Medical Treatment for patients with chronic sinus infections often involves antibiotics. Specially chosen antibiotics aimed at specific bacteria identified by an endoscopic nasal/sinus culture and sensitivity test is often necessary to control bouts of infection. Antibiotics are usually given by mouth but sometimes rinsing the nose with special antibiotic solutions (nasal irrigation) or nebulized antibiotics (aerosolized medication which is breathed in thru the nose) are used. In rare occasions intravenous antibiotics are required. Inhaled and oral steroid medications also often play a role in reducing the inflammation of sinusitis.
Other causes of sinus inflammation must also be identified and treated. Many patients today have noninvasive fungal sinusitis. Instead of being infected with fungus and mold these patients are reacting to these organisms that reside in their nasal mucus. As our nasal filter, the nasal mucus is trapping the contaminants we breathe in through our nose including fungus and mold. These patients often have recurrent infection, asthma, nasal polyps and very thick mucus that is similar to rubber cement. In addition to surgery these patients require frequent nasal irrigation to remove the thick mucus which has fungus embedded within it. They often benefit from anti fungal medications usually delivered into the nose as a liquid or aerosol. Occasionally patients require oral antifungal medication.
Is it an Allergy?
Evaluation for Inhalant and Food allergies is often helpful in patients with frequent sinus problems. Formal allergy testing using skin pricks and/or blood work is often helpful in identifying sensitivities to pollen, dust mold and other allergic triggers. Avoidance of triggers is often enough. In many cases anti allergy medication (oral and nasal antihistamines and steroid nasal sprays) is very helpful while some patients need allergy desensitization administered over a period of many months either with injections or sublingual (dissolves under the tongue) therapy.
Immune Testing involves measuring circulating antibodies in a patient’s blood. Their job it is to attack certain types of bacteria in the body. Low levels of antibodies can cause chronic infection throughout the body including the sinuses. During an immunology evaluation, patients often have baseline blood antibody levels measured and are then vaccinated against common bacteria. Several weeks later the antibody levels are re measured to see if the body appropriately produced new antibodies against those bacteria being vaccinated against. This tells us how the immune system responds in real life. Intravenous gamma globulin treatment (IVGG) is very helpful in helping this group of patients prevent infection and maintain sinus health.
Silent Reflux and Sinusitis
People with superesophageal or Silent Reflux (stomach acid coming up above the esophagus into the throat and back of nose) usually don’t experience heartburn or indigestion. Instead, other symptoms such as hoarseness, coughing and excessive phlegm, constant throat clearing, choking, burning sensation and the feeling of stomach contents coming up are typical. Nasal endoscopic examination of the larynx (voice box) and the nearby inlet to the upper esophagus is usually employed to confirm the diagnosis of this type of reflux. In some cases actual 24 hour pH testing is performed by putting a probe in the nose the nose so that the stomach acid coming up into the nose can actually be measured. In some cases the pH test is performed while the patient is taking anti-reflux medication, to make sure that antacid treatment is effective in eliminating the acid reflux.
Treatment for Silent Reflux
The main treatment for acid reflux is dietary and lifestyle changes. Antacid medications especially proton pump inhibitors such as Prilosec, Prevacid, Nexium, Protonix, Zegerid, Aciphex and Dexilant are often employed with these patients and often lead to a cessation of sinus problems.