How do I restore order to my sinuses?

January 6, 2009 5:55 AM

Calling all chronic sinusitis sufferers! How do you keep your sinus infections and symptoms to a minimum?

In the past year, I have developed a chronic sinus problem, though I may have had a low-lying nasal issue forever. My ENT ordered a CT scan and called my sinuses 'crappy-looking' and suggested surgery, but I'm not ready to take that leap yet.

The worst part for me is the post-nasal drip, coupled with dizziness/nausea and a constant stuffed-up feeling. Lately have been getting headaches, too.

Here is what I've tried:

1. Sinus rinse. I use inconsistently and only when I feel sinus problems cropping up, but I hear this may be my best maintenance option. Trying to increase use to daily.

2. Nasal corticosteroids. Also use only when symptoms are severe.

3. Humidifier. Is this really helpful in the long run?

Things I have not yet tried: Dietary changes, daily allergy medication [I am reluctant to take these unless I know what I'm allergic to], injections, etc.

Anything that helps or has helped you significantly? Please share!

posted by rachaelfaith to health & fitness (35 answers total)

mefi's favourite- the neti pot!
posted by sunshinesky at 6:06 AM on January 6, 2009

Everyone I know with terrible sinus issues has also terrible allergy issues. If you want to know what you are allergic to, go to an allergist and get the test. THEN get on some anti-allergy meds. Again, for my husband and my best friend, who both have god-awful allergies, it's a cocktail of Allegra-D or Zyrtec and FloNase that keeps them in good sinus shape.

You may be allergic to something environmental; I once worked in a moldy building and developed terrible sinus issues. If the sinus issues are not long-standing and have developed/worsened since you moved to a new home, new workplace, etc, I would look into that.

Neti pot (nasal irrigation) is a good thing, but if you have longstanding and continuous sinus inflammation/irritation you are only providing a temporary fix. My understanding of the neti process is that you SHOULD do it daily, since the benefit partially lies in 1) hydrating nasal tissues to lessen the chance of infection and 2) washing away things you are allergic to.
posted by Medieval Maven at 6:07 AM on January 6, 2009

Neti pot.
posted by Joseph Gurl at 6:14 AM on January 6, 2009

Humidifiers make a substantial difference for me, as a really dry night will set me back for a week. I keep saline nasal spray with me all the time for when I'm in heavily climate-controlled environments or I just feel like I need it. I generally only use the nasal wash when things are bad or getting bad, but I have a touchy gag reflex and I just can't take doing it every day.

My maintenance routine is a 24-hour Zyrtec every other day, Mucinex if I'm congested or have the face-ache or pressure in my ears, and a very occasional Sudafed if I'm so stuffy I know I'm going to sleep with my mouth open if I don't or if my ears are bad enough that I'm dizzy. Otherwise I think decongestants taken on a regular basis just make the problem worse. I use an nsaid for pain and pressure for the anti-inflammatory benefits, rather than acetominophen.

I would recommend seeing an allergist. It will make it a whole lot easier if you know what aggravators you're dealing with.
posted by Lyn Never at 6:16 AM on January 6, 2009 [1 favorite]

I should add that I also have acid reflux- and I hear that the two issues might be related?

I shall contact my stubborn allergist and see if he will test me - in the meantime, I also have been living in a place I suspect to have mold, and am moving soon. Hoping this will make a difference.
posted by rachaelfaith at 6:21 AM on January 6, 2009

Humidification and hydration- drink plenty of plain water.

Bodily fluid filter: if your boogers aren't free flowing, your head is going to get clogged up.
posted by gjc at 6:26 AM on January 6, 2009

I used to get 6-8 sinus infections a year. I was continually sick. I went on Zyrtec for a year and went down to about 2-4.

Nov. 2007 I stayed on the Zyrtec (now generic!!) and started using the neti pot EVERY DAMN DAY. I did not have ONE sinus infection last year (though I did have two strep throat infections till I beat that).

