ongoing infection
Question:
Russell Thames wrote:
After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.
Has your ENT considered that you may have a recirculation disorder caused by a slight problem with your surgeries? Here is an article you might show him: Iatrogenic maxillary sinus recirculation and beyond. (Original Article). Ear, Nose & Throat Journal, Jan, 2003, by Michael Gutman, Steve Houser Abstract Recirculation of nasal mucus occurs when secretions that have been transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium. Recirculation increases the risk of persistent sinus infection. In this article, we describe a case of mucus recirculation in a patient who had not responded to two previous sinus surgeries for recurrent rhinosinusitis. We also postulate the possibility of ethmoid recirculation. Introduction Functional endoscopic sinus surgery has been a most successful procedure, and clinical failure rates of less than 10% have been reported in the literature. (1) According to the Messerklinger approach, the key to eliminating persistent sinus infection is to re-establish physiologic mucociliary clearance patterns. (2) Patients in whom sinus surgery has failed have often exhibited evidence that their mucociliary clearance pathways were functionally or anatomically obstructed. One functional mechanism that has been well described is the recirculation phenomenon. (3,4) Recirculation occurs when secretions that have been transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium; the process then becomes cyclical. (5) Matthews and Burke described the adverse effect of recirculation: "The putative mechanism of sinus disease related to this recirculation involves the repeated presentation of allergens, bacteria, and inflammatory mediators contained in the mucus. If the mucus is not cleared, its viscidity increases, and its concentration of inflammatory agents increases its potential for inducing sinus mucosal inflammation and disease." (6) In this article, we describe our endoscopic identification of an incontrovertible case of mucus recirculation in a patient who had not responded to two earlier sinus surgeries for recurrent rhinosinusitis. We also emphasize the principles of the diagnosis and treatment of recirculation, and we postulate the possibility of ethmoid recirculation. Case report In 2000, we evaluated a 48-year-old man who had recurrent rhinosinusitis despite having undergone sinus surgery in 1996 and 1997. He had experienced a brief period of relief following the second operation, but thereafter several acute infections of worsening severity ensued. During our initial evaluation, the patient complained of severe nasal congestion and thick postnasal drainage despite more than 4 weeks of culture-specific antibiotic therapy. Adjunctive nasal irrigation had also been unsuccessful in alleviating his symptoms. Fiberoptic examination of the nasal cavities revealed that the iatrogenic ostia were patent bilaterally. A drop of turbid mucus was detected resting above the left iatrogenic ostium. Computed tomography (CT) detected a bilateral soft-tissue obstruction of the natural ostia, which were discontinuous with the surgically created ostia (figure 1). Based on these findings, the patient was taken for revision endoscopic sinus surgery. Intraoperatively, we noted that a tenacious ring of clear mucus was circulating through the natural and iatrogenic maxillary ostia (figure 2). To connect the two ostia, we inserted the ball-tipped end of the Houser Freer-seeker (Instrumentarium Surgical Corp.; Terrebonne, Que.) into the natural ostium and pulled it downward into the large iatrogenic ostium. We then sharply debrided the tissue remnants with the Hummer microdebrider (Stryker Leibinger; Kalamazoo, Mich.). We also performed bilateral revision anterior and posterior ethmoidectomies, a right frontal sinusotomy, and a reduction of the inferior turbinates. Follow-up endoscopy 3 months following surgery revealed that the new ostium was widely patent and well healed (figure 3). At 14 months, the patient reported a significant improvement in his condition; compared with his preoperative state, he was experiencing less congestion, mucus formation, and fatigue. Since then, he has required one course of antibiotic treatment. He continues to use a nasal irrigator periodically as needed (less frequently than before) and he continues to use a steroid nasal spray regularly. Discussion Under normal circumstances, clearance from the maxillary sinus proceeds from the natural ostium, which is usually located in the posterior third of the ethmoid infundibulum. (7) The secretions then traverse from the hiatus semilunaris to the medial wall of the inferior turbinate, and then they move posteriorly to the nasopharynx. It has been well established that mucus is cleared from the maxillary sinus via the natural ostium even in the presence of large nasoantral or middle meatal windows that are separate from the natural ostia. (2) In our patient, the CT finding of discontinuity between the natural and iatrogenic ostia led us to suspect that recirculation had been occurring. Our suspicion was confirmed endoscopically. During surgery, we re-established a physiologic mucociliary pathway by connecting the two ostia in the manner described by Coleman and Duncavage. (8) Theoretically, recirculation can occur in any sinus that has an accessory or iatrogenic ostium through which mucus can return to the sinus. The recirculation phenomenon has been observed in the sphenoid sinus.9 It has also been documented in a maxillary sinus following the creation of nasoantral windows. Recirculation has