Dr. Mirkin on sinusitis

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Chronic Sinusitis

Gabe Mirkin, M.D.

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.

A study in Otolaryngology and Head and Neck Surgery shows 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.

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.

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 "