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Maryland Health Today

Video Transcript: Sinusitis

Part One:

Ellen Beth Levitt: Welcome to Maryland Health Today. I'm Ellen Beth Levitt. if you have sinus problems, you certainly aren't alone. They affect an estimated 35 million Americans each year. On the show today, we'll learn about what causes these problems and the latest treatments.

My guest is Dr. Rodney Taylor, an ear, nose, and throat specialist at the University of Maryland Medical Center. Dr. Taylor is also an assistant professor of Otorhinolaryngology, Head and Neck Surgery at the University of Maryland School of Medicine.

Welcome to the show.

Rodney J. Taylor, M.D., M.S.: Thank you for having me.

Ellen Beth Levitt: Everybody, from time to time, has nasal congestion or sinus pain and pressure -- often because of a cold, and then it goes away. But I gather there are some people who have chronic sinus problems, is that right?

Rodney J. Taylor, M.D., M.S.: That is correct. there are many Americans who have troubles with their sinuses that may range from infections, allergies and viral infections. It's a very common issue.

Ellen Beth Levitt: What is the most common sinus problem? Is that called sinusitis?

Rodney J. Taylor, M.D., M.S.: The most common process that affects the sinuses is sinusitis. that means any inflammation by any cause that involves the sinuses. And so sinusitis is the most common event.

Ellen Beth Levitt: The term "its" means inflammation, right?

Rodney J. Taylor, M.D., M.S.: Exactly. And so inflammation could be caused by a viral infection, bacterial infection, allergy and there are a whole host of things that might actually cause inflammation in the sinuses.

Ellen Beth Levitt: Could it also be caused by a structural problem like a polyp?

Rodney J. Taylor, M.D., M.S.: Yes. part of the sinuses, one of their roles is to drain mucous from the sinus into the nose. So, if there is any blockage by a polyp or thickening of the lining of the sinus, it could prevent the sinus from draining. You can get an infection because of inability to drain the sinus.

Ellen Beth Levitt: I was amazed that the sinuses they are wide widespread throughout the face, right?

Rodney J. Taylor, M.D., M.S.: The sinuses are located beneath the eyes, between the eyes and in the forehead bone which is the frontal sinus and the last sinus is smack dab in the middle the head.

Ellen Beth Levitt: What is the purpose of the sinuses?

Rodney J. Taylor, M.D., M.S.: There are several ideas. Air is lighter than bone so the overall weight of the head would be less.

Ellen Beth Levitt: So we are aerodynamic.

Rodney J. Taylor, M.D., M.S.: We are all airheads.

It is to serve as a shock absorber. If you were to get blood trauma to the face the sinuses filled with air would collapse and protect the brain in the process. Then the final idea is that the sinuses are actually resonators. It's part of what makes your voice and mine unique as well. It gives a resonance to the quality of your voice that is unique to you.

Ellen Beth Levitt: They are filled with air and secretions flow through them.

Rodney J. Taylor, M.D., M.S.: That's right. They are lined with a lining call mucosa. It lines the inside of the nose. Part of that mucosa's job is to secret mucous. So, debris can be captured and move out of the nose and sinus so it can be swallowed. We are unaware of that. It happens all the time every day.

Ellen Beth Levitt: I guess if you have a blockage or inflammation that is slowing the process down that is when you feel symptoms, right?

Rodney J. Taylor, M.D., M.S.: Absolutely. You feel congestion. And that sort of sensation is within the sinus or under the eyes or between the eyes. That a common symptom.

Ellen Beth Levitt: What is the difference between acute sinusitis and chronic sinusitis?

Rodney J. Taylor, M.D., M.S.: I think a lot of time that is distinction is not well understood. The symptoms may be similar to chronic sinusitis they are more dramatic. With acute sinusitis, the symptoms will go away completely, and everything goes back to normal.

Ellen Beth Levitt: In what time frame?

Rodney J. Taylor, M.D., M.S.: Three or four weeks. Chronic sinusitis the symptoms persist longer than those four to six week period of time. It may last for months. The symptoms never fully go away. They may be better or worse during various times. Different triggers may make them better or worse. But, with chronic sinusitis the symptoms never fully go away. The lining of the sinuses never goes back to normal as it does with acute sinusitis.

Ellen Beth Levitt: Let's talk about the symptoms. You mentioned the pain and pressure. Are there other symptoms as well?