even been documented by graphite tracing in the ethmoid cavity following posterior ethmoidectomy. (10) We suggest that recirculation can occur following an anterior ethmoidectomy as well; such a process has not been previously reported in the literature. During an anterior ethmoidectomy, the typical first step is to perforate the anteroinferior wall of the ethmoid bulla. A microdebrider or forceps is then used to more fully open the bulla. If only an anterior ethmoidectomy is indicated, then the surgeon might inadvertently leave the posterior wall of the bulla intact. The posterior wall of the bulla tightly overlies the retrobullar space and basal lamella. The natural drainage point for the ethmoid bulla is frequently located at the most lateral part of the posterior bullar wall. This point would remain discontinuous with the iatrogenic defect if a bridge of posterior bullar wall that is medial to the natural ostium remains intact. According to the findings of Waguespack’s study of mucociliary clearance following sinus surgery, mucus situated on the lamina papyracea, previously the lateral wall of the bulla, will flow posteriorly onto the basal lamella. (10) We suspect that this mucus could easily loop back over the surgically created bridge of tissue and est ablish a circular flow pattern. In order to prevent ethmoid recirculation, we prefer to identify the ostium of the bulla and resect the bridge of the posterior bullar wall. To achieve this, we introduce a curved seeker along the lateral surface of the middle turbinate, back toward the basal lamella. We gently pass the seeker into the retrobullar space between the basal lamella and the posterior bullar wall. With careful manipulation, the seeker tip can be seen as it passes through the natural ostium of the bulla (figure 4). The seeker is then pulled back toward the surgeon to break the intervening bridge. A microdebrider can then effectively remove the remnants of the broken tissue bridge. In conclusion, sinus surgery can be very successful if physiologic pathways of mucociliary clearance are reestablished. The sinus surgeon should be meticulous in connecting any accessory or surgically created drainage pathways with the natural ostia. Although recirculation following anterior ethmoidectomy is purely hypothetical at this point, its existence is anatomically intuitive. Ethmoid recirculation might account for some cases of persistent sinus disease and symptoms despite an otherwise satisfactory anterior ethmoidectomy. The technique we have described is fairly simple and adds minimal time to the length of the surgical procedure. References (1.) Citardi MJ, Sillers MJ. The management of chronic rhinosinusitis after failed sinus surgery. International Online Journal of Otorhinolaryngology–Head and Neck Surgery 1998;1:1-4. (2.) Stammberger HR. Functional Endoscopic Sinus Surgery. The Messerklinger Technique. Philadelphia: B.C. Decker, 1991:17-37. (3.) Yanagisawa E, Yanagisawa K. Endoscopic view of recirculation phenomenon of the maxillary sinus. Ear Nose Throat J 1997;76:196-8. (4.) Chung SK, Dhong HJ, Na DG. Mucus circulation between accessory ostium and natural ostium of maxillary sinus. J Laryngol Otol 1999;113:865-7. (5.) Kennedy D, Shanlan H. Reevaluation of maxillary sinus surgery: Experimental study in rabbits, Ann Otol Rhinol Laryngol 1989;98:901-6. (6.) Matthews BL, Burke AJ. Recirculation of mucus via accessory ostia causing chronic maxillary sinus disease. Otolaryngol Head Neck Surg 1997;117:422-3. (7.) … read more »
Response:
Russell, I missed this the first time, but my ENT IS Dr. Stankiewicz at Loyola in Maywood! Please contact me.
Response:
<< "iJah", you posted: Can you elucidate on how you give yourself ‘electro-accupuncture’ sinus treatments please or point me to some info on the subject? I’ve been using accupressure to relieve neck and headache pain and it seems to work – not as well as a narcotic pain killer might – but it’s certainly far less innocuous than using pain killers or anything of that sort.
<=======================================
I bought a KWD-808-I acupuncture machine from goacupuncture.com. Follow the following link to that KWD-808-I info page: http://www.goacupuncture.com/cgi-bin/ns/ProductDetail.pl?SkuNo=G-06A It sells for $99.00 I could not find it cheaper at any other place, but you might be able to. There are three main important "acupuncture" sinus areas that I treated. I first treated almost the entire top of my head, for an hour, with electro-pads. But first, I shaved the top of my balding head so that the pads will stick. The results were dramatic. Another important acupuncture sinus area is the back of the head. I didn’t want to use needles, or shave the back of my head, so I used a heating pad on the back of my head for an hour. It seemed to help. There are also some important points under the nostrils and to the sides of the nostrils, which I treated. There are also some other important sinus points. I know that the "upside down sinus flooding" with peroxide, baking soda and kosher salt solved my sinus infection problems, but it did not take away my sinus problems. I really feel strongly that the electro-acupuncture treatments have resulted in my wide open and comfortable sinuses. They have never been better. To read more about what I did, and to read other’s comments about acupuncture, you can browse thru the notes at Healthboards.com’s acupuncture thread. Over there, I use the nickname Beerzoids. Here is a good place to start to read, if you are interested: http://www.healthboards.com/boards/showthread.php?t=13886&page=5&pp=5 My acupuncture posts start mainly with post #23.
