Care to chime in on my sinus issues?

June 22, 2012 9:31 AM

I would like to hear your experiences with sinus issues and your recommendations for mine.

Last October I got a cold that resulted in a sinus infection. After a couple of months of using a neti pot and all the usual home remedies for sinus issues (lots of fluids, hot compresses, etc.), I got another cold resulting in absolute sinus misery, went to QuickCare and got a prescription for cephalexin. It seemed to really knock it back for a while, but after a month or so it came back. More attempts to treat with steroid inhaler, neti pot with Alkalol, etc. Three months ago I went and got a prescription for Augmentin which, again, seemed to knock it back for about a month, but then it came back.

I can breathe pretty well but I always feel it surging around up there, in my upper sinuses, and I'm exhausted all the time, although I have plenty of other issues that could be causing that (very low iron, for one). Also, the severity varies a lot from day to day. Some days I feel almost normal, others I feel quite unwell.

My doctor, whom I don't particularly trust, wants me to have a CT scan. Since I never had any structural issues before this, I don't see why I would suddenly have one now. Unless maybe we're talking about a tumor, which seems a very remote possibility and not worth the expense and radiation exposure at this point. I tend to think that since both rounds of antibiotics did have an effect, this is in fact bacterial and we just haven't hit it with the right thing yet. On the other hand, those antibiotics completely nuked my gut both times and I still don't feel altogether right, so I'm not keen to take any unnecessary rounds of them.

On the topic of sinus issues, Google is an overwhelming firehose of information. My questions are:

1) Is there a site that has reviews & recommendations specifically for ENTs? I know there's one for endocrinologists specializing in thyroid issues, so thought I'd ask if there is for this. I'm going to have to travel to see one and don't want to waste my time & money. I'd rather spend a bunch to see a top doctor the first time.

2) Given the above description, do you have any useful information to offer? Don't worry, I know it's the internet. Still, people often have useful things to offer and if you do, I'd like to hear them.

Thank you

posted by HotToddy to health & fitness (26 answers total)

I can't help you with additional home remedies since you've tried all my recommended steps, but as far as antibiotics go, I have found probiotic bars (our favorites) which I get from Whole Foods to be a real help when I take antibiotics for my semi-annual cold/sinus infection/bronchitis.

Also, if you tell people your location, you may get a personal recommendation for a good ENT in your area. Good luck with next steps!
posted by immlass at 9:41 AM on June 22, 2012

My doctor has been suggesting I get a CT scan for my sinuses for about a year and a half. I haven't done so because, by her own admission, the answer to most anything they find up there is going to be surgery, and as a classical singer, I am unwilling to consider sinus surgery unless my life is much more impacted than it is now.

My understanding is, a sinus CT scan doesn't just look for structural abnormalities that would have been present for a long time. It can also look for polyps (which can develop quickly) or cystic infection which will escape antibiotics. Both of those issues can be addressed with fairly minor surgery; I'm just a special snowflake in how I don't want to take a knife to some important parts of my instrument.
posted by KathrynT at 9:41 AM on June 22, 2012 [1 favorite]

I went through this. ENT, CT scan, all of that. Everything was "normal" but I was miserable. This is of course just my own experience but what has worked for me is keeping a lid on my allergies and on the congestion. So, I now use Flonase regularly (nasal steroid) and when I feel the sinus pressure I take Advil Cold & Sinus. (Don't know if you can take sudafed-based products -- some people can't.) My problems have resolved about 85 percent, which I consider a miracle.
posted by ClaudiaCenter at 9:42 AM on June 22, 2012

For seeing an ENT, I would be looking at Spokane, WA, or the Seattle area.
posted by HotToddy at 9:43 AM on June 22, 2012

Also, sorry, I won't threadsit but I thought of something I should have mentioned. As far as I know I don't have allergies, in that I don't have any type of histamine-type issues such as sneezing, watery eyes, scratchy throat, etc. I don't know if that means I definitely don't have allergies, though.
posted by HotToddy at 9:46 AM on June 22, 2012

Oh man if you can get to the east side of Seattle, I can HIGHLY recommend Dr. Faw, of the Evergreen Sinus Center in Kirkland. He is very minimally invasive and just great in general.
posted by KathrynT at 9:46 AM on June 22, 2012

I have suffered from sinus issues for my entire life. It is exhausting and mentally really upsetting-- someone once described sinus congestion as feeling like drowning and I couldn't agree more. Anyway, I absolutely think that getting a CT scan is a good idea. I had one done years ago to make sure there weren't any structural issues causing my problems. It's not just for lifelong structural issues like a deviated septum. You could have also developed polyps or scarring in recent years that weren't there before.

