Posts tagged Sinus Infection
A new study offers some surprising answers to offering chronic sinusitis treatment. According to the study, those with this condition may find great relief in quality of life with nasal sprays and other nonsurgical treatments. For those with chronic sinusitis, this is great news because surgery may not be the best way to treat this infection. The general rule is: the less invasive treatment is the best response to most conditions.
Chronic sinusitis treatments can include nasal sprays and antihistamines may be as effective as surgery in helping some patients achieve a better quality of life, the small study found.
The study was funded by the U.S. National Institutes of Health and published online Oct. 29 in the journal JAMA Otolaryngology-Head & Neck Surgery. Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said, “Chronic sinusitis is the number one cause for chronic fatigue and is closely associated with snoring and sleep apnea.
Thirty-eight patients with chronic sinus infections were given medical therapy rather than having surgery. “Patients who have relatively minimally reduced productivity at work and minimally reduced quality of life from their underlying chronic sinusitis can avoid getting worse by continuing with medical
therapy,” said lead researcher Dr. Luke Rudmik, a clinical associate professor of endoscopic sinus and skull base surgery at the University of Calgary in Canada.
The decision to choose medical therapy versus surgery for chronic sinusitis should be based on patient preference, and the decision for each treatment should involve an honest conversation between the doctor and patient so that the patient understands the expected outcomes and potential risks.
Surgery, however, can be a good option too for people with severe sinus infections. Surgery is just an aide to the necessary long-term medical plan that is required to improve the quality of these patients’ lives. Surgery can be minimally invasive, performed with local anesthesia. During surgery, the doctor uses probes and a laser to remove tissue and bone and polyps that have developed during the infection and are narrowing the nasal passages.
With newer surgical techniques, these procedures allow most patients to be free of black-and-blue marks, with most going home the same day. After surgery, patients still need their medical treatment because the procedure doesn’t stop the running nose. The best chronic sinusitis treatment is designed for each patient.
The best news here is that traditional treatments, alternative treatments, and surgical techniques that have failed patients in the past have been renewed and improved so that for them new medical and surgical treatments may offer significant improvements for their quality of life.
Anyone who’s had a sinus infections will attest to the misery they suffer during allergy season. So it should come as no surprise that those who are hardest hit want—even need—relief now and thus they call their doctor complaining of the pain. Yet the nation’s ear, nose and throat doctors say that is not a good idea for most cases.
Most people who get sinusitis feel better within a week–your doctor will assure you of this–because many of those infections are caused by viruses. So even if you did get antibiotics, they are not going to help. Truth be told, this is how it is. You can only blow to your heart’s content and resist antibiotics for a typical sinus infection.
But should you be more sure about whether you’ve got a viral or bacterial sinus infection? Today, ENTs (Ear, Nose and Throat specialist) are becoming more and more involved with patients on figuring out what’s causing the infection, partly because patients should learn how antibiotics don’t work and can even harm the patient. And part of getting the patients to understand this is by their self-diagnosing the infection.
“For the first time we’ve really made it crystal clear how to self-diagnose your own bacterial sinus infections without going to the doctor, with a high degree of accuracy,” says Dr. Richard Rosenfeld, lead author of the practice guidelines published Wednesday by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
How can you tell if it’s bacterial or viral?
It’s rather simple: If you’ve been ill for fewer than 10 days and your symptoms remain the same, it’s most likely viral. If your symptom become worse within 10 days or if they get worse in that 10 days after having improved a bit, bacteria could be to blame. The premise here for waiting it out in the DIY approach is that it’s OK to wait and see what happens, rather than rushing off for antibiotics.
Even if it is bacterial, antibiotics help very little Rossefeld says, and adds that “most of what’s going on is your body fighting off the infection yourself with maybe a little boost from antibiotics.”
So what can I do for some relief?
ENTs highly approve of nasal saline washes, as well as over-the-counter pain medications. The saline washes out mucus and reduces stuffiness, and refreshes and –re-invigorates the membranes, Rosenfeld says.
Steroid nose sprays may help with inflammation, the guidelines say, especially for people with chronic sinusitis, which lasts more than three months.
Chronic sinusitis shouldn’t be diagnosed just on symptoms, the guidelines say. A doctor needs to document inflammation of the nose and sinuses, which is usually done by inspecting the nose with special scopes.
You can diagnose acute sinusitis from the comfort of your home remember, but not chronic sinusitis. For that you need a doctor.