Response:
- Hide quoted text — Show quoted text -Steven Litvintchouk <sdlit…@earthlinkNOSPAM.net
wrote in message <news:cNh9c.1946$NL4.1657@newsread3.news.atl.earthlink.net… Russell Thames wrote: After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses. Has your ENT considered that you may have a recirculation disorder caused by a slight problem with your surgeries? Here is an article you might show him: Iatrogenic maxillary sinus recirculation and beyond. (Original Article). Ear, Nose & Throat Journal, Jan, 2003, by Michael Gutman, Steve Houser Abstract Recirculation of nasal mucus occurs when secretions that have been transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium. Recirculation increases the risk of persistent sinus infection. In this article, we describe a case of mucus recirculation in a patient who had not responded to two previous sinus surgeries for recurrent rhinosinusitis. We also postulate the possibility of ethmoid recirculation. Introduction Functional endoscopic sinus surgery has been a most successful procedure, and clinical failure rates of less than 10% have been reported in the literature. (1) According to the Messerklinger approach, the key to eliminating persistent sinus infection is to re-establish physiologic mucociliary clearance patterns. (2) Patients in whom sinus surgery has failed have often exhibited evidence that their mucociliary clearance pathways were functionally or anatomically obstructed. One functional mechanism that has been well described is the recirculation phenomenon. (3,4) Recirculation occurs when secretions that have been transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium; the process then becomes cyclical. (5) Matthews and Burke described the adverse effect of recirculation: "The putative mechanism of sinus disease related to this recirculation involves the repeated presentation of allergens, bacteria, and inflammatory mediators contained in the mucus. If the mucus is not cleared, its viscidity increases, and its concentration of inflammatory agents increases its potential for inducing sinus mucosal inflammation and disease." (6) In this article, we describe our endoscopic identification of an incontrovertible case of mucus recirculation in a patient who had not responded to two earlier sinus surgeries for recurrent rhinosinusitis. We also emphasize the principles of the diagnosis and treatment of recirculation, and we postulate the possibility of ethmoid recirculation. Case report In 2000, we evaluated a 48-year-old man who had recurrent rhinosinusitis despite having undergone sinus surgery in 1996 and 1997. He had experienced a brief period of relief following the second operation, but thereafter several acute infections of worsening severity ensued. During our initial evaluation, the patient complained of severe nasal congestion and thick postnasal drainage despite more than 4 weeks of culture-specific antibiotic therapy. Adjunctive nasal irrigation had also been unsuccessful in alleviating his symptoms. Fiberoptic examination of the nasal cavities revealed that the iatrogenic ostia were patent bilaterally. A drop of turbid mucus was detected resting above the left iatrogenic ostium. Computed tomography (CT) detected a bilateral soft-tissue obstruction of the natural ostia, which were discontinuous with the surgically created ostia (figure 1). Based on these findings, the patient was taken for revision endoscopic sinus surgery. Intraoperatively, we noted that a tenacious ring of clear mucus was circulating through the natural and iatrogenic maxillary ostia (figure 2). To connect the two ostia, we inserted the ball-tipped end of the Houser Freer-seeker (Instrumentarium Surgical Corp.; Terrebonne, Que.) into the natural ostium and pulled it downward into the large iatrogenic ostium. We then sharply debrided the tissue remnants with the Hummer microdebrider (Stryker Leibinger; Kalamazoo, Mich.). We also performed bilateral revision anterior and posterior ethmoidectomies, a right frontal sinusotomy, and a reduction of the inferior turbinates. Follow-up endoscopy 3 months following surgery revealed that the new ostium was widely patent and well healed (figure 3). At 14 months, the patient reported a significant improvement in his condition; compared with his preoperative state, he was experiencing less congestion, mucus formation, and fatigue. Since then, he has required one course of antibiotic treatment. He continues to use a nasal irrigator periodically as needed (less frequently than before) and he continues to use a steroid nasal spray regularly. Discussion Under normal circumstances, clearance from the maxillary sinus proceeds from the natural ostium, which is usually located in the posterior third of the ethmoid infundibulum. (7) The secretions then traverse from the hiatus semilunaris to the medial wall of the inferior turbinate, and then they move posteriorly to the nasopharynx. It has been well established that mucus is cleared from the maxillary sinus via the natural ostium even in the presence of large nasoantral or middle meatal windows that are separate from the natural ostia. (2) In our patient, the CT finding of discontinuity between the natural and iatrogenic ostia led us to suspect that recirculation had been occurring. Our suspicion was confirmed endoscopically. During surgery, we re-established a physiologic mucociliary pathway by connecting the two ostia in the manner described by Coleman and Duncavage. (8) Theoretically, recirculation can occur in any sinus that has an accessory or iatrogenic ostium through which mucus can return to the sinus. The recirculation phenomenon has been observed in the sphenoid sinus.9 It has also been documented in a maxillary sinus following the creation of nasoantral windows. Recirculation has even been documented by graphite tracing in the ethmoid cavity following posterior ethmoidectomy. (10) We suggest that recirculation can occur following an anterior ethmoidectomy as well; such a process has not been previously reported in the literature. During an anterior ethmoidectomy, the typical first step is to perforate the anteroinferior wall of the ethmoid bulla. A microdebrider or forceps is then used to more fully open the bulla. If only an anterior ethmoidectomy is indicated, then the surgeon might inadvertently leave the posterior wall of the bulla intact. The posterior wall of the bulla tightly overlies the retrobullar space and basal lamella. The natural drainage point for the ethmoid bulla is frequently located at the most lateral part of the posterior bullar wall. This point would remain discontinuous with the iatrogenic defect if a bridge of posterior bullar wall that is medial to the natural ostium remains intact. According to the findings of Waguespack’s study of mucociliary