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Frequently asked questions about sinusitis from a noted ear, nose,and throat specialist Dr. Murray Grossan, Cedars Sinai Medical Center - is a noted board certified ENT specialist. Dr Grossan is one of the USA's leading medical experts on Sinusitis. Dr Grossan is the creator of the pulsatile sinus irrigator, an award winning medical device and subject of numerous research studies over the past 30 years. Dr. Grossan is also author of the best selling allergy and sinus relief book, The Sinus Cure, published by Ballantine books.
Q. What are the main causes of sinus disease ? <top> A. The main causes of sinus disease are blowing nose too hard, not clearing up the first infection, getting chilled , not resting, and drinking iced drinks. This may start out a mild infection but with heavy "macho" blowing, the pus is spread all around the nose and ear. With the allergy sufferer, after sneezing and exhaustion, without rest, the sinus infection may become chronic. Weather can make a sinus condition worse, but it is not be a cause. In menstruation and pregnancy there may be swelling of the membranes, but this is not the cause of the sinusitis. Most sinus problems show slow nasal cilia. These are the microscopic hairs that beat to move the bacteria out of the nose into the throat where they are swallowed and the stomach takes them out. By using saline with a pulsatile irrigation device the cilia are pulsed at a rate of 20 pulses per second at a special pressure that is just right. Thick mucus is removed so that the cilia return to normal rate of beating. If the pressure is too high you can put pus into the ear or other parts of the sinuses. There is a chemical called ICAM - 1 that is the entry way for the common cold virus. Pulsatile irrigation is ideal for removal of this so that the cold virus can't enter. IgE is the chemical that the allergy products - dust, pollen - combine with to make the allergy symptoms. This is also removed by pulsatile irrigation. The flow of the saline past the sinus openings displaces out the pus in the sinus. There are at least 30 medical journal articles that recommend this treatment for both sinusitis and allergen control. Q. Why is a nasal irrigator more effective than saline nose drops? <top> A. The saline drops don't pulse the cilia back to normal, don't flow past the sinus openings to displace the pus and may contain preservatives that irritate the nose. Q. How often should you use the nasal irrigator? <top> A. The sinus irrigator should be used daily if there are symptoms ,or if the common cold or allergy season is bad. If there are no symptoms, this means the cilia are working OK and you don't need the irrigation. Q. The recent Mayo Clinic research findings talked about finding fungi in the nostrils of sinus sufferers. Could one add an anti fungal such as grape seed extract to the saline solution for better results? <top> A. I see no objection to adding grape seed extract to the irrigation. It will take me some time to evaluate the result of this addition. Q. After using your sinus irrigator I have the urge to blow my nose-is this a good thing to do? Does it clean out the nostrils of bacteria, allergens etc or does blowing my nose dry it out again? <top> A. After you irrigate, your sinuses contain the saline solution. This solution has displaced the mucus, bacteria, etc that was in the sinus. Usually the cilia start to move as a result of the pulsation and this is why 20 or more minutes later the saline comes out. This is very desirable. It shows the saline went where you want it to go. Q. I noticed you don't recommend steam inhalation for sinus relief why? I have always found when I have a cold, a steam inhalation with eucalyptus was helpful. <top> A. steam inhalation does bring circulation to the area, but hot steam can inactivate the cilia and if the nose has swollen membranes, the steam keeps the moisture in the tissue from evaporating. Q. Would it be helpful to take saline spray to the workplace to keep one's sinuses moist in the dry air-conditioning at work? <top> A. Good Idea! Saline spray is very helpful for dry sinuses and to moisten the membranes. Q. So, would using a saline spray several times daily be a good preventative measure for sinus sufferers to keep their sinuses moist? It seems a really cheap, and easy thing to do? <top> A. Yes, daily saline spray can be helpful to prevent sinus problems. Q. What do you consider to be the optimal humidity for a sinus sufferer in their bedroom at night? <top> A. The optimal humidity is about 20 %. Q. What is the best compromise between fresh air/open windows [more moisture] and avoiding allergens entering the bedroom? <top> A. Simple answer! Close the windows in allergy season. The plants pollinate at 5 AM. If the windows are open the pollen hits the nose. For allergy sufferers the body thermostat doesn't work well and any chilling starts the cascade of sneezing, etc. Q. Some sinus sufferers seem to have the worst time at night, waking up with pain over the eyes and nose. Why is that? <top> A. The reason why sinus sufferers feel worse at night, and awaken with pain is that during sleep, the cilia "sleep", so dust, pollens accumulate giving maximum swelling. Q. For the early morning sinus sufferer I see you recommend lemon tea on wakening? Why? <top> A. For the allergy sufferer the thermostat is off kilter. Instead of getting up out of bed and