Also, get tested for allergies. You can develop them at any point in life, so even if you've had allergy testing done before or haven't ever thought you had allergies before, get it done now. And yes, allergies can cause sinus congestion instead of the usual allergy symptoms. I am allergic to cats and my only symptom is sinus congestion-- no watery eyes or sneezing or runny nose.

I do not have an ENT recommendation but I have been really pleased with the allergy office at the Capitol Hill (Seattle) Polyclinic.

Other things you can try:
-see if your doctor thinks a short round of prednisone may be in order. It's not something you want to be on for very long but I have taken it when my sinus infections haven't responded to anything else
-Similarly, you may want to ask your doctor/allergist about using a prescription nasal spray like Flonase. It's not dangerous like the OTC sprays.
-12-hour Sudafed, the REAL stuff that you get at the pharmacy counter (you don't need a prescription; it's kept behind the counter to keep it away from meth-makers)
-Use a NeilMed nasal irrigation bottle rather than the neti pot; I've found it works better at getting a stream of saline way up there than the neti pot.
-Acupuncture? Eh, maybe not your thing. I tried it a few times and liked it.
posted by joan_holloway at 9:53 AM on June 22, 2012

I didn't know I had seasonal allergies (and definitely didn't have them when I was younger), but my nurse practioner diagnosed them just by looking in my ears and nose (who knew they make the insides of ears red?). When I was having recurring sinus infections my doctor told me to take OTC allergy meds every day - xyrtec or it's ilk. I disliked the idea, but the fact of the matter is that I've Maybe had one sinus infection in the several years since - a huge improvement.

Bottom line: my sinuses still aren't great, but the daily allergy med does seem to have made a difference.
posted by ldthomps at 10:11 AM on June 22, 2012 [1 favorite]

I have sinus issues - just the pain/pressure. I'm not allergic to anything and there seems to be no trigger. I've been having them all my adult life, too. A few things that work for me:

- Pseudoephedrine (Sudafed, or generic) but yes, the one you get at the counter.
- saline spray
- non drip decongestant nasal spray (not one with Phenylephrine; it's super-ineffective for me), but I find these dry me out so much I NEED the saline spray
- humidifier
posted by sm1tten at 10:21 AM on June 22, 2012 [1 favorite]

Since you are going to travel, you may want to seek out an ENT (or pulmonologist) with a subspecialty in rhinology. The American Rhinologic Society has a physician directory.
posted by Wordwoman at 10:38 AM on June 22, 2012

oh...sinuses are the suck. getting tested for allergies is something that doctors (in my experience) tend to avoid like the plague and rarely reccommend...why? there's a TON of allergens out there, making adequate testing just about impossible...and theres a high risk of going into anaphalactic shock...in their office...covered by their liability insurance...YMMV.
what you can do: look around your garden/the neighborhood/nearby...if it's an allergen, chances are it's hiding right under your (ahem) nose...pick 3 plants a day and sniff the hell out of them. odds are, one of them is going to set you off. get rid of it. uproot it, burn it, salt the earth.
Theraflu is the tactical nuke of sinus remedies. you won't be able to drive a motor vehicle, carry on a conversation, or retain what most would describe as 'conciousness'...but you'll feel a lot better. again, YMMV.
I'm guessing from the neti pot and low iron that you're a vegetarian, no? if so, sounds like you might be doing it wrong (i.e. not getting complete nutrition)...if this IS a bacterial thing you reeeally need to take your vitamins and maybe a big steak or two during your next round of antibiotics...a steroid injection might be a good idea too.
posted by sexyrobot at 10:43 AM on June 22, 2012

Well, people don't typically know they have structural issues... until they get a CT scan.