clearance following sinus surgery, mucus situated on the lamina papyracea, previously the lateral wall of the bulla, will flow posteriorly onto the basal lamella. (10) We suspect that this mucus could easily loop back over the surgically created bridge of tissue and est ablish a circular flow pattern. In order to prevent ethmoid recirculation, we prefer to identify the ostium of the bulla and resect the bridge of the posterior bullar wall. To achieve this, we introduce a curved seeker along the lateral surface of the middle turbinate, back toward the basal lamella. We gently pass the seeker into the retrobullar space between the basal lamella and the posterior bullar wall. With careful manipulation, the seeker tip can be seen as it passes through the natural ostium of the bulla (figure 4). The seeker is then pulled back toward the surgeon to break the intervening bridge. A microdebrider can then effectively remove the remnants of the broken tissue bridge. In conclusion, sinus surgery can be very successful if physiologic pathways of mucociliary clearance are reestablished. The sinus surgeon should be meticulous in connecting any accessory or surgically created drainage pathways with the natural ostia. Although recirculation following anterior ethmoidectomy is purely hypothetical at this point, its existence is anatomically intuitive. Ethmoid recirculation might account for some cases of persistent sinus disease and symptoms despite an otherwise satisfactory anterior ethmoidectomy. The technique we have described is fairly simple and adds minimal time to the length of the surgical procedure. References (1.) Citardi MJ, Sillers MJ. The management of chronic rhinosinusitis after failed sinus surgery. International Online Journal of Otorhinolaryngology–Head and Neck Surgery 1998;1:1-4. (2.) Stammberger HR. Functional Endoscopic Sinus Surgery. The Messerklinger Technique. Philadelphia: B.C. Decker, 1991:17-37. (3.) Yanagisawa E, Yanagisawa K. Endoscopic view of recirculation phenomenon of the maxillary sinus. Ear Nose
… read more »
Response:
Russell, as one who has been there, done that – let me just share my experience with you. I had repeated sinus infections for twenty years. I had asthma for 33 years. Every day I was on Theo-Dur, Singulair, Advair Diskus 500/50, Guaifenesin, Flonase and then Albuterol for my rescue inhaler. There was no such thing as a simple cold for me – every little sniffle that someone around me got, resulted in a sinus infection for me, or a bout with bronchitis. I had pneumonia five times and went through three sinus surgeries. The surgeries only seemed to help a little. Each year my health seemed to be worse than the year before. Allergy shots did little. You may have an anaerobic infection which would require Metronidazole. You may have a fungus that the Mayo Clinic recently stated was responsible for some chronic sinus problems. Or you may have had, at one point, either mycoplasma or chlamydia pneumoniae – both airborne, both can enter the body through the mouth or nasal passages and wreak havoc on you. At least in the case of chlamydia pneumoniae, it (like the sexually transmitted chlamydia) can continue to travel further into your body – sometimes resulting in asthma over time if it hasn’t been eradicated. PCR is a newer dna test and if it involves swabbing or testing sinus backwash after flushing, the results may be inconclusive. No standards have really been set for these tests yet. The best way to test for asthma caused by one of those bacteria is with a bronchoscopy – an invasive procedure to test tissue sample taken from the lung. I don’t know if there’s such a test for the sinuses. The doctor I saw in Madison last year who discovered a link between c. pneumoniae and some of these problems, and has been studying them for 15 years, tested me with serology tests and by swabbing my throat and also gargling and testing the backwash. The pcr tests came back negative. The serology tests showed that at some time in the past, I’d had both mycoplasma and c. pneumoniae. So, odds were good that it was probably making my condition worse. The doctor treated me with Azithromycin aka Zpak or Zithromax. I took 500 mgs for three days, followed by 750 mgs a week later, and once a week following for a total of 12 weeks. Much to my surprise – and the surprise of the doctor in Madison, since I’d had this for so long, the asthma was completely resolved and I’ve been off all asthma meds for almost a year. My allergies went from severe to mild. My sinus problems went from nonstop and severe to mild and related to the allergies – and for once are actually not even noticeable with the antihistimine and nasal spray I take. Unfortunately, it’s difficult to find doctors who will look at this research that has been taking place for years. Some still don’t consider that you might have an anaerobic sinus infection (I did once!), nor will they do anything to test for fungus despite the fact that Mayo has come out with some interesting evidence on it. Also, some doctors (and people reading this, no doubt) will say that taking an antibiotic for 12 weeks is dangerous and blah blah blah. I always laugh at that one. Azithromycin was actually tested for twelve weeks by the FDA with no problems except in those who had liver disease. Docs can give you antibiotics for a year if it’s acne, but if it’s something else, nobody wants you to have it for some reason. I was on them four or five times a year every year anyway, not to mention the cortisone shots and prednisone bursts – and maybe it’s me, but I didn’t view a continuation of that to be the healthier thing to do. This past year is the first year I’ve not been on any antibiotic (since the Azithromycin) since I was 15. I’m 49 now. I don’t know where you’re located, but if you want to know more, either write me at the email address shown in this post, or visit www.asthmastory.com and write me there. I’m a forum moderator, not the person who put the site together. I can give you the name of my ENT who treats for fungus, anaerobic infections and is now treating people if he suspects the cause of their problems is mycoplasma or c. pneumoniae that you once had (not a current, active infection or you’d be a lot sicker). If you’re in WI, I can give you that doctors name instead. (the one who has been studying this and resolved my asthma, my son’s asthma, my friends son’s asthma and the asthma of a lot of people I don’t know….lol) Oh – for the record – I’ve posted here in the past with problems just like you and haven’t been around because I no longer have a need. I’m not selling anything – just took a look at the newsgroup on this rainy afternoon and felt compelled to write. Whatever you do – good luck and may you be blessed to find the health I’ve been gifted with.