starting the day, the allergic/ sinus patient erroneously warms up his body by sneezing and hacking. This does warm the body but it starts a cascade that is undesirable. By drinking hot tea before getting out of bed the body is warmed and there is no need to sneeze. Q. It is the middle of the night and I wake up with my sinuses killing me- the best quick fix? I am not going to irrigate in the middle of the night. <top> A. Prevent this before it happens. Do pulsatile irrigation and let chewable papaya tablets dissolve in your mouth the day before. Take one chewable papaya tablet four times daily and allow to dissolve in your mouth between the cheek and gums. If you wake up place a chewable papaya tablet in your mouth and let it dissolve. You should be able to go back to sleep. Clear-ease® is an excellent natural enzyme product designed for maximum absorption and effectiveness. Q. I read that heart burn and digestive problems trigger sinus problems-is this why you recommend papaya enzyme tablets to reduce sinus swelling? <top> A. No, this has nothing to do with heart burn or reflux of acid from the stomach. You can take papaya for digestion, but in that case you swallow it. This is a totally different deal. The chewable papaya for sinusitis is anti inflammatory, reduces swelling and thins the mucus, allowing the cilia to function. If it is a really painful sinus pain, the relief can be very dramatic. Q. You talk about using slow acting niacin as a supplement how does that help? <top> A. Slow release niacin is recommended where painful muscles are present. At a daily dose of 125 mg niacin is especially helpful in removing lactic acid from the area. Often the person doesn't know if the sinus pain / headache is from the neck referred to the sinus area or from the sinus area itself. Or could be from both. The niacin helps the neck pain. Q. I have read that Urtica /Stinging Nettle is recommended in Germany for sinus trouble as it supposedly eases inflammation of sinus passages and boosts your body's production of bacteria killing white blood cells in as little as two days. Your comments? <top> A. I haven't had personal experience with this. Q. There are a number of new over the counter saline plus herbs/oils sprays such as Alkalol, Ayr, Ocean available. Can you comment on what you see to be the best of the bunch? <top> A. Alkalol is an excellent mucus thinner that patients use with the sinus irrigator. AYR, Ocean, and the other saline sprays are OK for dry nose. After you finish the bottle you can mix your own as long as you replace it once a week. Q. What do you think of Vancenese and Flonase as prescription nasal sprays? <top> A. These are good products, dozens of good studies support their use. They are cortisone derivatives. They can, on long term use, cause erosion or ulceration and bleeding. If the doctor prescribes it I would certainly use it, but don't forget other "helpers" - dust proofing the bedroom, hot tea, avoid iced drinks, and other important items. Q. What are the ingredients to avoid in over the counter nasal sprays-the ones that have the rebound effect and make you worse long term? <top> A. Any of the Afrin type nose sprays can have rebound effect. This can be quite upsetting. First you use it every 12 hours, then you need it every 8 hours, eventually you need it every 2 hours. In addition, that much medication makes you nervous. If this occurs you need prescription medication to counteract the nose drops. Q. Does Sudafed have a rebound effect? <top> A. No Q. When is the time for any sinus sufferer to say "Ok I have had it" and ask for antibiotics? <top> A. If the discharge continues to be colored, and there is fever and general feeling sick, then is the time to consider antibiotics. Q. When should you go for surgery? Do you see surgery as being over used as a recommendation? <top> A. Surgery is indicated when regular treatment fails and x -rays show significant disease plus absent drainage channels. It never hurts to get a second opinion, then you can relax that you really do need the surgery. At least in our practice we don't overuse surgery since we spend considerable effort to avoid it, but sometimes there is no other way. Q. What type of saline mixture is recommended for irrigating? How important is it to get the proportion of non iodized salt to water exactly right? Is it better to use a premixed saline...? solution? <top> A. The jury is still out as to the best concentration of salt solution to use. Currently hypertonic saline does pull excess mucus out of swollen tissues and my patients appreciate the relief. Many patients do well on one teaspoon salt to a pint (16 oz) of water. We prefer Breathe-ease® XL Nasal Moisturizer and Irrigation Solution. The formulation has been reported best for nasal cilia and the acidity is balanced. Non-iodized salt may be used as well. I recommend non-iodized salt because some persons are sensitive to the iodine. Q. In summary: What would be a good regimen of care for a problematic sinus ? <top> A. Be very gentle when you blow. Use bed rest and warm applications to the sinus area when there are symptoms. Continue the pulsatile irrigation until the return is clear. This usually indicates return of function of the cilia. When there is sinus infection be sure to take in enough fluids so that your urine turns light. Do the procedures that restore the normal nasal cilia.
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