I'm an emergency doctor so I need to know a little bit about a lot of things, and I use eMedicine because it's good information, there's a page on nearly everything, and it's free.

From the eMedicine page on Chronic Sinusitis:
"Always consider serious underlying conditions, such as tumors and immunodeficiency states, in the workup. In general, plain radiography has low sensitivity and specificity. CT scanning is considered the imaging standard for evaluation of chronic sinusitis. Routine blood cell counts and sedimentation rates are generally unhelpful; however, these may be elevated in patients with fever."
posted by treehorn+bunny at 10:48 AM on June 22, 2012 [1 favorite]

I had ten weeks of sinus infections turn to pneumonia...lots of medical drama followed (short version: bedridden for 3.5 months and diagnosed late in life with a genetic disorder). Then doctors told me they had no goal to get me well, that their goal was "symptom management". I politely declined their offer to watch me die slowly. Here is an attempt at summing up what worked for me (and I apologize in advance for any deficiencies -- it is tough to sum up eleven years of work):

I concluded that recurrent infections were either the same infection which had never cleared up or a case of re-exposure. In case of re-exposure, I tracked down the source and eliminated it. For cases of "never really cleared up", I used a pincer strategy. I found that for sinuses, lungs and ears, I could only clear up persistent infections by using both a topical treatment and a systemic treatment at the same time. If I did only topical, the infection moved to the deeper tissues until the topical stuff stopped. If I did only systemic the infection moved to the surface until the deeper tissues were more survivable.

For irrigation, I found that a xylitol-saline combo was gentler and more effective. I found ways to make sure I irrigated all surfaces of my sinuses, not just the floor (which I what a neti pot sems to do).

I found I had to actively work at rebuilding my gut ecology after taking strong antibiotics. Otherwise, the damage to my gut just left me more vulnerable to infection. I did a lot of things for that, so I cannot do it justice in one post. But some things I did a lot of for a long time: organic yogurt, sea salt, coconut oil, lettuce, avoid yeasty foods.

I also consumed sea salt to support sinus health. It is an important component of mucus.

This was not quick. It took a while, though I did see immediate and steady improvement. I focused on rebuilding a healthy body so it could fight its own battles and gradually got off drugs.

I hope that helps.
posted by Michele in California at 11:07 AM on June 22, 2012

My Seattle area ENT has long since retired, but then I haven't needed him in over 20 years. I suffered through years of chronic sinus congestion: excruciating pain and complete blockage of nasal passages during routine colds and minimal airflow during the best of times. I would have a cycle of infection passing from throat/tonsils/sinuses...I lost my senses of smell and taste for over a year. I lost a drastic amount of weight because my upper teeth hurt too much to put chewing pressure against.
I stubbornly and stupidly resisted a surgical option, even though my ENT described the damage and pain I was causing myself. I took an antibiotic cycle almost every six weeks for a year, I took every over-the-counter medication, every prescribed medication... until I finally was so medicated and zombified, I could not remember getting to places, I'd leave work and just magically be home with no memory of the drive. The night I was in such agony that I was holding a thick sewing needle over a flame to sterilize it so I could use it to drain my facial pressure. I'll say that again: I thought it was a great idea to stick a needle against my cheek and tap it into my skull!
I called the ENT the next day to schedule the surgery. I did it the day after Thanksgiving, 1990. I worked that weekend as a cashier,standing at a cash register in a hardware store. I had packing up my nose, I looked goofy. But I was a poor student who couldn't afford the time off. It took about 7-10 days for healing and swelling, but there was a day when I inhaled and it was like magic. I never knew that all my life I took in air through my nose at less than 10% capacity. It was quite a while before the velocity of air hitting the back of nasal cavity stopped surprising me.
My point? Relief, lasting, permanent pain and pressure relief can be yours in such a short amount of time. I know others may have had a different experience with sinus surgery, but if I had to go through the surgery and recovery every year to get even just one year of relief I would without hesitation. Even in the worst cold I have had since, my nose has never, ever had congestion causing any loss of breathing ability.
posted by Jazz Hands at 11:24 AM on June 22, 2012 [2 favorites]