Rodney J. Taylor, M.D., M.S.: Sure. They can be varied. Some of the common symptoms will be pain and pressure particularly with a bacterial infection. You'll feel pressure within the cheeks or over the forehead. So, you'll have that decreased smell, increased drainage from the nose. There may be fever with a bacterial problem. And there may be dental pain because the roots of the molars go into the floor of the sinus. So there can be a variety of different symptoms. One way to think about it is the symptoms sort of are like a common cold except exaggerated.

Ellen Beth Levitt: And just never goes away?

Rodney J. Taylor, M.D., M.S.: It never goes away with chronic and with acute it may take weeks to resolve.

Ellen Beth Levitt: We'll talk about treatments later on in the program. But, I've also heard there's something called rhinitis. What is that?

Rodney J. Taylor, M.D., M.S.: It's allergic rhinitis. It means inflammation within the nasal cavity. It doesn't extend into the sinuses which are off to the side. It's within the nasal cavity itself.

Ellen Beth Levitt: So, rhino means nose?

Rodney J. Taylor, M.D., M.S.: That's right.

Ellen Beth Levitt: And that's where the otorhinolaryngology comes in. you're the rhino part of the terms.

Rodney J. Taylor, M.D., M.S.: That's right. It actually comes from the Greek, where oto means ear and rhino is nose and larynx is throat.

Ellen Beth Levitt: What are the symptoms of rhinitis? Are they different from sinusitis?

Rodney J. Taylor, M.D., M.S.: Interestingly, Ellen Beth, there may be a continuum. So, people who have issues with their sinuses may have symptoms with their nose as well. And those symptoms will be nasal congestion, obstruction, drainage from the nose, discharge that may be discolored and itching and scratching within the back of their nose. It may also involve the eyes. They are the classic symptoms of rhinitis.

Ellen Beth Levitt: This comes along with allergies?

Rodney J. Taylor, M.D., M.S.: It's the most common trigger finish to rhinitis or allergic rhinitis yes.

Ellen Beth Levitt: You can have it without an allergy?

Rodney J. Taylor, M.D., M.S.: You can. There are different forms of rhinitis as well. You may have infectious rhinitis from viruses. You can also get rhinitis from pregnancy.

Ellen Beth Levitt: Really?

What would be the connection there?

Rodney J. Taylor, M.D., M.S.: A higher estrogen load tends to cause more swelling and inflammation of the nose. Unfortunately, with pregnant women, you can't give them a lot of medications and so it can be a significant quality of life issue.

Ellen Beth Levitt: Can these develop from a bad cold that just never resolves?

Rodney J. Taylor, M.D., M.S.: Chronic sinusitis in fact can. What you may classically hear the story that someone had a cold. And the blockage or the normal drainage from the sinus is inhibited in such a way that you get a cascade of the inflammation within the sinus and that sinus can't drain. The lining we discussed earlier may undergo irreversible changes. It doesn't function as it normally did in the past.

Ellen Beth Levitt: When should someone see the doctor, or should they cope on their own for awhile? As you were saying it can become a chronic problem.

Rodney J. Taylor, M.D., M.S.: That's an excellent question. So often the ability to distinguish a bad cold from flare up of allergies to sinusitis can be difficult. Time-- the question you ask is important. If someone doesn't have a prior diagnosis of sinus disease or allergies, one the key time points is the week mark. After seven days if your symptoms don't feel like they are getting better, instead of getting better are you decidedly worse. That's a perfect time to seek your physician. That may be the hallmark of an acute sinus infection, for which we do want to give medication to you.

Ellen Beth Levitt: What impact does it have on a person's life?

Rodney J. Taylor, M.D., M.S.: They can be significant. So, there is some literature and studies that demonstrate the most common reason that people that miss work is because of flare-ups of their allergies. It's the number one reason why people miss work. In fact, the reason that people are least productive at work tends to be the same reason. The number two reason that people are not as productive at work is because of flare-up of their allergy and sinus condition. It could have an impact on work and your ability to do your hobbies and recreation that you like to do. It can be meaningful.

Ellen Beth Levitt: I gather there are effective treatments?

Rodney J. Taylor, M.D., M.S.: There are. I wish I could tell you that there was a perfect treatment for everyone. And some people will receive variable amounts of relief and improvements of their symptoms. So far and away the most common thing we do, we do medical treatment which might involve topical steroids and nasal sprays. Some people get wonderful relief.

Ellen Beth Levitt: We'll talk about the specific treatments in a moment. Let's take a break. When we come back more with Dr. Rodney Taylor. So stay with us.

