible that it's sinus cancer instead, and, if so, should we demand a biopsy? She has persistently raised levels of pAnca (perinuclear anti-neutrophil cytoplasmic antibodies), but none of the doctors can figure out a cause. What could the pAnca mean? Thank you for your help.
Dr__Sindwani: This sounds a little complicated and its hard to comment without examining the patient and seeing her imaging studies. Ethmoid sinuses are not commonly the site for ‘cysts’. Tumors or cancers in young people like your daughter's age are fortunately quite rare.

Pain and headache can come from sources other than the sinuses as well. Remember, there are migraines, cluster headaches, etc.

Blood testing like ANCAs (anti-neutrophil cytoplasmic antibodies) and so forth look for other underlying conditions that can affect the nose or other parts of the body.

Sinusitis, Allergies and Asthma
baglady: I have had a history of motion sickness, allergies and chronic sinusitis, often affecting my ears with fluid retention and ear pain. Later I acquired a difficult-to-diagnosis vestibular disorder that, after two and a half years, I am still trying to get diagnosed. I would like to know if that history could have any impact on an already vulnerable vestibular system. My allergies still affect me occasionally that I can only treat with a cromolyn sodium nasal spray and 10 mg of loratadine antihistamine because they do not produce dizziness as a side effect.
Dr__Sindwani: Side effects from medications are experienced (or not experienced) differently in different people. Sinus problems can influence the way the ears balance pressure and drain fluid by interfering with the normal functioning of the eustachian tube. The ET tube is a tube or pipe that connects the nose to the ears and is located at the back of one's nose. Sometimes the use of nasal steroid sprays can help with this as can treating active sinus infections.

beach_blanket: Is there a connection between chronic sinusitis and asthma?
Dr__Sindwani: Yes! There is a connection between sinuses, asthma and even allergies, too. All of these conditions affect the lining of the airways. Often, getting the sinuses under control will improve asthma and vice versa.

frend: How do you determine the difference between allergies and sinus infections?
Dr__Sindwani: The correct diagnosis is based on history and physical examination. Often the two co-exist. Classic symptoms we ask about for allergies are clear drainage, itching nose and roof of mouth, sneezing, and eye irritation, often during certain seasons. Sinus infections usually present more acutely with pain in the face, more sudden onset nasal blockage, and greenish or yellow drainage, and the patient feels quite ill. There are differentiating features on clinical examination, too. Using nasal endoscopes (tiny telescopes we insert painlessly into the nose) we can actually see sinus infections, and sometimes even sample the pus to culture the exact bug that is causing them!

Treatment for Sinus Problems
lacerta227: Will sinus infections abate on their own without the use of antibiotics, or are antibiotics needed?
Dr__Sindwani: Most sinus infections are viral, so your body will be able to ‘fight
 them off on its own. In fact, if you have an intact immune system, you are probably just fine to fight off mild-moderate bacterial infections on our own, too! Antibiotics taken for bacterial infections (which is the only time you need them and where they will work) should shorten the duration of illness and get you feeling better sooner.

okd: Do you recommend the use of a neti pot for sinus issues?
Dr__Sindwani: Use of saline flushes or irrigations with devices like the neti pot, bulb syringes, etc. are useful for a variety of sinus infections. Flushing routinely with room temperature saline can improve nasal and sinus functioning. This is especially more effective after the sinus cavities have been opened from surgery. In this case, we sometimes will even add medicines to the flushes (like antibiotics or steroids), which are delivered directly to the diseased sinuses.

gloriab: What can I do to keep my chronic sinusitis under control?
Dr__Sindwani: If you are diagnosed with chronic sinusitis (usually by history, examination, and CT scan) medical and surgical options should be discussed with your ENT doctor. Once you have ‘maximized’ the drainage of your sinuses (often with surgery) ‘maintenance’ of your sinus health is often kept up using nasal steroid sprays and irrigations, most commonly with saline although medicated irrigations with antibiotics or other medicines can also be used as needed.

jello: What is the best way to avoid sinus problems?
Dr__Sindwani: It is hard to 'avoid' sinus problems, since many causes have been implicated. I would recommend that you see your doctor earlier rather than later though, if you have any bothersome nasal or sinus symptoms. If you visit your physician sooner, you can quickly get diagnosed with an issue if one is present and move forward to treatment. Sometimes people present to us with a more severe form of an illness because they let things go longer than they should have, which can make successful treatment of the problem more challenging...

swanto: Will having a humidifier in the bedroom help to eliminate sinus infections?
Dr__Sindwani: A humidifier is a good thing to try to help moisten the air in one’s room, which can lead to better functioning sinus and nasal passages.

