In a Panic:
A few years ago, an otolaryngologist from a children’s hospital in another state called in a panic to ask me if they could send a 3-year-old boy to me by helicopter (they had heard that I was a “sinus guy”).
They described a very ill little boy with high fevers, who had been chronically ill with sinusitis. After I asked about the little boy’s medical history, I asked what they had already tried. The answer was “3 months of antibiotics.” He did not have any complications from his sinusitis (yet), such as meningtis or abscess.
So, what do you think that I recommended?
Right – nasal saline rinses. I suggested that they begin nasal saline rinses, twice per day, immediately. They were very skeptical. After all, how could a little saline rinsing accomplish what months of antibiotics (including in-patient intravenous antibiotics) could not?
They wanted to fly him to me by helicopter. They wanted me to operate on him immediately. Seriously. Thinking that a medical helicopter transport would be a bit of an overreaction, I was firm, telling them that his fevers should decrease over the next 48 hours once they started the sinus rinses. I suggested that if he continued to have fevers, or any complications from his sinusitis, they could transfer his care to our hospital.
CT Scan at the Starting Point:
The following is a series of CT scan images (axial orientation, looking up at the sinuses from below, from the neck), taken one week apart. The first is the little boy’s CT scan before beginning sinus saline irrigations. His sinuses – all of them – were completely full. ”Pansinusitis”.
How to “Read” a CT Scan:
Some instructions on reading sinus CT scans: black is air; white is bone; gray is “soft tissue,” or everything else – brain, eyeball, cheek tissue, thickened sinus lining, or snot. The two orange arrows point to the maxillary sinuses. Instead of being full of air (black) like normal, they are full of gray – something else: snot, thickened lining, polyp, it is uncertain.
3 Weeks of Nasal Saline Rinses:
The First Week of Saline Rinses
They began the nasal saline rinses.
As predicted, the little boy’s fevers stopped over the next 24 hours.
When I called to check up on him, the doctors there were amazed that such a simple remedy was doing what 3 months of antibiotics had not. They reported that the little guy was feeling much better.
Still, they were skeptical, and against my recommendations, they insisted on repeating his CT scan every week for the next few weeks. “Just to be sure.”
This second CT scan was taken one week after starting sinus rinses.
The bright orange arrow points to a maxillary sinus with an central area of black – air! Whoohoo! Air is what should be there.
There is still a thick gray area surrounding that black, likely residual thickening of the sinus lining. That concentric, all the way around, thickening is typical for chronic inflammation. That was consistent with his history of chronic sinusitis.
After only one week of sinus rinses the sinuses are open, now getting air into them – pneumatization! that’s a good thing. I recommended that they reduce the sinus rinses from twice per day to one per day.
The Second Week of Saline Rinses
This third CT scan was taken two weeks after starting sinus rinses.
The two bright orange arrows point to the black area (air) in both maxillary sinuses. The central area of air is larger than previously, and the surrounding area of gray (thickened sinus lining) is thinner. Both good signs of decreasing inflammation in the sinuses.
The Third Week of Saline Rinses
This fourth CT scan was taken 3 weeks after starting sinus rinses.
The arrows point to normal-appearing maxillary sinuses, with very thin gray lining tissue surrounding the air within the maxillary sinus.
The final image here (#5) was from the same CT scan, from a little higher up, where the arrows point to the ethmoid sinuses, that were also clear of infection by the third week of saline sinus rinses.
Saline Sinus Rinses in a 3-year old – the “wrestling match”:
Success, with just a little saline.
When I spoke with the parents of this little boy they reported that doing his sinus rinses was like “a wrestling match” for the first 4 or 5 days. They said that, so he didn’t get hurt during the process, it had required both parents to hold him still while rinsing his nose. They were amazed when, by about the 5th day, he stopped struggling and accepted the daily sinus rinses. They had concluded that he accepted them because he was feeling so much better.
Both the boy’s parents and his physicians were (understandably) very anxious that his sinusitis would recur. Who could blame them? He had been very ill, with multiple hospitalizations during his first 2-3 years of life.
They asked if there were anything else that could be done to optimize his chances of remaining disease-free. I replied that, in addition to once-per-day sinus rinses, they might consider adenoidectomy – removing his adenoid tissue. This is a (relatively) low-risk surgical procedure that has the potential to provide huge benefits.
Considering that he also had asthma, I did recommend an adenoidectomy. Adenoid tissue can be a reservoir for bacteria and viruses, and chronic adenoiditis will often be a trigger source for asthma.
Surgery: Adenoidectomy, NOT Sinus Surgery
Following his adenoidectomy, the parents reported that he was mostly weaned from his sinus rinses. He has since been allergy-tested, but the results were disappointingly negative. Allergy tests revealed only some minor reactions to molds.
They told me that he still does sinus rinses for a couple months every Spring and every Fall, during the mold seasons, to prevent a recurrence of sinusitis. When his sinusitis did recur, they were able to limit his symptoms using sinus rinses. He has not been hospitalized again since.
Based on this example, and on more than 10 years of using this remedy for myself and for my patients, I conclude:
Simple saline nasal rinses are THE most effective remedy for sinusitis. Saline rinses are an excellent home remedy for allergic rhinitis, too.
Thanks for visiting. See you right here over the next month as we review sinus anatomy, histology, and physiology, as well as things that you can do to make sinus rinses easier and more effective.
Best health and success to you and your families.
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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)