That nasal passage infections have been an important area of research for ENT specialists is no secret. Research in morphology and bacteria have recently yielded some crucial research in infections that originate in the nasal passage ways. Some animals are physically shaped by their environment in whole, not just in part. For example, earthworms are entirely slender so that they can weave in and out of narrow spaces in the ground. Evolution plays a key role in such benefits. But does that hold for all things big and microscopic? Interestingly, bacteria come in two shapes: there’s the spherical bacterium (coccus) and the stick-shaped (bacillus)?
Biologists and morphologists wonder if there’s a reason behind why one is spherical and the other slender-shaped. After analyzing pathogenic bacteria living in the nasopharynx, the upper part of the nose, questions of shape have been answered. These bacteria have changed over time, evolving from bacillus to coccus. In an article published in the journal PLOS Genetics, Professor Frédéric Veyrier, of INRS-Institut Armand-Frappier Research Centre, along with his colleagues, demonstrated that the change may have occurred to allow bacteria to pass through the defenses of their host’s immune system.
Respiratory infections are the number three cause of death worldwide. So understanding how these bacteria, or pathogens, make it into the upper respiratory passage way is critical. These pathogens are highly evolved, some so well that bacteria like Neisseria meningitidis and Moraxella catharralis can sometimes cause severe infections in humans. Genetic analysis of the ancestors of these bacteria pinpointed a key gene: yacF. The absence of this gene makes it possible for the shape of these bacteria to evolve. The N. meningitidis and M. catharralis found today in humans are spherical and missing the yacF gene.
The bacteria’s changing from stick-shaped to spherical has allowed the composition of certain molecules on their surface to transform. These molecules, peptidoglycans, play a vital role in how the immune system recognizes bacteria.
“We have long believed that the shape of bacteria was a fixed variable,” noted Professor Veyrier. “We even use it as a way to classify bacteria. Some mystery remains as to how the various species regulate their shape. This research demonstrates that the environment in which the bacteria evolve has an impact on their morphology. These are exciting results because we were able to identify the same change in two different species–and therefore its impact could be a key aspect in the specific way these pathogens are adapting to the human nasopharynx.”
By deepening our understanding of the evolution of bacteria, researchers believe they’ll be able to create new tactics that will prevent severe infections, even those related to sinus infections. This research about bacteria evolving over time could lead to preventing and treating such nasal passage infections that attack more than your head and sinuses, but your entire body.
Anyone with chronic sinus trouble will tell you how it causes problems with breathing and sleep. Anyone can also tell you that much research has been done about improving sinus problems. But what about those with both sleep apnea and sinus problems? In a recent study, published in the JAMA Otolaryngology — Head & Neck Surgery, researchers have found that surgery may help those with chronic sinus problems so that they can breathe easier, better, and even improve the lives of those with the sleep-related condition called obstructive sleep apnea.
In the study, researchers found 15% of people with chronic sinus problems also had the sleep disorder obstructive sleep apnea (OSA). And those who had surgery for clearing the sinuses reported a better quality of life and improved sleep, regardless of whether or not they had a sleep disorder. Of course, this is not surprising for sinusitis treatment. Improved quality of life is the purpose of many surgeries for sinusitis. However, what’s important about this new study is that patients with both sinusitis and OSA have a substantially reduced quality of life, but those with both conditions had dramatic improvements in quality of life following surgery.
OSA is a condition that causes people to stop breathing hundreds of times during sleep throughout the night. For those with OSA, the tongue and other structures might relax too much, blocking the airway and preventing breathing. There are several signs of OSA. Here are the most common ones: Snoring, choking and gasping for air, and daytime fatigue.
Dr. Jordan Josephson, an ENT specialist at Lenox Hill Hospital in New York City, says, “Sinus and nasal problems often are part of the problem leading to snoring and sleep apnea, and are often overlooked and left untreated.” Josephson was not involved in the current study, but was a reviewer of it. He added that patients with sinus problems and nasal breathing problems “should all be evaluated for snoring and sleep apnea.”
For the study, researchers studied 400 patients who underwent surgery for chronic sinus problems. They then checked the outcomes of those with both chronic sinus problems and OSA. Of this group, sixty had OSA, and following surgery these patients had improved psychologically and with their sleep problems.
The link between OSA and chronic sinus problems is still inconclusive, but might much evidence suggests how air passages through the nose and airways and how sleep affects the body’s ability to manage infection have a lot to do with both conditions.
