Sinusitis Treatment Regimen


Wellington S. Tichenor, M.D.
New York, N.Y.

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I have treated patients with sinus problems for about 25 years. In the past 10-15 years it seems sinus infections have gotten progressively worse. More and more people suffer for longer and longer periods of time. I am one of those sufferers. My sinus infections started as a result of not being adequately treated for a cold. Over the course of three years they got progressively worse. As a result I ended up having to have surgery (twice) and now have been essentially cured, but that doesn't mean that I don't still get occasional episodes of sinusitis. The sinusitis is much easier to treat, however. Fortunately, most patients are able to be treated without surgery. Ninety to 95% of patients with chronic sinusitis can be effectively treated with medical therapy.

You may then ask, if 95% of people with sinusitis get better, why haven't my symptoms gone away? The reason is very simple. Sinusitis is very difficult to treat. As a result, patients typically don't get better quickly, and if they're not treated correctly they may never improve. If you're not getting better it doesn't mean that you're not getting good care, but it may mean you're not getting the very best care. Unfortunately most doctors don't understand the best way to treat it.

I am a medical specialist in treatment of sinusitis. Lots of people are surprised that I am not an ENT surgeon. But going to an ENT is like going to a cardiovascular surgeon if you have chest pain from heart disease. You see a medical specialist first ( a cardiologist) for medical treatment.

This is not to say that ENT surgeons shouldn't treat sinusitis. Often they can, but if you see a surgeon, you are more likely to have surgery than if you see a medical specialist in sinusitis. And in addition if you have already had surgery, it may be much more difficult for the ENT doctor to treat you.

My original training was in internal medicine and allergy, so although I don't take care of general medical problems any more, I do take care of some patients with allergies and asthma. (By the way lots of people without allergies see allergists; we don't just give allergy shots - too bad most people don't know that. They could get better a lot faster because we know a lot more about treatment of problems like asthma, allergies and sinusitis). In fact the vast majority of patients that I see don't even have allergies at all, they have sinusitis.

This is the hardest section for me to write in this entire website. I would like for you to be able to understand how I treat patients in my office so that you can get the best treatment for your sinusitis wherever you can go for treatment. If you have read this far, you probably have spent much time, energy and money trying to get better. If you haven't had to spend that much, you are lucky. It is hard for most people to understand that a sinusitis specialist has special skills (and I'm not including surgery) which allow them to be successful in treating a difficult problem like sinusitis. That concept may be difficult to convey here, but by the time you've finished browsing through this website, I hope I will have achieved it. It is like a patient with chest pain going to see a cardiologist if the internist can't take care of the problems initially.

Probably as a result of having sinus problems myself, I have made many changes in the way I treat sinus infections-not so much in the medications or dosages, but in terms of the approach to treatment. When I had sinus infections, I felt like life wasn't worth living any more, between the exhaustion, pain and just feeling miserable. I was scared of having complications from the sinus infections, but even more scared of having surgery. I had side effects from the medications that nobody had heard of, and it seemed like there was just one problem after another. I think having gone through that made me 1) appreciate much more about how patients suffer with sinus infections, 2) understand more about how patients need to be treated as well as 3) empathize better with what they are going through.

The first time a patient comes into my office we have them fill out some forms, and then I will go over their history in detail. The history is probably the most important part of my evaluation. We get a strong suspicion not only of whether a sinusitis is brewing but also clues to treatment and factors which may worsen it. I spend a lot of time going through my patient's history (you can't do it in 5 minutes) and then do an examination. I was trained as an internist, so I don't just look at my patient's nose, but also listen to their heart and lungs as well as whatever else is necessary. It takes a long time (often 1-2 hours)to review all of the problems as well as the kinds of treatments that are used. We don't just treat the initial symptoms, we want to get you better permanently. It isn't easy. It means taking medications and sometimes altering various things about your lifestyle. It could be as simple as getting a vaporizer and putting it by your bedside so your nose and throat don't get dried out at night, or it may mean keeping a glass of water by your bedside. But sometimes it means making major lifestyle changes.

Long-term treatment

People often ask how long they have to take medications. It is often for weeks or months, but after a while, you usually can taper off the medications. Some people do need to have ongoing treatment, but obviously we would like to try to minimize that if at all possible. I talk to my patients about what can be done in order to do that. What is critically important though, is to get you over your sinusitis completely if it is at all possible.

Medications

Of the commonly used medications, the ones we like to use as briefly as possible are the antibiotics. Long term use can cause resistant bacteria (a very serious problem now), allergy and side effects. Other medications we use commonly include mucus thinners, decongestants, steroid nasal sprays, and anti-inflammatory agents. We also sometimes use antifungal agents.
In the course of the rest of the website we will discuss most of the medications that need to be used to treat sinusitis. Because of the number of requests, we have included a partial list here. It is important to realize that some or all of them may need to be used in each patient. Please discuss the medications with your doctor. Please do not send emails asking about specific medications as those must be discussed with your doctor. In some cases we have included hyperlinks explaining the medications. In others you must use the search engine Please read through the website so that you can better understand what the various treatments can do:

The most important treatments are in bold.

Please remember to close down the pop-up window after looking at the hyperlinks.
Steroid Nasal Sprays Bactroban diet
guaifenesin Eucalyptus massage
oral decongestants garlic Neosporin
decongestant nasal spray    vitamin C Peroxide
vaporizer Quercetin Hydropulse irrigator
oral antibiotics Herbs Rinoflow
oral steroids Alkalol antifungals
potassium iodide Nasal gels Eucalyptus
Nasalcrom Nasal irrigation Acupuncture
Papaya NSAIDS Atrovent
Hot Air Betadine Astelin
saline nasal spray IV antibiotics personal steamer
Entertainers Secret Spray IVIG Allergy therapy
Devices for obstruction BreatheZen

The costs of sinusitis treatment are not so much the doctors bills, but medication and other costs, especially if you don't have a prescription plan. Antibiotics typically may cost $100 per week, but if treatment isn't optimal, there is also the potential loss of work time. There are also laboratory costs and the costs of surgery if treatment isn't provided soon enough, which can run $10,000 - $20,000.


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Remember, you need a doctor with a special interest in
sinusitis if you're not getting better.

Last updated October 16, 2011
© 1998-2011
Wellington S. Tichenor, M. D.
642 Park Avenue
New York, New York 10021
(212) 517-6611

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