Sinus problems

[doctormike]

As with most things like this, the devil is in the details.


First of all, with nasal complaints it can be VERY difficult to track down the specific source, even in person with the benefit of nasal endoscopy and x-rays. Things like allergies, chronic sinusitis (thickening of the sinus lining and/or polyps), acute sinusitis (bacterial infection in the sinuses themselves), non-allergic rhinitis (reactions to environmental irritants), anatomic problems (like a deviated septum) all overlap and can often be present at the same time, and have additive effects.


Just to clear up something - while it is true that antibiotics should not be used without a good cause, it is very common to treat someone with known chronic sinusitis and an acute worsening of symptoms with these drugs with good results. You almost never have a test that can determine the presence of absence of a bacterial infection. The nose is a non-sterile space, so sticking a swab in the nose does not give reliable results. I never use plain nasal cultures in guiding therapy.


If you really need to culture (for example, an immunosuppressed patient who is suspected of having an unusual organism), you usually need to take cultures from the sinuses themselves, which frequently requires anesthesia. A CT scan may show opacified sinuses (grey tissue where there should be black, designating air), but even that is not a test that differentiates between chronic and acute infection.


Plain x-rays are not very helpful, you really need a CT scan to show sinus detail. A deviated septum can cause nasal obstruction and in rare cases, can complicate the normal drainage of the sinuses. Surgery is the only treatment for that, but it would be unusual for this to be the main problem if you didn't have this problem before your move...


I totally agree with the Neti-pot and nasal irrigation. This is one of the few things in medicine that is cheap, safe and works. Make sure you use sterile water.


In some cases there will be polyps obstructing the sinus drainage pathways, and surgery can help that if medical management doesn't. Allergies are also something to check out if your symptoms only started after the move.


So, while I can't really diagnose anything over the Internet, and I can't be specific about the your original question, I'm happy to try to find a local referral for you (PM me if you like).

 

[Ben Prusinski]

Thanks doctormike, I appreciate the insight. I feel 100% better today. No congestion, clear breathing no yellow discharge. The nasal irrigation has been a big help and the machine I use works better than the neti pot and nasal rinse squeeze bottle I tried last time. I am scheduled for a x ray of the sinus area next month. I agree with you that CT scans are more useful than xrays unfortunately most docs don't want to do that right away. A good referral is appreciated. I like my current ENT but he does not focus on special needs for divers. My gut feeling tells me that I picked up a bug at the Santa Clara dive expo as there were tons of people inside a conference center and that is full of germs. I want to be well for my Bonaire and Cayman dive trips this year

 

[requin02]

Hey man i feel your pain. I use a plant / oil based medicine (otc) called Sibrovita which is very effective to clear my sinuses in conjunction with daily saline rinse. I dont know if you can find it in the USA though.

Sibrovita® | diagnosia.com


r.

 

[doctormike]

I agree with you that CT scans are more useful than xrays unfortunately most docs don't want to do that right away.

Not sure about that. At least in ENT circles, I haven't seen anyone get plain sinus films in many years. They really are of limited value, have similar costs compared to a CT scan, and don't give you much of a break in terms of radiation exposure. Remember, a CT scan is an x-ray, one that uses specialized hardware and software to create a detailed image of the fine anatomy of the sinuses, which would be key in identifying blockage that could cause problems in diving. They have gotten pretty cheap, a lot of dentists, oral surgeons and orthodontists have them in their offices now...

If someone is sending you for a plain sinus x-ray, ask them what they are looking for and what they are going to do with that information. The only thing that they can reliably diagnose and guide treatment is an air-fluid level in the sinuses (acute sinusitis, unusual in this context), or inferiorly based retention cysts or polyps in the maxillary sinuses (generally useless information, since these typically don't require treatment). So I don't see what the point would be in getting this study if you were feeling better...

My 2 PSI... keep irrigating, and safe diving!

 

[pjhansman]

After years of sinus infections every time I caught a slight head cold, I had polyp surgery about 7 years ago. It worked wonders.

Now I regularly use a saline nasal rinse, and it's been years since I've had a significant sinus problem.

An interesting side note: the surgery resulted in a complete loss of my sense of smell. After 6 years I finally found a sympathic ENT who added a few drops of Pulmicort to my saline rinse. In less than a week my sense of smell returned completely.