Posts tagged Sinusitis
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.
A growing body of research has pointed to some common problems found among western societies: That allergies, asthma and chronic sinus problems are increasing. Although the research is not conclusive, some researchers suspect one main reason for these growing problems is the “hygiene hypothesis,” also called the “cleanliness hypothesis.” This theory states that a lack of early childhood exposure to infectious organisms such as those found in gut flora, probiotics or common parasites increases the chances of allergic diseases because the immune system is naturally suppressed. In other words, the immune system’s tolerance is weakened because it hasn’t been exposed to certain bacteria and parasites that it should have at an earlier age.
Some of the microorganisms that many allergy and asthma suffers have not adapted to are allergens. People who are not routinely exposed to some allergens can develop allergies, particularly as children. When they are later exposed to an allergen, the body misidentifies the foreign substance as dangerous and then reacts with hives or other allergy symptoms.
There are many detractors of this hypothesis. But did you know that allergies and asthma are uncommon in developing or underdeveloped countries yet are increasing in developed countries?
Furthermore on increased allergies, research has shown that severe allergies are connected to chronic sinus problems and asthma. The connection to all these conditions has to do with the inflammation in the airways, which is similar in the nose and sinuses or in the lungs.
What can we do to prevent these conditions from progressing or causing greater severity in the other conditions? There is growing evidence that early management of allergies or sinus inflammation can reduce the risk of developing asthma. Immunotherapy (allergy shots, or now sublingual drops or tablets) in allergic and asthma-prone children has been shown in a couple of studies to reduce developing asthma and reducing asthma attacks.
According to Dr. Michael S. Benninger, “Sinus surgery may also be preventative in some people.” In a recently presented paper at the American Rhinologic Society’s spring meeting, researchers suggested people who underwent sinus surgery had lowered the severity of and even prevented their asthma from occurring.
Other interesting results from the paper include:
- Allergy patients with chronic sinusitis were at a higher risk of developing asthma than those with no allergies.
- Early surgical treatment (less than two years after a sinusitis diagnosis) resulted in less long-term asthma than in those who had surgery later (four to five years after a sinusitis diagnosis).
Sinuses affect the lungs and vice versa. What may cause inflammation in the sinuses may do so also in the lungs, especially for those with allergies. For those with allergies and chronic sinusitis, keeping the sinuses under control helps the lungs, and keeping the lungs under control helps the sinuses. Aggressive treatment, whether with allergy immunotherapy or sinus surgery, may help reduce the risk of developing a worse airway disease, like asthma.
What all this means is that we might be recommending surgery and immunotherapy earlier in order to relieve later symptoms.
One final though before you slather your children’s hands in antimicrobial gel: sometimes a little dirt is good for a little while. Of course, this doesn’t mean they should wash their hands regularly; it means we don’t have to be overly cautious with a little dirt sometimes because it might reduce the development of asthma and severe sinus problems.
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.
Endoscopic Sinus Surgery: Good News for People With Chronic Sinusitis
Endoscopic sinus surgery is a minimally invasive procedure that offers new hope for sufferers of chronic sinusitis. Advancements are quickly being made when it comes to surgery, and endoscopic surgery, in particular, now boasts a number of benefits. In fact, the changes made in how sinus surgery is performed may allow many people who have chronic sinusitis find relief. The changes have certainly made this an exciting treatment option and the least invasive surgical procedure for the condition now available.
One of the benefits to this new method is it requires much less time to perform. Because of this, the amount of time a patient needs to be under anesthesia is also reduced. Moreover, the surgery can be mapped out prior to the operation, which also helps reduce time. The cumulative effect of these time-savings means there is no need to stay overnight at the hospital. In fact, patients are normally sent home a few hours post-surgery. Recovery is also very quick, adding to the overall appeal, and people are well enough to return to work within a few days.
The real breakthrough, however, is with the incision, or, more precisely, the lack of incision. Previously, surgery for this condition required a long incision on the face with the concurrent chance of scarring. The new procedure is done through the nasal passage so, cosmetically, the patient is unscathed.
Not only are surgery times shortened, and appearances greatly improved, but the accuracy is exceptional as well. Using the endoscopic probe means that a precise view of nasal passages and problem areas are readily available. ENT’s can treat the problem in a manner so meticulous that healthy tissue remains intact and untouched. This provides better overall results, making the treatment even more effective. One last benefit is that the pinpoint nature of endoscopic sinus surgery results in much less bruising and swelling, too. Thus, after the surgery, the patient will look as good as they now feel.
Chronic Sinus Issues Stem From Unlikely Source
For those of you who deal with constant or chronic sinus issues, you are not alone: There are millions of sufferers in the U.S., with it actually being of the most common complaints among patients. The problem, though, is that doctors have somewhat been at a loss as to how to go about treating this persistent problem. One of the reasons it has been so difficult to treat is that its source was not clearly understood. Scientists decided to set up an experiment where they could learn once and for all where this sinus condition (known as chronic rhinosinusitis) originated.
Over the years, the number of theories as to what caused this frustrating condition has grown. The reasons range from allergies to infection to gastroesophageal reflux disease, or GERD. Treatments to cure the problem also vary across the board. These include things like antibiotic treatments and even surgery to open up the nasal passages. Unfortunately, these treatments are not usually successful or don’t work with all patients. Fortunately, scientists may have finally figured out the main cause of the condition.
While closely examining what made nasal passages become chronically inflamed, researchers found that the cause was something that really posed no threat to health. How so? Previously, it was thought that perhaps some virus, bacteria or fungi infected the area and caused the reaction. Instead, it was discovered that the body harbored a number of bacteria colonies that peacefully coexisted, and that these seem to cause no harm and are normally found in various areas. During their studies, researchers found that these colonies set off an immune system response in some people. Nasal passages then become inflamed. Seeing as the bacteria are usually present, the inflammation becomes a constant factor. The bottom line is that some people have an overzealous immune system that, for whatever reason, attacks even when there is no threat.
Doctors and researchers are hopeful that these findings not only offer a better understanding of the condition but, also, lead to a cure.
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.