I still use my neti pot EVERY DAMN DAY. It feels so good to be able to breathe!
posted by fiercecupcake at 6:40 AM on January 6, 2009

My husband had great success by limiting the allergens in our house. He still gets sick, but not nearly as often as before. We pulled up the carpet all through the house and went to hardwood or stained concrete floors. We added the allergen-reducing mattress and pillow covers to our bed. We launder our sheets faithfully every five days and dust the bedroom every other day. He is very careful to use a mask when painting or cutting the grass or any other type of work that involves fumes or dust.
posted by raisingsand at 7:07 AM on January 6, 2009

Good advice to keep allergens and irritants to a minimum. The less inflamed and annoyed your sinuses are normally, the easier it is for them to keep themselves happy.
posted by gjc at 7:12 AM on January 6, 2009

Acid reflux is related to sinus stuff, and it is the primary cause of my sinus problems.

Get a foam wedge for your bed so you're propped up in the night. Take ranitidine or another preventative med regularly, and avoid coffee, spicy food, huge meals. Basic stuff. You can google "acid reflux" and get more ideas about this stuff. If it continues to be a problem, see a gastroenterologist.

Sinus surgery sucks, but it only sucks for a couple of days and then BAM you're recovered. That might be better for you than weeks and weeks of low grad misery.

Reflux is a big deal sometimes, it can move from causing sinus problems to causing other issues like pneumonia (happened to me, or at least that was my doc's best guess for pneumonia coming out of seemingly nowhere).

Good luck.
posted by sondrialiac at 7:29 AM on January 6, 2009

I live on daily doses of Sudafed. My theory is that if my sinuses are less clogged up, I stand less of a chance of them fostering infection in there. Plus, you know, yay for being able to both hear and breathe.
posted by DarlingBri at 7:30 AM on January 6, 2009

Allergy shots and a tonsillectomy did it for me.
posted by The corpse in the library at 7:30 AM on January 6, 2009

I should also mention that I am a big baby about surgery, so even though it might be a good option, I am avoiding it as much as possible. I am not good with pain and generally recover slowly.
posted by rachaelfaith at 7:35 AM on January 6, 2009

I would push the allergist to find out if you are allergic to anything. I had chronic sinus issues for 2+ years and just never got tested because I didn't think it was allergies/couldn't target a specific thing that made my symptoms worse. Turns out I am allergic to dust mites. I bought a mattress that wasn't 25 years old and some new sheets and pillows and have been pretty much symptom free for 8 or 9 months. It was an easy fix and I feel dumb for not getting to the bottom of the issue earlier.

When things were bad, I had a lot of success with a sudafed/neti pot cocktail, and less success with the daily stuff like zyrtec or claritan. Also, I once had prescription flonase that was pretty good stuff.
posted by mjcon at 8:02 AM on January 6, 2009

I had the blood test from my allergist and then we started immunotherapy. I can't believe how much it's helped. His words at the start: "You're one sinus infection away from surgery," to now, "You'll be able to discontinue immunotherapy in about a month!" I also take a daily dose of Claritin and NasaCort. I'm very, very allergic to dust. Very. I'll never be able to be medication free, but at least I didn't have to have the surgery.
posted by cooker girl at 8:22 AM on January 6, 2009

N'thing neti pot....I have allergies, asthma, the whole bit. And the neti pot just works (not for my asthma, but it makes life easier for my sinuses).
posted by PsuDab93 at 8:23 AM on January 6, 2009

For me, the neti pot thing did nothing -- it was Flonase that helped me amazingly. I don't use the Flonase year round but during weeks that I'm starting to feel that familiar pressure.
posted by ClaudiaCenter at 8:26 AM on January 6, 2009

2. Nasal corticosteroids. Also use only when symptoms are severe.

My doctor tells me that these are only effective when used over the long term. They aren't going to help if you start and stop all the time.
posted by ssg at 8:35 AM on January 6, 2009 [1 favorite]

Just in case you ever do decide to go the surgery option, I can tell you that having my sinus polyps removed (as a kind of "bonus" during jaw surgery) has changed my life. My chronic sinus issues have virtually disappeared, and I have had 2 (maybe 3) colds in the past four years since surgery (compared to the 3 or 4 colds I would get annually, of which at least 2 would turn into infections).
posted by scody at 9:03 AM on January 6, 2009

The only thing that's made a significant impact has been moving to Florida. I get fewer sinus infections now, but am plagued by metafilter's second favorite, tonsil stones. To be honest, even though I enjoy nasal rinsing in a weird kind of way, it has less of an impact than taking sudafed does.
posted by PhoBWanKenobi at 9:11 AM on January 6, 2009

I take a Claritin every night. If I miss a dose I feel the pressure come right back. Usually I get a sinus infection every 6 months. I have not had one in more than a year now.
posted by shmurley at 9:17 AM on January 6, 2009

Xlear. Relieved MY sinus hell. Relieves my wife's allergy hell.