Peter Fotinakes, a neurologist and sleep disorders specialist at St. Joseph Hospital in Orange, Calif., has one theory for the two conditions overlapping, “When we’re asleep, we prefer to breathe through our noses.” He further added, “When we can’t, we open our mouth to breathe, and when you open your mouth, it sets your tongue free.” That freed-up tongue, he said, can fall back into the airway, blocking it.
Does this mean anyone with a chronic stuffy nose and fatigue should go straight for sinus surgery? Of course, not. Patients should try noninvasive measures first, such as medication before surgery. But many patients have experienced tremendous benefits in both disease severity and overall quality of life after sinus surgery. Seeing an board-certified ENT specialist is in your best interest if you’re looking for solutions to your chronic sinusitis and you suspect a sleeping disorder.
No one likes the prospects of surgery, but the good news is that newer surgical techniques can be performed on an outpatient basis without general anesthesia with minimal discomfort and most patients can go back to work the next day. This is welcome news for those suffering from both chronic sinus problems and sleep apnea.
Antibiotics have been a wonder drug since their beginning. You can’t overstate penicillin’s impact on medicine and society, especially its role in treating bacterial infections, preventing the spread of disease and minimizing serious complications of disease.
But sometimes too much of a good thing does more harm than good. For example, what happens when antibiotics are overprescribed? They should be used for serious bacterial infections, but now, due to overprescriptions, have become less effective, even ineffective, because certain strains of bacteria have become resistant to newer and stronger antibiotics.
Some main reasons for this trend in antibiotics losing their effectiveness is due to overuse and misuse by doctors and hospitals. Both play a role in ensuring best practices of such drugs. Granted that bacteria develop resistance to any drug is normal and expected. But also the way drugs are used affects how quickly and to what extent drug resistance occurs.
If you didn’t know, a bacterium becomes more resistant to a drug when it has changed in some way that either protects itself from the drug or neutralizes that drug. And any bacterium that survives an antibiotic treatment strengthens itself and can multiply and then pass its resistant properties on. In short, bacteria become stronger and more resistant to treatment.
In general, antibiotics are only for bacterial infections, not viral ones. For example, we use antibiotics for strep throat, caused by the bacterium Streptococcus pyogenes, but it’s not the right treatment for sore throats caused by viruses such as a severe flu, because the flu originates from a virus.
If you take an antibiotic for a viral infection, the antibiotic attacks the good and bad bacteria in your body. The good bacteria can then promote antibiotic-resistant properties in harmless bacteria and that can be shared with other bacteria.
Yet many people with severe sinus ailments—like facial pain, fever and nasal congestion—want immediate relief and often wonder why their doctors don’t prescribe antibiotics right away. As mentioned in the last blog, patients and doctors need to bide their time wisely, and that means even if you’re really sick with a high fever, it’s still okay to wait out the use of antibiotics. Research shows that there’s not any greater benefit with antibiotics.
The American Academy of Otolaryngology—Head and Neck Surgery Foundation recommends “watchful waiting” for people with sinusitis before they resort to antibiotics. This is not a new guideline and has always been part of best practices for ENT specialists.
For those acute sufferers, the guideline applies to acute sinusitis, even when symptoms last 10 days or more. In addition to this time, seven more days for a total of 17 days should pass before antibiotic therapy should begin. We understand that such a wait is dreadfully painful, but in the long run, it’s essential to keeping the good bacteria strong and the bad bacteria weak by your body’s natural immune system when suffering from acute sinusitis. Remember, your body needs to keep a certain balance and part of it is its good and bad bacteria.
We’ve known for some years that antibiotics don’t help most bronchitis cases and other respiratory problems, like sinusitis. In fact, taking antibiotics isn’t as effective for treating bacterial sinusitis as is widely believed. The American Academy of Otolaryngology—Head and Neck Surgery Foundation says antibiotics fare only slightly better than waiting for the infection to go away on its own. This scant improvement is most likely not worth taking antibiotics. Yet over-prescribing antibiotics persists—even when they don’t help and can even hurt — a study says.
A new study published last month in the American Journal of Managed Care reports that particularly with urgent care, primary care and emergency departments, clinicians seldom follow evidence-based care guidelines for the treatment of common sinusitis. The study criticizes several clinical practices such as over-prescribing antibiotics and over-ordering CT scans.
From the report, only 29 percent of adult acute sinusitis encounters followed accepted clinical guidelines for the prescription of antibiotics, according to the Kaiser Permanente study. And they found the ordering of CT scans more likely in emergency room visits, resulting in expensive imaging tests.