Response:
On Sun, 28 Mar 2004 10:52:45 -0500, "CanDo" <rasm1…@bellsouth.net
wrote: It’s now been about 2.5 years since I started flooding my sinuses with peroxide, baking soda and kosher salt (average 2 times per month). I have not had another sinus infection during that time. Also, during that time, I have given myself electro-acupuncture sinus treatments and my sinuses feel great most of the time.
You’ve been succesful too then – that’s great!
Response:
On Sun, 28 Mar 2004 15:27:25 GMT, Steven Litvintchouk <sdlit…@earthlinkNOSPAM.net
wrote: I’ve been thinking of updating it, but I think it needs such major revision that it’s too big a job for me to do alone. (hint hint)
That’s great Steven. Maybe we can work on it as a group effort Do you want to coordinate it? I for one will be glad to help – just let me know what you need or propose a manner of proceeding. Then maybe we can submit a draft later for comments and iterate until there is a consensus in favor of it. – Hide quoted text — Show quoted text -
For one thing, the FAQ as written isn’t really a "Frequently Asked QUESTIONS" list–where are the questions? It’s more of a tutorial on sinusitis, which is unnecessary by now since there are enough great websites it can simply just point to. We’ve seen a lot of frequently asked questions on this NG. Like what antibiotic(s) to use, what to do if you have mysterious symptoms, etc. That’s what a true FAQ list should have.
Response:
<< "Don Brady", you said: Seldom is one completely cured.
Rather, one gets sinusitis under control, to the extent that it does not impair one’s lifestyle. We have had a few people who did totally cure themselves and pretty well drop out though (including the FAQ author). <=========================================
On Sun, 28 Mar 2004 10:52:45 -0500, "CanDo" <rasm1…@bellsouth.net
wrote:
It’s now been about 2.5 years since I started flooding my sinuses with peroxide, baking soda and kosher salt (average 2 times per month). I have not had another sinus infection during that time. Also, during that time, I have given myself electro-acupuncture sinus treatments and my sinuses feel great most of the time.
Can you elucidate on how you give yourself ‘electro-accupuncture’ sinus treatments please or point me to some info on the subject? I’ve been using accupressure to relieve neck and headache pain and it seems to work – not as well as a narcotic pain killer might – but it’s certainly far less innocuous than using pain killers or anything of that sort.
Response:
<< "Don Brady", you said: Seldom is one completely cured. Rather, one gets sinusitis under control, to the extent that it does not impair one’s lifestyle. We have had a few people who did totally cure themselves and pretty well drop out though (including the FAQ author).
<=========================================
It’s now been about 2.5 years since I started flooding my sinuses with peroxide, baking soda and kosher salt (average 2 times per month). I have not had another sinus infection during that time. Also, during that time, I have given myself electro-acupuncture sinus treatments and my sinuses feel great most of the time.
Response:
- Hide quoted text — Show quoted text -Don Brady wrote:
On Sat, 27 Mar 2004 20:54:48 -0500, knob <h…@dontemailme.com wrote: I think it’s great that you shared this information. However what keeps people around here after they are cured? Seldom is one completely cured. Rather, one gets sinusitis under control, to the extent that it does not impair one’s lifestyle. We have had a few people who did totally cure themselves and pretty well drop out though (including the FAQ author).
I’m glad for him, but it means that the FAQ hasn’t been updated in 5 years. I’ve been thinking of updating it, but I think it needs such major revision that it’s too big a job for me to do alone. (hint hint) For one thing, the FAQ as written isn’t really a "Frequently Asked QUESTIONS" list–where are the questions? It’s more of a tutorial on sinusitis, which is unnecessary by now since there are enough great websites it can simply just point to. We’ve seen a lot of frequently asked questions on this NG. Like what antibiotic(s) to use, what to do if you have mysterious symptoms, etc. That’s what a true FAQ list should have. — Steven L.