NO MORE SUGAR + Draksha. ENDED my reflux hell.
posted by dpcoffin at 9:30 AM on January 6, 2009

I had surgery 8 years ago. For 6 years, I was entirely symptom free. Within the last year or so, my symptoms, including multiple sinus infections a year, have begun to return. My ENT tells me that the results of the surgery are quite often not permanent, and that revision surgeries are sometimes necessary down the line. Not sure whether that's a definitive argument against surgery, but it's a data point.
posted by decathecting at 10:09 AM on January 6, 2009

Surgery for me was undone when my 8-month-old kicked my nose on Recovery Day 2. Yes, agony. Also, a permanent bend to the right that has smashed one of my nostrils nearly closed! No thanks on a repeat.

I use the nasal steroid spray every day (usually just once, in the morning) and it's a life-saver. I went from using two or three boxes of cold medicine a month, every month, to maybe a couple of those pills a year when my annual winter cold arrives, stealing my voice (as it did yesterday).

One of my kids is trying out the spray, too, and just as ssg wrote, it's more effective when he uses it every day.
posted by wenestvedt at 10:14 AM on January 6, 2009

Anecdotal, but I have 3 friends who seemed to have eliminated their chronic sinus infections when they cut out dairy. If you are afraid of surgery, I would start with that. If nothing changes after a month, you'll know it's not that part of your diet.
posted by oneirodynia at 11:12 AM on January 6, 2009

Another vote for daily nasal irrigation.

I shall contact my stubborn allergist and see if he will test me

You mean you have an allergist and he hasn't even suggested you be tested? If he refuses I'd start looking for another allergist.
posted by Taken Outtacontext at 12:19 PM on January 6, 2009

Take your neti pot into the shower with you. I find it makes all the difference as to if my sinuses get rinsed or not.
posted by BoscosMom at 1:44 PM on January 6, 2009

I don't know how (un)common my experience with sinusitis is, but in the event that you want to check out all possibilities . . .

I started enduring chronic sinusitis which led to the same desperate search that million of others have undertaken to find some respite. I tried all the washes, nasal rinses etc. I went to four ENTs including someone described as the "best in BC", all of whom recommended surgery. Like many others I was quite scared by the many horror stories such as empty nose syndrome.

One day I was irrigating my teeth, when I notice that water was running out of my nose. That lead me to my Periodontist who with a simple Xray discovered a fistula between my gum and maxillary sinus. This apparently had ocurred as a consequence of a tooth extraction which was subsequently covered by a bridge. The fistula was closed, and since then - no problems.

How four ENTs failed to diagnose this is beyond me. This experience has convinced me that surgery is the first option of this profession.
posted by Neiltupper at 2:20 PM on January 6, 2009

Nasal irrigation has cut the number of times I get sick way back. I have chronic sinusitsis and allergic rhinitis, and asthma. I do nasal irrigation, Nasonex (a corticosteroid), a 24 hour antihistamine and my asthma meds daily. As much as I hate medicating this much, it works most of the time unless I go somewhere really humid or polluted.

Diet - I have cut back on the amount of dairy, meat and sugar I eat over the years. I once went on a sugar and dairy free diet for a month and felt awesome, but it was too hard to keep up. Sometimes I will drink a glass of red wine if I feel a bit congested. I also drink a lot of water and green tea through the day, seems to help.

I'm allergic to dust mites and cats so choose to live in a home with hardwood floors. It damages the environment a bit, but I prefer to tumble dry my bed linen hot instead of leaving it outside to dry.

I do not take sudafed or benadryl unless the pain is really bad. They make me incredibly dozy.
posted by wingless_angel at 3:22 PM on January 6, 2009

I sympathize. Here is what helped me, in order of effectiveness:

1. Garlinase garlic supplement. This changed my life. If I take this supplement I don't get sinus or ear infections. The brand is important.

