16-17B Sneezing


Synopsis: Many people confuse allergies, colds, and sinus infections. A physician specializing in these maladies describes the differences, and the new ways sinusitis can be treated.

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Host: Nancy Benson. Guest: Dr. Lisa Liberatore, otolaryngologist specializing in sinus and sleep issues, Totum Health, New York.

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16-17 Sinusitis

Nancy Benson: It’s spring allergy season… and most predictions are that it could be one of the worst ones ever. Most places around the country had a relatively mild winter, and that’s given trees and other pollen sources a running start in creating respiratory misery. Some people who thought they never had allergies before are starting to wonder – is that persistent stuffy nose really a cold, or something else?

Dr. Lisa Liberatore: Typically, if somebody reports a lot of body aches or what we call systemic symptoms, in other words, fevers, chills, body aches, that’s not typical of allergy.

Benson: That’s Dr. Lisa Liberatore, a board certified otolaryngologist specializing in sinus and sleep issues at Totum Health in New York.

Liberatore: Then you know you’ve got some type of infection happening, ‘cause you won’t get a fever with an allergy. And then the longevity of the, how long those symptoms lasts for will sometimes give you a clue as to whether it’s viral or bacterial. Very often a person may start with a viral infection and what I’ll tell the patient is it’s been more than seven to ten days, and then they start to see yellow thick green mucous coming out or the coughing heavy, then usually a bacteria sort of secondarily chimes in after the person’s immune system has been weakened by the viral infection.

Benson: If it is a cold or other viral infection, don’t expect an antibiotic from your doctor. It wouldn’t do any good anyway. You just have to ride it out.

Liberatore: If you’ve got cold-type symptoms, runny nose, kind of aches, you can start just by using your mother or grandmother’s advice, rest, fluids, saline mist in the nose can help move the mucous through the nasal passageways and a decongestant can help relieve the symptom.

Benson: But what if you’re one of those people whose colds never go away… or whose colds always progress to something worse? Liberatore says it’s likely you’ve got a structural problem in your sinuses.

Liberatore: I have patients who will say every cold turns into a sinus infection. That’s usually because they have some narrowness of their passageway to start with, so they have very little room to tolerate congestion. That’s from the infamous deviated nasal septum where the partition that separates the right and left nasal cavity may be more over to one side or the other and the side that it’s crooked or deviated over to would be typically the side that the person would then get a secondary sinus infection on that side. Because now there are two problems why people get sinus infections — one is if there’s too much mucous being produced and it overwhelms the cavity, or there’s not enough room for that mucous to drain. Bacteria loves stagnant mucous; it’s like bacteria food.

Benson: That’s what makes chronic sinusitis keep coming back. Antibiotics don’t get rid of the bacteria breeding ground.

Liberatore: That’s the person who keeps getting sinus infections, or takes an antibiotic and may feel better, but as soon as they are off the antibiotic they feel like they get sick again. They keep going in this cycle of antibiotics, okay, I feel okay, and then maybe a week later back to the same thing. The chronic sinus sufferers typically don’t have pain. They don’t complain about pain and very often they don’t even realize why they are feeling sick or headachy or dizzy. They may complain more about postnasal drip or mucous in the throat or the feeling of having to clear their throat all the time. Chronic sinus suffers are very often relieved to find out that’s why they are feeling the way they are, because they have a chronic sinus problem which means that their head is filled with mucous or thickened tissue in the sinuses which does not allow the sinuses to drain properly.

Benson: Liberatore says people with chronic sinusitis often end up with symptoms that affect their quality of life even more than they realize.

Liberatore: We have a statistically significant quality of life questionnaire; it’s called a SNOT 20. I didn’t make that up. It stands for sino-nasal outcome test – SNOT 20 — and it’s 20 symptoms that patients rate from zero to five; zero is never have a problem to five is severe, as severe as you can. They rate 20 different symptoms and they range from nasal congestion, postnasal drip, maybe a loss of sense of smell, but then they continue to lack of productivity or difficulty focusing. I love doing that before and after surgery because patients don’t realize that what’s become their new normal is not normal.

Benson: Liberatore says many primary care physicians are aware of only the two ends of the sinusitis treatment spectrum — antibiotics or full-blown sinus surgery. But today there are smaller steps in the middle that aren’t as drastic as surgery, yet are much more effective than antibiotics.

Liberatore: The baby steps can be things that we can actually do in the office to create more space where the sinus is drained. So we can use a tool called balloon sinoplasty, which is the same principle that you use to open up the arteries of the heart; that was the same idea that somebody had to dilate the sinus passageways. So a little wire is placed through the nose after anesthetizing the nose, and then the balloon is inflated and then that dilates that sinus opening. You’re not actually removing tissue just dilating it, and then the balloon is removed and then I use a irrigating cannula through that opening and the patient leans forward over a container and we wash, we flush the sinus out, because very often I use the analogy, it’s like a pimple, we have to pop the pimple, we have to get all that material out of there.

Benson: Once the sinus is open, Liberatore says the next step is to be sure it stays that way, by placing some inflammation prevention at the former source of the block.

Liberatore: That’s a great little device called a propel, “p-r-o-p-e-l”, and they came up with the idea of a little mesh which opens up into the passageway that you’ve created and it has steroids on it, which leak into the area for three weeks’ time. So over three weeks time you’re getting a little bit of this anti-inflammatory material right at the site that you’re trying to reduce inflammation.

Benson: These days, even sinus surgery isn’t as bad as most people think. Liberatore says doctors don’t have to break your nose to fix a deviated septum. And once surgery’s done, they no longer use packing to stop the bleeding, so recovery is much less painful. So she says no matter why people have a constant stuffy nose… now there’s something they can do about it. You can find out more about all our guests on our website, radiohealthjournal.net. Our production director is Sean Waldron.

I’m Nancy Benson.

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