Response:
On Sat, 27 Mar 2004 20:54:48 -0500, knob <h…@dontemailme.com
wrote: I think it’s great that you shared this information. However what keeps people around here after they are cured?
Seldom is one completely cured. Rather, one gets sinusitis under control, to the extent that it does not impair one’s lifestyle. We have had a few people who did totally cure themselves and pretty well drop out though (including the FAQ author).
Response:
- Hide quoted text — Show quoted text -DreamHarp7 wrote:
Rest, exercise, and diet, and avoiding dust, are also critical for me. I find that a good night’s sleep (9 hours) alone will reduce inflammation considerably. And vigorous exercise will open up and clear out the sinuses just like irrigation. I can relate to the lack of rest. My chronic sinusitis began after I had triplets. (also had a 2 year old) I had no sleep or rest for 2 years! What kind of "diet" is best for chronic sinusitis? High protein???
Can’t hurt to try! Go grill up a nice big steak.
Response:
I think it’s great that you shared this information. However what keeps people around here after they are cured? – Hide quoted text — Show quoted text -Monika wrote:
X-no-archive: yes long shot…. i got a different infection after having FESS… a nasty bug i picked up at the hospital. anyways, they did a C&S and identified the bug (pseudomonas). four months and five antibiotics later i was finally rid of it. anyways, i think the nasal rinse/spray of the antibiotic and the oral antibiotic combination was the most effective treatment. i don’t know what "bug" you all are suffering from, but the double whammie (oral and topical) antibiotic worked for me. best wishes "Russell Thames" <rjtha…@mtco.com wrote in message news:e08315e0.0403261726.707d6878@posting.google.com… After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.Hopefully I can get another referal from the new Doc to go see a true expert.In the meantime I will continue irrigating etc.To what extent ,I wonder,does this type disease shorten ones life span?As the body ages the complications of all this must get worse. Any comments are welcome and appreciated ———Russ
Response:
- Hide quoted text — Show quoted text -knob wrote:
Russell Thames wrote: After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.Hopefully I can get another referal from the new Doc to go see a true expert.In the meantime I will continue irrigating etc.To what extent ,I wonder,does this type disease shorten ones life span?As the body ages the complications of all this must get worse. Any comments are welcome and appreciated ———Russ I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics.
Biofilms are just the latest hot topic when it comes to chronic sinusitis. We’ve also got Mayo Clinic’s theory of fungal sinusitis, UPenn’s theory of ethmoid partition infection, MetroHealth’s maxillary recirculation phenomenon theory, on and on and on. Sinusitis may be like cancer in that in reality, there isn’t one single disease called "sinusitis" or "cancer", but a host of separate disorders that all have to be treated differently. There is no similarity between the etiology of leukemia and lung cancer or colorectal cancer, nor are they treated the same ways either. — Steven L.
Response:
On 27 Mar 2004 07:56:10 -0800, rjtha…@mtco.com (Russell Thames) wrote:
It’s good to be optomistic but in my case I don’t see how any medication can repair damaged mucosa.It is my understanding that once it reaches a point it never works correctly again. The only alternative is to remove the disfunctional mucosa in hopes that the regrown membranes work better i.e. roll the dice.
That was the theory at one point but I believe the current expert consensus opinion is now that the mucosa will recover once other factors are normalized. I had one doctor tell me what you say above – that my maxillary sinuses were diseased to the point that the only solution was to remove the mucosa. I knew by then that this was an out-of-date point of view and ignored her. I had surgery a few years ago at U. Penn. and my maxillary sinuses are improving steadily. I can tell you the phases they go through as they recover. First, the one that was last to go opens up and gives a bloody taste. Eventually, it stops tasting bloody the the one that was originally first to go starts opening up on the opposire side, and it tastes bloody until the inflammation goes down. It’s funny, but I can tell the state of my sinuses by the echo of my voice and other factors. I also have checkups periodically. I can also juge by the amount of post-nasal drainage I get. It is possible to clear that now at least on-and-off if I get the inflammation down. Rest, exercise, and diet, and avoiding dust, are also critical for me. I find that a good night’s sleep (9 hours) alone will reduce inflammation considerably. And vigorous exercise will open up and clear out the sinuses just like irrigation.
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Rest, exercise, and diet, and avoiding dust, are also critical for me. I find that a good night’s sleep (9 hours) alone will reduce inflammation considerably. And vigorous exercise will open up and clear out the sinuses just like irrigation. I can relate to the lack of rest. My
chronic sinusitis began after I had triplets. (also had a 2 year old) I had no sleep or rest for 2 years! What kind of "diet" is best for chronic sinusitis? High protein??? – Hide quoted text — Show quoted text –
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On 27 Mar 2004 21:03:22 GMT, dreamha…@aol.com (DreamHarp7) wrote:
I can relate to the lack of rest. My chronic sinusitis began after I had triplets. (also had a 2 year old) I had no sleep or rest for 2 years!