Part Two:

Ellen Beth Levitt:Welcome back to Maryland Health Today. I'm Ellen Beth Levitt. We're talking about sinus problems on the show. My guest is Dr. Rodney Taylor, an ear, nose, and throat specialist at the University of Maryland Medical Center. And Dr. Taylor is also an assistant professor of Otorhinolaryngology -- Head and neck surgery at the University of Maryland School of Medicine. are there some effective treatments to help people with chronic sinus problems?

Ellen Beth Levitt: There are, Ellen Beth. A lot of people it depends how frequent they get the symptoms. For example, there may be someone who knows during certain times of years that their allergies are affected and the pollens and ragweed affects them. For those people we'll give them a directed medication for that time of year. There are others who have symptoms that are longer in duration and much more problematic. So we'll fashion and tailor a treatment plan that works for them. So people who have predominant nasal symptoms, nasal congestion that we talked about--

More in the nose not in the sinuses?

Rodney J. Taylor, M.D., M.S.: Exactly. They benefit from a topical steroid. It's a spray in the nose once a day. It's actually a medication that takes a week or so to build up. I explain to patients don't give up after a day or two. It's important to be consistent. that is the gold standard medication for medical therapy for allergy and chronic sinus disease.

Ellen Beth Levitt: The steroids. they are safe steroids, right?

Rodney J. Taylor, M.D., M.S.: Excellent question. The word steroid has a buzz to it. It's a topical steroid. You don't take it by mouth. There is no absorption. it is focused delivery to the nose and sinuses.

Ellen Beth Levitt: What about people who have chronic sinusitis that there are changes inside the sinuses that you are talking about?

Rodney J. Taylor, M.D., M.S.: There are newer medications. They block the chemicals that cause the longer-term inflammation in the body. there is an array of medications that are tailored to the person and given what their symptoms are.

Ellen Beth Levitt: Interesting. So what about how long your symptoms continue? Do those medicines clear up the problems generally or do you have to take them forever?

Rodney J. Taylor, M.D., M.S.: Excellent question. Everything goes back to normal with acute with chronic it does not. These people will be on medication long-term. much like asthma, once you have chronic sinusitis you always have it. it's not reversible. There may be times when your symptoms are at a minimal and times that you are troubled with your symptoms. So for those who have mild chronic sinusitis, they may be on one medication. When they have a flare up or an infection you need to be on medication such as an antibiotic to deal with the infection and a decongestant. And we move our paradigm of treatment to much like the asthmatic patient. we are trying to avoid attacks of the sinus much like people are trying to avoid asthma attacks.

Ellen Beth Levitt: I see. How do you diagnose these problems?

Rodney J. Taylor, M.D., M.S.: It's a clinical diagnosis. With a complete history and physical exam you are able to come to that diagnosis. It's imperfect. Experienced clinicians you may have a 75% success rate by history and exam alone. there are times we invoke other studies such as a CT scan. You may be familiar with that term, which will help to make the diagnosis of chronic sinusitis.

Here we see a picture of that.

When you look at the CT scan you see the bony facial skeleton that is white. sinuses ought to be filled with air. The illustration we have you see pockets of air within the sinuses beneath the eye. There is a rim of gray thickening that wouldn't be there in someone with a normal CT scan. the area between the eyes is filled with gray. That's a hallmark of chronic sinusitis on the CT scan.

Ellen Beth Levitt: Does that normally show up as black?

Rodney J. Taylor, M.D., M.S.: Absolutely. That's a person that has classic chronic sinusitis.

Lots of congestion. You would see more black and air within the nose and sinuses if you or I had a normal CT scan.

Ellen Beth Levitt: Is the color of secretions a tip-ff?

Rodney J. Taylor, M.D., M.S.: That's a common misconception. Very often I'll see a patient, and they will say Dr. Taylor my drainage is green or yellow now. What that may mean it could be a flare-up of their allergies or it could be from a viral infection or a bacterial infection. When the patients come to the office, they want medication because the color of their secretions. That's not as helpful as you think.

Ellen Beth Levitt: A lot of people think that there is a discoloration in the mucous that must mean I have an infection. I better get on the medication right away. You can't tell by the color of your secretions what you have.

Rodney J. Taylor, M.D., M.S.: That's right. there is a broader implication to our society. When we over prescribe when there is not a bacteria it increases resistance. It's harder to treat when you do have an infection. There is more and more resistance very often too many medications are prescribed when there really shouldnt be.

Ellen Beth Levitt: What about over-the-counter medicines? Are there alternative or herbal medications that work?

