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December 24, 2009

Recurrent Chronic Sinusitis Often Due to Allergies


A 2009 research paper lends credence that allergies may be a VERY important player in patients who suffer from recurrent sinus infections. Such patients will improve with antibiotics only to have their sinus infection symptoms recur shortly after completing the antibiotics.

The research described how allergy exposure to patients resulted in a rapid and radiographically significant response of sinus disease including mucosal thickening and/or opacification. How fast? Within 60 MINUTES!!!

These findings lend support that should patients suffer from recurrent sinus infections that do not clear readily with antibiotics alone should be investigated for allergies. Furthermore, allergy testing and management should be performed in all patients considering sinus surgery. Why? Because if allergies are playing a role, opening up the sinuses via surgery will only exacerbate allergy triggered sinus infections.

It is also not unusual that a patient may confuse allergy symptoms with a sinus infection which is yet another reason why allergy evaluation and treatment is important in sinusitis evaluations.

What is our office protocol for evaluating patients with chronic sinus infections?

1) History supportive of recurrent sinus infections in spite of antibiotics as well as trial of allergy medications
2) CT Sinus documenting presence of sinus disease for surgical consideration as well as elucidating whether true sinus problems are causing the symptoms
3) Allergy testing (Our office performs immunoCAP blood testing instead of skin prick testing)

If allergy testing is positive, aggressive allergy control is the first step prior to (or at the very least concurrent with) any other intervention including sinus surgery.

Should allergy testing and CT sinus come back normal, immunodeficiency workup is than pursued.


Reference:
Diagnostic Value of Nasal Allergen Challenge Combined With Radiography and Ultrasonogrphy in Chronic Maxillary Disease. Arch Otolaryngol Head Neck Surg. 2009 Dec;135(12):1246-55. doi: 10.1001/archoto.2009.189.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

4 comments:

  1. I am a broken record here but I have to say again, I love my neti pot! Keeping the nasal passages clear can go a loooong way toward helping w/ any ENT issues.
    I have also seen a number of people who still need additional measures after having sinus surgery. This is another case where "options" become key and many are turning to newer alternatives like balloon sinuplasty.
    Take care.

    ReplyDelete
  2. Yeah, I noticed when someone is allergic to something, they sneeze non-stop. It is connected to the sinus, right?

    skin allergist new york city

    ReplyDelete
  3. I completely agree with saline flushes as something to use in setting if chronic sinus infections. Good point.

    ReplyDelete
  4. there is no way of knowing until i try i guess but i cannot see myself pouring stuff up my nose! just me though.
    my doc told me that my nasal passages are not allowing for good air flow and he did mention the balloon sinuplasty thing, as well as irrigation. i'm supposed to try a netti pot but like i said i just don't see it happening!

    ReplyDelete

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