Ahh I suspect this is not unsual. Try an exercise and sleep weekend and see if it helps (I find I need exercise or I cannot sleep long periods, so I need both).
What kind of "diet" is best for chronic sinusitis? High protein???
I would just say normalize it to correct any deficiencies – which may be hard to identify. I do find that evena little Salmon helps me all over. But you cannot go overboard on this becuase of heavy metal contamination. Eat only wild salmon, not farmed for that reason (mercury). It costs more but you can buy it in Whole Foods frozen for a lower price. I would not personally go on a high-protein diet (except briefly perhaps to lose wieght). My own strict vegetarian diet was *too* low in protein. This would probably apply to almost nobody else.
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After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.Hopefully I can get another referal from the new Doc to go see a true expert.In the meantime I will continue irrigating etc.To what extent ,I wonder,does this type disease shorten ones life span?As the body ages the complications of all this must get worse. Any comments are welcome and appreciated ———Russ
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Russell Thames wrote:
After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.Hopefully I can get another referal from the new Doc to go see a true expert.In the meantime I will continue irrigating etc.To what extent ,I wonder,does this type disease shorten ones life span?As the body ages the complications of all this must get worse. Any comments are welcome and appreciated ———Russ
I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics. He mentioned a family of drugs (which I can’t remember right now) that may hold some promise. There’s other theories too but not many ent’s will treat you based on one. Bottom line… IMO, your screwed till there’s a true breakthrough. I’ll bet we’re 10 years or more away from a cure.
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On Fri, 26 Mar 2004 22:42:06 -0500, knob <h…@dontemailme.com
wrote: I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics. He mentioned a family of drugs (which I can’t remember right now) that may hold some promise. There’s other theories too but not many ent’s will treat you based on one. Bottom line… IMO, your screwed till there’s a true breakthrough. I’ll bet we’re 10 years or more away from a cure.
U. Penn. led by Dr. Kennedy believes that infection lodges int he bony ethmoid partitions. They remove a lot of the fine partitions to cure the infection.
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- Hide quoted text — Show quoted text -Don Brady wrote:
On Fri, 26 Mar 2004 22:42:06 -0500, knob <h…@dontemailme.com wrote: I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics. He mentioned a family of drugs (which I can’t remember right now) that may hold some promise. There’s other theories too but not many ent’s will treat you based on one. Bottom line… IMO, your screwed till there’s a true breakthrough. I’ll bet we’re 10 years or more away from a cure. U. Penn. led by Dr. Kennedy believes that infection lodges int he bony ethmoid partitions. They remove a lot of the fine partitions to cure the infection.
From what I read it didn’t sound too promising. Apparently it is best if in the early stages of being chronic. It would be great to hear from someone who had this done.
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On Sat, 27 Mar 2004 00:51:19 -0500, knob <h…@dontemailme.com
wrote: U. Penn. led by Dr. Kennedy believes that infection lodges int he bony ethmoid partitions. They remove a lot of the fine partitions to cure the infection. From what I read it didn’t sound too promising. Apparently it is best if in the early stages of being chronic. It would be great to hear from someone who had this done.
Actually as far as I know it is extremely promising. They quote very good statistics. I had it done. I never had obvious infections anyway, though, so I can’t personally comment that much on the cases of those who do. Once caution I would have is that since it is somewhat more extensive surgery, I would only have it done by a surgeon with extensive experience using this approach.
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- Hide quoted text — Show quoted text -Don Brady <dbr…@pobox.com
wrote in message <news:b4v9601alig7ncbkokeq6t66ictfhil8ku@4ax.com… On Fri, 26 Mar 2004 22:42:06 -0500, knob <h…@dontemailme.com wrote: I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics. He mentioned a family of drugs (which I can’t remember right now) that may hold some promise. There’s other theories too but not many ent’s will treat you based on one. Bottom line… IMO, your screwed till there’s a true breakthrough. I’ll bet we’re 10 years or more away from a cure. U. Penn. led by Dr. Kennedy believes that infection lodges int he bony ethmoid partitions. They remove a lot of the fine partitions to cure the infection.
Unlikely this approach would benifit me as my problem lies in the maxillary sinuses
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- Hide quoted text — Show quoted text -knob <h…@dontemailme.com
wrote in message <news:1069u08hd7hm5c2@corp.supernews.com… Russell Thames wrote: After having FESS in may 03 and revision Oct 03 I stiil have infection.I have done everything I know to resolve it.Many thanks to all who have posted here as I have learned of things that have given me some relief.My ENT was at aloss so he refered me to Dr. Stankiewicz at Loyola for a consultation.My insurance denied coverage so now I am off to see another local ENT which is most likely a waste of time and money.My ENT is leaning toward poor mucociliary flow and mucosal problems.Most of the mucopurulent drainage seems to be in bothe maxillary sinus despite the widley patent condition in the sinuses.Hopefully I can get another referal from the new Doc to go see a true expert.In the meantime I will continue irrigating etc.To what extent ,I wonder,does this type disease shorten ones life span?As the body ages the complications of all this must get worse. Any comments are welcome and appreciated ———Russ I’m pretty much in the same boat. I got in to see a researcher and he told me that although I am pretty open from surgery I still have an infection. He said one leading theory right now is that bacteria grows on the surface of the sinus lining and develops a biofilm to protect itself from antibiotics. He mentioned a family of drugs (which I can’t remember right now) that may hold some promise. There’s other theories too but not many ent’s will treat you based on one. Bottom line… IMO, your screwed till there’s a true breakthrough. I’ll bet we’re 10 years or more away from a cure.