2. Food rotation diet to isolate food allergies/sensitivities. In my case, post-nasal drip disappears if I avoid dairy, eggs, and gluten.

3. Humidifier in bedroom. Check and change filter regularly to avoid mildew.

4. Adequate sleep.

5. Stay well-hydrated and drink hot tea.

Regarding neti and nasal washes, I just can get myself to do that. But it sounds like a good idea.
posted by valannc at 3:33 PM on January 6, 2009

I had chronic sinus infections and ended up having surgery in high school. Like others posting, it made a huge, huge difference. I didn't have another sinus infection for at least a decade, and I'm not even sure if it was one, as I didn't need antibiotics.

Get allergy tested. If your allergist won't do it, find another one. I found that over time, even prescription meds (Seldane, Allegra, Zyrtec) just weren't cutting it in the increasingly awful ragweed and pollen seasons we were having. I went, got tested, and started allergy shots. They don't hurt, but the initial part is a pain in the butt because you have to go every week. Slowly it tapers to every other week, until you end up at every month. That also made a huge difference with my awful allergies.

I remember asking the doc, "So when does ragweed season start again, so I can watch for it?" He looked at me and smiled. "For my sensitive patients, a week ago."

Especially in the winter, a humidifier makes a big difference.

Live somewhere with hardwood floors and dust and vacuum regularly.
posted by canine epigram at 6:11 PM on January 6, 2009

I have allergies. Bad ones. However, once upon a time a neurologist was chatting with me and mentioned that there is a link between the whole sinusitis hell and migraine which sounded like a load to me as I had been able to more or less manage my headaches with many of the hot water/steam methods listed above. (There's some giant nerve in your head which get's into an ugly loop from one or the other... something like that.)

Then I saw a neurologist who put me on headache meds which effectively capped the whole thing.

If I spend too much time in a moldy thrift shop, the allergies are still there but the difference is night and day.
posted by Lesser Shrew at 8:56 PM on January 6, 2009

Nasal irrigation always made my sinuses worse. I'm alone in this, aren't I?
posted by The corpse in the library at 6:20 PM on January 7, 2009

My wife had serious sinus problems, meaning that for 10 years, she had about 16 infections per year lasting 5-6 days each. During them she was tired, had intense sinusoidal pain, blistering headaches, extreme sensitivity to noise, and I could hear her sinus troubles interrupting her sleep several times a night.

She tried the following:
- Nasal irrigation (no improvement)
- Ayr saline nasal mist (did not help)
- Diet modification (no difference)

- Humidifier (always helped. Whenever we traveled, we bought one)
- Sudafed 12 hour non-drowsy. Active ingredient pseudoephedrine (always helped temporarily, but not to the point of stopping the pain)
- Sinus surgery (Huge difference! Life is good again!)
- HEPA vacuum (Made things even better!)

She now gets less than 3 sinus infections a year, they're much shorter, they're less intense, and she sleeps without waking herself up. We no longer need the humidifier.

Regards
posted by lockedroomguy at 12:51 PM on January 9, 2009

I'm really late to the party, but I'll toss my 2 cents in anyway.

You should be careful when using a neti pot and you have an infection. One time I did this I ended up having a pretty nasty fever for a day. I felt great after the fever passed, but I've been wary about using my neti pot since then (I have chronic nasal irritation / allergies / maybe more). It might have been OK for me to use the neti pot after that first fever, but my sinuses close up fairly often, and it's not good to force water into your head.

Also, be sure you get all the water out of your head before lying down. Facing the ground for a few minutes and breathing calmly through your nose (not trying to force anything out) is best, but you can also go on a brisk walk or do something to elevate your heart rate, and you'll start expelling some more water out of your nose.

If you have seasonal allergies that arrive in the spring, I highly suggest unfiltered local honey. The best source is often a farmers market-type event. The honey will look murky, not clear like store-bought honey. I don't believe the primary source (orange blossom, alfalfa, clover, etc) matters, as long as it's from local bee hives. I take my honey in tea, often a cup or two of tea a day with a spoon-full of honey per cup. Since I started eating honey a few years ago, spring is quite survivable. My eyes might water a bit, but I'm not hiding inside all the time.
posted by filthy light thief at 9:54 AM on March 31, 2009