My ENT was insistent on testing me for allergies, and treating my recurring sinusitis as non-invasively as possible (until after years, surgery was the only option. I had a broken nose, however, that led to a whole mess of problems).

you could have nasal polyps or infected adenoids--which would show up in a CT scan.
posted by inertia at 11:37 AM on June 22, 2012

I've had a history of pretty severe sinus issues, and could never really pin down the cause. Was it gluten? Allergies? I do live in the corn belt, but found that it was no longer seasonal. I had chronic sinus infections, which were sometimes mitigated by my regular yoga practice. It turns out spending ten minutes a day upside-down really clears you out. But when I got home to try the neti pot, I just stood there over the sink, waiting for even a drip to come out. Basically, my nasal condition always...just...sucked.

I finally went to a ENT (possibly the best one in Illinois, luckily for me), and was somewhat thankful to be in a terrible state when I visited his office. He tried a saline flush, but it just kept dripping out, so he ordered a radial CT. They found several small polyps, which were causing mucus blockages to become septic. Chronic sinusitis. I immediately agreed to have the surgery, and my goodness the world is brighter! Recovery time was slightly agonizing, but worlds easier to deal with than the rhinoplasty I had some years back to correct the deviated septum.

Anyhow, I would go for the Radial CT. If it's polyps, look into having it/them removed. Yes, there's a slight chance of recurrence, but the relief is beyond words.
posted by obscurator at 11:43 AM on June 22, 2012

I had chronic nasal polyps for many years (no allergies). Drugs were not effective, the only thing that worked was surgery. Like, every two or thee years, enough times that I can't remember how many it's been, easily 15 over the course of my life.

When I moved to Seattle, I eventually connected with Dr. Anonsen at Overlake. We did a few rounds of surgery, mostly successful in the short term. Then she put me on a sinus rinse (using a compounded prescription of triamcinalone, a topical steroid, and saline).

That was 5 1/2 years ago. I saw her two weeks ago, and I'm still polyp-free at this point.

So two things:

1) If you want an ENT in the Seattle area, see Anonsen. Hands down the best I've ever had.
2) Look into a regular sinus rinse. Even without the polyps, rinsing is good for you. Just make sure you use distilled or sterilized water along with a salt+baking soda suspension. If you get diagnosed with polyps, see if your doctor can get you on triamcinalone.
posted by Gorgik at 12:35 PM on June 22, 2012

Happy to read about JazzHands positive experience with sinus surgery, but I wanted to offer a word of caution about any surgical options. I have genetic structural sinus issues (our maxillary sinuses are symmetrical) that were inherited from my mother, and both of us go through a month or two of sinus infection hell every year. Her problems are much worse than my own, and she had surgery to correct the issues. Unfortunately, the surgery wasn't successful, and she lost about 90% of her sense of smell (and, thus, taste) in the process.

This was long enough ago that I don't remember the specifics of the procedure, and there are obviously a huge number of potential issues that might have surgical solutions with varying degrees of associated risk.

My own sinus infections nearly always bloom into bronchitis, and I've had pneumonia twice as a result of chronic sinusitis. A few years back I was flying back and forth between Seattle and the Bay Area about once a week and spending time with newborns and toddlers on the weekends. Between the planes, different allergens from two cities, and the toddler bacterial breeding pool, I was sick for about six months. My doctor recommended wearing a mask while flying, limiting contact with the kids, and a stronger systemic antibiotic paired with both oral and nasal steroids. Since my sinus problems almost always result in a concomitant infection in my upper respiratory tract, I'll often end up taking Augmentin paired with Zithromax or Levaquin.

In my experience, the oral steroids (prednisone) made a big difference, but are not much fun to take. You only take them for about a week, but they will probably dramatically alter your mood while you're taking them. If you're sick already, it really sucks to experience totally uncontrolled bouts of volatile emotion.