It’s good to be optomistic but in my case I don’t see how any medication can repair damaged mucosa.It is my understanding that once it reaches a point it never works correctly again.The only alternative is to remove the disfunctional mucosa in hopes that the regrown membranes work better i.e. roll the dice.
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- Hide quoted text — Show quoted text -Russell Thames wrote:
knob <h…@dontemailme.com wrote in message <news:101165ki22si00@corp.supernews.com… Try to get someone to give you a pcr test for mycoplasma. Russell Thames wrote: Well it’s been one week to the day since my six week course of levaquin ended.I also had two week prednisone taper.Had FESS in May to remove alot of polyps and revision surgery in oct.I have been irrigating twice a day.When I irrigated today when I got home from work I got alot of green mucus out.Seems as though without antibiotics I have infection.I had a CT three weeks into the levaquin and my ENT said it looked better than the last one(before revision).He said I was open and there was nothing else that could be done surgically.He mentioned sending me to see some sinus guru in chicago at John Hopkins.I forgot the name.I think he is out of ideas,isn’t that encouraging?Can anyone offer some suggestions as to what to do?I have tried everything I know except H2O2 irrigating which is looking better and better despite the mixed information I have read. Thanks All Russ This is a new one on me.What is it and how is the test done?Mucus culture?Blood?
PCR means "polymerase chain reaction." PCR amplification is a way to mass-produce copies of a DNA molecule. What he’s talking about is that even small amounts of DNA from only a few mycoplasma bugs can quickly be detected by PCR amplification. I assume it’s done with a mucus culture. But frankly, I wasn’t aware that mycoplasma caused much human sinusitis. I know it’s been implicated in LOWER respiratory problems (i.e. chronic cough, worsening of asthma, etc.). — Steven L.
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- Hide quoted text — Show quoted text -knob <h…@dontemailme.com
wrote in message <news:101165ki22si00@corp.supernews.com… Try to get someone to give you a pcr test for mycoplasma. Russell Thames wrote: Well it’s been one week to the day since my six week course of levaquin ended.I also had two week prednisone taper.Had FESS in May to remove alot of polyps and revision surgery in oct.I have been irrigating twice a day.When I irrigated today when I got home from work I got alot of green mucus out.Seems as though without antibiotics I have infection.I had a CT three weeks into the levaquin and my ENT said it looked better than the last one(before revision).He said I was open and there was nothing else that could be done surgically.He mentioned sending me to see some sinus guru in chicago at John Hopkins.I forgot the name.I think he is out of ideas,isn’t that encouraging?Can anyone offer some suggestions as to what to do?I have tried everything I know except H2O2 irrigating which is looking better and better despite the mixed information I have read. Thanks All Russ
This is a new one on me.What is it and how is the test done?Mucus culture?Blood? Thanks
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Well it’s been one week to the day since my six week course of levaquin ended.I also had two week prednisone taper.Had FESS in May to remove alot of polyps and revision surgery in oct.I have been irrigating twice a day.When I irrigated today when I got home from work I got alot of green mucus out.Seems as though without antibiotics I have infection.I had a CT three weeks into the levaquin and my ENT said it looked better than the last one(before revision).He said I was open and there was nothing else that could be done surgically.He mentioned sending me to see some sinus guru in chicago at John Hopkins.I forgot the name.I think he is out of ideas,isn’t that encouraging?Can anyone offer some suggestions as to what to do?I have tried everything I know except H2O2 irrigating which is looking better and better despite the mixed information I have read. Thanks All Russ
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Try to get someone to give you a pcr test for mycoplasma. – Hide quoted text — Show quoted text -Russell Thames wrote:
Well it’s been one week to the day since my six week course of levaquin ended.I also had two week prednisone taper.Had FESS in May to remove alot of polyps and revision surgery in oct.I have been irrigating twice a day.When I irrigated today when I got home from work I got alot of green mucus out.Seems as though without antibiotics I have infection.I had a CT three weeks into the levaquin and my ENT said it looked better than the last one(before revision).He said I was open and there was nothing else that could be done surgically.He mentioned sending me to see some sinus guru in chicago at John Hopkins.I forgot the name.I think he is out of ideas,isn’t that encouraging?Can anyone offer some suggestions as to what to do?I have tried everything I know except H2O2 irrigating which is looking better and better despite the mixed information I have read. Thanks All Russ
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