Sinusitis strikes nearly 31 million Americans per year, according to the American Academy of Family Physicians, costing around $3 billion because of tests and procedures, outpatient and emergency department visits, and medication. It is one of the most prescribed conditions for which antibiotics are used, but national clinical guidelines state that antibiotics should only be used when it lasts more than seven days.
Providers may be going against what is suggested by current guidelines, the researchers suggest, resulting in unacceptable standards of care. From the study, antibiotics were prescribed in 89.2 percent of the 152,774 EHR encounters. Nearly 50 percent of these encounters were with patients having symptoms for fewer than seven days.
Granted, each recorded visit entails a different set of symptoms with unique circumstances, especially for those presenting the most urgent and severe symptoms. But from the study, over 75% of the cases took place at the primary care providers’ offices. This number is much too high, considering that most patients were given antibiotics when they had only exhibited symptoms for less than 7 days. We understand the importance of immediate relief, but it’s the long-term harm that should be overriding our decisions.
Despite the frequency of acute sinusitis cases, treatment and prescription habits have not been closely monitored. “A clear understanding of current practices requires awareness of how acute sinusitis is treated in different acute care settings,” say the researchers, from Kaiser Permanente’s large, integrated Southern California system.
This study points to how we as healthcare providers need to better understand and coordinate acute care services in order to achieve the triple crown of health care: that is, improving the patient-care experience, the overall population’s health, and reducing healthcare costs.
The age-old problem of over-prescribing antibiotics may be partly due to the difficulty in differentiating bacterial sinusitis infections from the more common viral ones. To help clinicians identify patients who are likely to benefit from antibiotics for acute sinusitis, the most pragmatic and evidence-based approach is to focus on the patient’s length of symptoms.
Nearly 37 million Americans suffer from sinusitis each year. Some of these people will have chronic sinusitis, a common condition in which the cavities around the nasal passages become inflamed and swollen—lasting anywhere from 10 days to 8 weeks.
For most people who suffer stuffy noses and sinus pressure from head colds, their experience is at most uncomfortable because these symptoms last a few days. But for a few others, these symptoms don’t go away within few days. For those with chronic sinusitis, these symptoms may drag on for weeks, and in the worst cases, even months. Fortunately, scientists have stumbled upon a potentially new and effective therapy that might address one of the underlying factors associated with managing chronic sinusitis.
The researchers of a recent study developed a simple method to make molecules called low-molecular-weight, arginine-rich peptides from an already-approved drug compound called protamine. Peptides are a type of amino acid and can create antibodies to boost the body’s immune system. In the lab tests, researchers increased nitric oxide production in mouse immune cells and cells that line airways, making them a good candidate for further development of antibodies to boost the immune system.
Nitric oxide (NO) plays a critical role in your body’s immune system. Scientists found that that a peptide molecule from protamine plays an important role as an antimicrobial agent that helps prevent sinus infections. One reason people have chronic sinusitis is that low levels of NO are lodged in the nasal passages. The NO has been linked to trigger and exacerbate this condition in just small amounts. As you recall, sinusitis may make breathing through your nose difficult and can also lead to facial pain and headaches. One therapeutic approach could involve boosting NO levels, and for Mark E. Meyerhoff and colleagues, they want to further test the possibilities of NO improving chronic sinusitis in adults.
Addressing underlying factors that contribute and improve chronic sinusitis are keys to improving this condition.
Sinusitis affects about one in eight adults in the US, and this translates into over 30 million annual diagnoses. With a cost of $11 billion per year for managing adult sinusitis, it is no surprise that a large part of this cost comes from antibiotic therapy. In fact, nearly one in five antibiotics prescribed for adults are for sinusitis, making it the fifth most common condition responsible for antibiotic therapy.
Yet a new guide published by The American Academy of Otolaryngology—Head and Neck Surgery has recently made changes for ENT specialists that will affect those figures concerning antibiotic therapy. To better serve those with sinusitis, the guide recommends improved doctor-patient communication as the key to offering other methods besides antibiotics that have similar results.
To further hammer this point home about doctor-patient relations, this updated clinical practice guideline identifies quality improvements, and makes explicit actionable recommendations for clinicians managing adult sinusitis, including a greater focus on patient education and patient preference as part of the larger equation.