nance: I have used Nyquil® before going to bed for a long time to help clear sinus passages. I cut the dose in half due to thyroid problem. If I stop taking Nyquil®, will I probably have rebound reaction?
Dr__Sindwani: We usually worry about rebound problems with topical over-the-counter nasal sprays. But any medication, depending on the individual's tolerances, etc., could cause you to feel differently after stopping it, especially if it has been used long term. I would explore with your doctor why you need the medication or what symptoms you are trying to improve upon by using it, as there may be more effective options for you.

go_it: How long is it safe to use prescription nasal sprays?
Dr__Sindwani: Prescription nasal steroid sprays are safe to use for years. Most are minimally absorbed in the blood stream and do not have effects that generally affect other parts of the body. Common, nuisance side effects of steroid nasal sprays and any nasal sprays are local nasal irritation and some minor nosebleeds. These can often be avoided by directing the spray nozzle outwardly towards the ear or outer part of the nose, and away from the middle of the nose, known as the septum.

planto: I had sinus surgery for polyps a few years ago, and I hated the packing in my nose afterward. I know I need to have more polyps removed. Is the packing necessary, or is there another option?
Dr__Sindwani: I rarely, if ever, use nasal packing anymore after sinus surgery—even for polyps. We have worked hard at coming up with new techniques and instruments for surgery that minimize bleeding, so packing is usually not required. Studies have shown that packing is the worst part of the entire surgery experience, so you are not alone!

jolly_good: I have suffered from allergies in the past, and have had several sinus surgeries. I currently take several medications to find relief (Allegra®, antibiotics, etc.) Is there a permanent surgical solution for sinus problems?
Dr__Sindwani: Unfortunately, there is no cure for chronic sinusitis (the main reason why people have sinus surgery). Detailed and appropriate surgery to adequately open the sinuses often does help cut down on symptoms, but ongoing medical therapy—and treatment of predisposing conditions like allergies—is usually required.

Nightly Drainage and Other Diagnoses
nance: I have drainage every night, regardless of the season, into my throat during my sleep. I wake up many times during the night to cough up mucus. I use a neti pot, and have tried  Allegra D®, but the problem persists. My left nostril always seems to be semi-blocked for a long time. Please advise me about what more I can do. Thank you.
Dr__Sindwani: Sometimes drainage can be related to allergies, irritations or even sinus infections. Identifying the true cause (where possible) and aggressively treating the underlying cause(s) is important to improve symptoms. Blocked breathing is often caused by a variety of things, including allergies and possibly even anatomic problems like swollen turbinates or a deviated (crooked) septum. When anatomic issues like this are discovered on examination, we try treating medically but if appropriate relief isn't obtained, surgery is often very successful in improving symptoms. Surgery for swollen turbinates and a deviated septum are well-tolerated procedures that are done without an overnight hospital stay. The surgeries are performed through the nose without any cuts, bruises, black eyes or even nasal packing in most patients.

class094: When I lie down, my nose becomes stuffed, and I often have to breathe through my mouth. What causes this, and what can I do to correct it? It seems to only happen at night.
Dr__Sindwani: Some congestion of the nasal passages with lying down is normal physiology when blood pools in your head more due to gravity, but you could be experiencing it more because of an anatomic narrowing in your nose like a deviated septum or swollen turbinates.

miklos: I had been suffering with excess mucus for about two months and a cough that appears to sound like whooping cough. The mucus is almost gone but the cough still remains occasionally. Is this a symptom of whooping cough?
Dr__Sindwani: If the cough is persistent, that could be a sign of something else that is going on. Cough is a common symptom that can come from the sinuses/nose, throat, lungs or even the gastrointestinal tract in relation to reflux. A thorough medical evaluation should help sort that out.

Curly: I have been having left-sided ear aches, headaches and dizziness that come and go. Any suggestions? Thank you.
Dr__Sindwani: You should probably see an ENT.

Nutrition and Sinusitis
Francoise: I have developed zinc and mild protein deficiencies over the years as a result of obsessively following a heart-healthy diet. This was suspected of leading to bouts of sinusitis that later turned into chronic sinusitis with only dry nasal congestion, some little dry cough, and malaise with no nasal or chest mucus. I had some mild, dry chest discomfort that my respirologist felt was linked to the sinusitis. Earlier this year, I began having a balanced diet with zinc supplementation and within five months, the chronic sinusitis that had lasted over two years was gone. Does the protein/zinc deficiency link to my sinusitis seem credible? Is there a likelihood of getting it again?
Dr__Sindwani: Everyone's bodies—and sinuses—are different! If the alterations of your diet are helping, I would try and stick with them.


Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic expert Raj Sindwani, MD is now over. Thank you Dr. Sidwani for taking your time to answer our questions today about Sinus Disorders.
Dr__Sindwani: Thank you for all of your questions today!

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