Rodney J. Taylor, M.D., M.S.: There is a whole host of over-the-counter medications that you can use. That's a large industry in and of it self. One of the common things you can use are decongestants. They help to open up the sinuses. You can take those for four or five days at the time or the lining of nose can get addicted. You can take decongestants by mouth. and for people who dont have high blood pressure, that's a safe way to go. There is the saltwater or saline that can be used to rinse out the nose and rid the nose of a lot of secretions, which is helpful.

Ellen Beth Levitt: What about steam? If you stand over a boiling pot of water or chicken soup? Does that help?

Rodney J. Taylor, M.D., M.S.: Humidity can be helpful. One of the reasons it is because when the secretions get thickened and lay in the sinuses the humidity helps to break it up. It helps to drain the sinuses. You feel better.

Ellen Beth Levitt: Does surgery ever help, or is that prescribed with I people with chronic sinus problems?

Rodney J. Taylor, M.D., M.S.: For chronic sinusitis it can be an important help. We mentioned earlier that the sinuses can be blocked with a polyp or a thickened lining. and the area of drainage has been compromise. The goal of surgery is to open the sinuses so they can drain again. It helps to prevent some of the infections or the frequency of infections that people with chronic sinusitis can get.

Ellen Beth Levitt: We see the tools that you use when you do the sinus surgery. It's a delicate type of surgery because of all the structures in the head.

Rodney J. Taylor, M.D., M.S.: That's right. At the University of Maryland we have state of the art image guidance systems that is you are within a millimeter of the eye or the brain. If you are not careful or if there is a lot of sinus disease, it's known that you could get into the eye or you can make a hole into the base of the skull and cause a spinal fluid leak. You don't want that. So this technology is able to help to clean out the sinuses in a complete way while keeping the other structures safe.

Ellen Beth Levitt: Interesting. How does that work? What kind of technology do you have a camera in the instrumentation?

Rodney J. Taylor, M.D., M.S.: Once again the patient comes that day. they get a special CT scan. There is a connection, there is an infrared connection in some instances and some instances there is a radio frequency connection that lets you know from the instrument that you have in your hand. It actually triangulates with the instrument on the machine so that you can know less than a millimeter where you are.

Ellen Beth Levitt: Interesting. You mentioned something earlier that some sprays your nose could become addicted to them.

Rodney J. Taylor, M.D., M.S.: That's right.

Ellen Beth Levitt: What does that mean?

Rodney J. Taylor, M.D., M.S.: The nasal decongestants over-the-counter they go by various names if you use them for than four five days at a time the lining of your nose can become addicted. And literally five or ten minutes later it feels worse when you started. the special receptors are down regulated. It works for a moment and makes the problems worse.

Ellen Beth Levitt: It's like a rebound effect.

Rodney J. Taylor, M.D., M.S.: That's right. There is a name for it.

Ellen Beth Levitt: What products are those? How would we know what they are to be careful of them?

Rodney J. Taylor, M.D., M.S.: Any sprays that says decongestion on it. There are different chemicals that can provide the decongestant. Some of the brand names are Affrin. And the store brands carry them under their own label. You have to read and all of them have a warning on them so you will know.

Ellen Beth Levitt: I wanted to ask about your research. What is your research interest regarding sinusitis and rhinitis?

Rodney J. Taylor, M.D., M.S.: As we speak right now there is no cure for chronic allergies and chronic sinusitis. The topic that I am looking at right now is looking at natural modulators in the immune system and to tweak them in such a way that it doesn't overreact or cause to much inflammation with things like pollen that we breathe in. What we actually have as a goal not just to prevent chronic sinusitis, but to reverse it. That's research that my colleague and I are doing at the University of Maryland.

Ellen Beth Levitt: Best of luck with that. Thank you for joining us today.

Rodney J. Taylor, M.D., M.S.: My pleasure.

Ellen Beth Levitt: My guest has been Dr. Rodney Taylor, an ear, nose and throat specialist at the University of Maryland Medical Center. and Dr. Taylor is also an assistant professor of Otorhinolaryngology-- Head and neck surgery at the University of Maryland School of Medicine.

If you have any comments or questions about this program, please contact me by email at eblevitt@umm.edu.

If you'd like to reach Dr. Taylor or any other University of Maryland physician call 1-800- 492-5538. Or, visit the web site, where you'll find a great amount of health information and be able to see other Maryland Health Today programs. The address is www.umm.edu.

Take good care of yourself.

We'll see you next time for Maryland Health Today.

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This page was last updated on: December 30, 2008.

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