Of recent, there has been a trend in getting medical professionals to improve the lack of communication between the practitioner and the patient, and those in the medical field are taking notice. Thus, it isn’t surprising to read about a new guideline on managing adult sinusitis by having better communication. In this essential guide, Richard M. Rosenfeld, MD, MPH, explained, “More than ever before, there is a prominent role for shared decision-making between patients and clinicians when managing adult sinusitis–especially in deciding whether to use antibiotics for acute bacterial sinusitis or to instead try ‘watchful waiting’ to see if a patient can fight the infection on his or her own.”
Besides being more restrained in prescribing antibiotics, Dr. Rosenfeld also emphasized the importance of shared decisions regarding sinusitis symptom relief options such as pain relievers, topical intranasal steroids, and nasal saline irrigation.
Other differences between the 2007 guideline and the 2015 update include:
- more explicit details about the role of alternatives to antibiotics;
- more recommendations for amoxicillin with or without clavulanate when antibiotics are prescribed, while the prior guideline recommended amoxicillin alone;
- more discussion about the management of acute and chronic sinusitis, including other procedures.
This clinical guideline for managing adult sinusitis was updated by a multi-disciplinary panel of experts in otolaryngology-head and neck surgery, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate.
Healthy Sinuses: A “How To” Guide
Sinus infections, congestion, and other symptoms can make this time of year miserable. The good news is there are some things you can do to develop and maintain healthy sinuses. Moreover, if you do get sick, the same strategies that keep your sinuses healthy will also help you heal faster.
Drink up. This is important, as drinking plenty of fluids, particularly water, can be one of the best preventative measures for our sinuses. When you stay hydrated, it will help to thin mucus discharge. This, in turn, will help prevent congestion and the miserable symptoms associated with it. Drinking water will also keep your immune system strong. Both of these factors are important in fighting off infection and keeping sinuses clear.
Another way to help keep sinuses well lubricated is to use a humidifier. In drier climates, or when a heating system is used (wood heat in particular), mucus membranes will dry out. This can leave you open to congestion, irritation, or infection. Adding humidity to the air also helps you sleep better at night and also helps to keep your skin from drying out.
Limiting alcohol intake and not smoking are proven to help keep sinus passages clear and healthy. If you do smoke, quitting can be hard. It is worth the effort, however, as the health benefits can be seen almost immediately—and this is especially true when it comes to the sinuses.
Traveling can expose you to a number of things. Developing congestion because you are tired and your immune system is weakened, or being exposed to other people with cold and flu infections, are common features of traveling. By a nasal spray before your trip and keep it on hand. Nasal sprays aid in clearing the sinuses and preventing congestion or blockage. Also, avoiding certain allergy triggers will help ensure your nasal passages are not inflamed. Again, drinking plenty of water before, during, and after your trip will help keep your body strong and your sinuses healthy.
No one enjoys the cold and flu season, but by following a few simple guidelines, you can get it through it with healthy sinuses. ‘An ounce of prevention is worth a pound of cure’, may be a cliché, but that doesn’t mean that it isn’t true. Taking care of some basic health needs, and having the right tools on hand, can go a long way to keeping your sinuses at their best.
You’ve probably heard it said that you can tell if you have a virus or a bacterial infection by the color of your mucus. Clear means you just have to wait it out. Greenish yellow means it’s time to head to the doctor for some antibiotics. But is this always the case? No.
Many times, discolored mucus is the result of a sinus infection. The problem is that some sinus infections are viral, and the great majority are caused by a fungus. If your sinus infection is fungal or viral, antibiotics won’t help. You may feel some lessening symptoms if you get bed rest and drink plenty of fluids, but it isn’t the antibiotic that is helping. More likely the antibiotic is what is causing your stomach discomfort. At the same time, your body is building up resistance to the antibiotic. Now, if you actually get a bacterial sinus infection, the same antibiotic may not be able to fix the problem.
So what is up with the green mucus? It’s actually caused by iron, which gives off a greenish color. When you have an infection, your body produces extra white blood cells to fight it off. These cells produce an enzyme which breaks down the bacteria. Iron is found in the enzyme, resulting in the discolored mucus. The longer it hangs out in your sinuses, the more green it will appear when you finally expel it. In fact, early morning mucus can be discolored just because you’ve been sleeping all night and haven’t been able to clear it out. So don’t assume you have a bacterial infection just because your first nose-blowing session in the morning creates a discolored mess.
The only time to really get worried is when your mucus resembles pus when you blow it out or cough it up. Just taking a couple of days off to rest and drink fluids is usually enough to get past sinusitis. Try a nasal decongestant or a sinus rinse to recover more quickly. If your symptoms persist for over a week, then a doctor’s visit is prudent.