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Chronic Sinusitis

Every doctor eventually realizes how difficult it is to treat sinusitis. Most of you who have been diagnosed as having sinusitis, and have sought help from allergists, ear-nose-and-throat-doctors, internists or surgeons, know that you still have sinusitis, even though you may have had surgery, allergy shots, all kinds of medications and shots or any other treatment.

Many people find relief with saline irrigation, using various devices that are readily available in drugstores; check with your doctor or pharmacist for their recommendations.

Your sinuses are cavities containing air in the bones of your head. They make your head lighter. If the bones in your head were solid, your head would weigh more than 50 pounds, your neck would not be able to hold it up or turn it, and the human race would never have survived in competition with other animals. The problem with having sinuses is that the air in a sinus cavity must always have the same air pressure as the air outside, so all sinuses must have passageways to the outside that allow the pressure inside a sinus to be equal to the outside pressure.

If the barometric pressure drops suddenly, as it does often before a storm, and your sinus passageway is blocked, the higher pressure in the sinus will press on the bones surrounding it to cause a horrible headache. When your nose is stuffy, the inner linings of your nose are swollen, and the same swelling can shut the sinus passageway, preventing air pressure inside your sinus from changing to balance the pressure outside, and you can develop a sinus headache.

If your nose is stuffy most of the time and your mucous is clear, you could have an allergy, an irritation from smoking or air pollution or from some unknown cause. If thick yellow-green mucous drips from your nose, you probably have a sinus infection. Your doctor should order a sinus cat scan X ray. If the X ray shows that you have fluid levels in your sinuses, you have sinusitis.

Nobody really knows how to treat sinusitis. Allergy injections are almost always a complete waste of time, unless you get a stuffy nose every spring and fall when the tree, grass and ragweed pollen are in the air. People who have a chronic stuffy noses all year round rarely benefit from allergy shots. Sinus surgery usually is ineffective and costs a lot on money and pain for no benefit whatever. A couple of years ago, a study from the Mayo Clinic showed that people with chronic sinusitis usually carry fungi in their noses, but multiple efforts to treat sinusitis with long-term anti-fungal medications have failed.

A study in Otolaryngology and Head and Neck Surgery showed that long-term low-dose erythromycin therapy helps to control persistent chronic sinusitis after sinus surgery. This study could help the millions of people who go from doctor to doctor for help in treating their chronic stuffy noses, headaches, pressure in their faces and usually thick yellow-green mucous coming from their noses.

Doctors usually prescribe cortisone-type steroids which make a person with sinusitis feel better, but cortisones have never cured anyone and they can cause horrible side effects such as osteoporosis, obesity, diabetes, high blood pressure and so forth. Taking antibiotics for one week almost never cures a sinus infection. Many previous studies show that you have to take antibiotics for a long time to cure sinusitis. What is encouraging about this paper is that the authors treated their patients, each day, for more than a year with 250 mg of Biaxin, a potent erythromycin antibiotic, and 12 out of 17 patients improved dramatically. The doctors checked their patients every three months for a year. After each patient had been treated with Biaxin for one year, their saccharine transit time, a measure of mucociliary transport, improved. This test measures the ability of the cilia lining their noses to clear mucous and pollution from the nose. Also an endoscopic nasal examination showed that there was marked improvement in the linings of their noses. They also had an improvement in being less stuffy, clearing their sticky secretions faster, and having far less mucous dripping from their noses. They also had far fewer and less severe headaches. The researchers said, "The present study suggests that long-term, low-dose treatment with erythromycin antibiotics is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment." However, this treatment is controversial and is not accepted by most doctors. Discuss it with your doctor.

Otolaryngol Head Neck Surg 2002;126:481-89 "One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: Clinical outcome and effects on mucociliary parameters and nasal nitric oxide"

Checked 4/2/15

May 30th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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