On one particularly bad occasion when I first moved to Seattle, I got both pneumonia and food poisoning at the same time. I ended up in the ER after coughing up blood and they put me on prednisone. Aside from the general misery of a 105 degree fever, vomiting, and pneumonia, the prednisone had me crying uncontrollably on the couch for a couple of days.
posted by drklahn at 1:52 PM on June 22, 2012

If you do have sinus polyps, one easy thing you can do is take aspirin (normal strength - 325mg) every day. Apparently this changes something in your metabolism to be unfavorable to polyps. It's provided a lot of relief for me.

However, people with allergies can be allergic to aspirin, which can be pretty serious. If you've never taken it before or haven't in the past couple of years, you should probably have someone 'sit' you for an hour after you take it, just in case.
posted by Adamsmasher at 2:39 PM on June 22, 2012

Calvin Knapp, Minor & James Hospital, Seattle, here is his Yelp review.. He did extensive FESS surgery on me 15 years ago and I have never had sinus problems since. Great doc, really thoughtful. Top notch surgeon.

You must start with a CT scan. No way to know without it. Chronic infections cause structural problems.
posted by spitbull at 4:04 PM on June 22, 2012

PS me of the alternative medicine bullshit hyped for sinus disease is worth wasting your time with.
posted by spitbull at 4:07 PM on June 22, 2012

Here's my little sinus story that might be useful to you: after years and years of sinus problems that were diagnosed as allergies, sinus infections, and sinus headaches, I spontaneously ruptured an ear drum. The ER doctor referred me to an ENT who immediately did a CT scan. The scan showed a highly deviated septum and 90% blockage of several of my sinuses with polyps. Something that no other previous doctor I'd seen had caught.

Surgery fixed the septum and removed a boggle-worthy amount of polyps. I ended up adding nearly an entire octave to my voice range. My sleep also improved. It really changed my life. I have only had one sinus infection in the 20 years following the surgery.

So basically, CT scans can end up showing stuff that comes as a major surprise. If you don't trust this doctor, definitely find one that you do and don't automatically rule out the CT scan. The surgery is totally optional but it can really help in the long run.
posted by skye.dancer at 10:02 PM on June 22, 2012 [1 favorite]

Also had a sinus CT reveal a deviated nasal septum when I'd had sinusitis for about two months (the first private practice ENT reported it was normal, oddly, after spending 3.5 seconds in the room with me -- you'll see why it's odd in a second). I had day surgery septuplasty and turbinate reduction to correct my deviated septum with Tim Smith at OHSU's Center for Health and Healing in downtown Portland. I'd had horrible "migraines" including facial tenderness my whole life on the side that was deviated (they were actually kind of skeptical that I could breathe through that nostril before! No wonder I snored / found yoga breathing exercises dubious!) and the headaches have been reduced by about 75%. They're able to do a video sinus scope under local at every visit there, too. I highly recommend them.
posted by sweltering at 3:12 AM on June 23, 2012

Oh and if you are looking for an allergist to go along with your ENT (I need both, myself), Dr. Len Altman at Northwest Allergy and Asthma in Seattle (at Northgate) is my doctor, and he is amazing. He's consistently listed as one of the city's best doctors, is on the cutting edge of all the research, will problem solve with you until you're fixed, works with ENTs and refers only to the best people and is generally incredibly caring as well as brilliant. Everyone in the waiting room there is always miserable as hell, but the treatment works.

Only your CT can say whether you need an ENT or an Allergist, ultimately.
posted by sweltering at 3:20 AM on June 23, 2012

Wow, I'm so glad I asked this question! Tons of helpful information. I went right out and bought some behind-the-counter Sudafed (I can feel it breaking up right now, sweet relief!) and will make an appt with either Anonsen or Knapp, probably Knapp since I already see a couple of other doctors at Minor & James anyway and have been really happy with them. Thanks so much to everyone who replied!
posted by HotToddy at 8:25 AM on June 23, 2012

Real pseudoephedrine is the greatest thing ever. Somehow I now feel that being treated like a criminal when you buy it is an acknowledgment of its super power.

Let us know how it goes. Knapp is a fantastic doc. I have fond memories, or as fond as one's memories can be for a guy who cut large pieces of bone and scar tissue from inside my head.

It was a miraculous end result.
posted by spitbull at 9:55 AM on June 23, 2012