5-Step Program to Eliminate Chronic Sinusitis (and 1 more)
Biofilm
The role of biofilms in chronic rhino-sinusitis (CRS) was recently reviewed on this blog.
If we accept that biofilm-forming bacteria cause chronic rhino-sinusitis ….
How can we use this information to treat our sinusitis?
First, physical forces are needed to remove some biofilms. For some people, this means surgical removal of the thick, tenacious bacterial matt that has accumulated. This is particularly true for those with sinusitis and cystic fibrosis.
For most people with CRS, elimination and maintenance of good nasal and sinus health may be achieved following these steps.
The 5-Step Program to Eliminate Biofilm and CRS
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Start with Saline Rinses (I use Nasopure)
Nasal saline rinses. Nasal Saline Rinsing as a remedy for sinusitis has been amply covered here on this blog.
- The second thing to do is to add something to the saline rinses that will help dissolve the biofilm. Like what? Baby Shampoo. Really.
It’s called a surfactant, and it helps dissolve biofilms.
Physician-scientists at the University of Pennsylvania studied the addition of 1% baby shampoo to nasal saline rinses. They found that the baby shampoo helped reduce the thick, viscous secretions and postnasal drainage in patients with CRS in 60% of their patients. Their study was reported in 2008 in the American Journal of Rhinology.
CAUTION: don’t use too much – it burns (I know from personal experience). A few drops in the bottle should do it. - We know which bacteria are best at forming biofilms - staph and pseudomonas are pretty good at it. That includes MRSA. Several studies have now shown that HONEY is a great natural antibiotic! It is very effective against staph and pseudomonas. You can simply add some honey to your nasal saline rinses to benefit from this natural antibiotic.
- The addition of antibiotics to the saline rinses. A review of the medical literature on the use of antibiotics added to nasal saline rinses to treat CRS concluded that they are effective. The full-text pdf can be downloaded from the link here.
- Using a pulse-irrigator for really resistant CRS may help flush out the biofilms. There have been very few controlled clinical trials that evaluate pulse-irrigation for nasal rinses to treat CRS, but this study from the University of California, San Diego, supports the use of “water-pic-like” pulse irrigators. I recommend these for my patients with very resistant CRS.
- Finally, because the adenoids have been found to be a reservoir for the biofilm-producing bacteria that cause CRS (link to full-text pdf; this is a beautiful study from my friends at the University of Virginia), removing the adenoid tissue can benefit those with CRS. If it comes to that, an adenoidectomy is a much more gentle surgery than either sinus surgery, or a tonsillectomy, and an adenoidectomy may eliminate CRS. As a last resort.
So, if you or your child have chronic rhino-sinusitis, start with #1 above, and move your way down the list until you achieve a cure.
Assuming That You Are Also Doing All the Other Stuff …
Working on this list assumes that you are already taking great general care of your health:
- That you have removed toxins and irritants from your life.
- That you get enough sleep to keep a healthy immune system.
- That you eat a balanced, healthy, and nutritious diet. Don’t neglect your nutrition and diet.
- Don’t neglect your sleep.
- Don’t neglect your environment:
Eliminate the various toxins in your home and work environment.
These other topics are covered here on this blog.
Resources
- Header Image Credit of Flourescent Microscope Image: Biofilm growing on stainless surface. From CDC, photo by Dr. Rodnay M. Donlan: “Biofilms: Microbial Life on Surfaces”, by Murga & Donlan, 2002. http://commons.wikimedia.org/wiki/File:Polymicrobic_biofilm_epifluorescence.jpg
- For the best nasal saline rinse system that I have found (Nasopure), and a great resource for those with children who are troubled by sinusitis or allergies – including awesome videos that show your child how to do nasal saline rinses – check out Dr. Hana’s Nasopure webiste: http://www.nasopure.com/
- Transparency: I have NO financial or other arrangements with Dr. Hana Solomon or Nasopure. I simply think that her site is a valuable resource, and the Nasopure saline rinse system is the one that I use personally, and recommend to my patients.
- For optimizing your indoor air quality, and reducing rhinitis and sinusitis, from this blog: http://www.boogordoctor.com/category/environment/environment-air-indoor/
- Also, consider buying Dr. Hana’s book, Cleaning the Air One Nose at a Time: http://www.boogordoctor.com/2010/06/pediatric-sinusitis-allergies-rhinitis-dr-hana-solomon-nasopure/
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What are YOU using in your nasal saline rinses?
Have you tried any of the tips above?
Did they work for you?
Please leave a comment to tell all of us about your experiences – we will all learn from each other.
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45 Responses to “5-Step Program to Eliminate Chronic Sinusitis (and 1 more)”
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25. Feb, 2011
[...] This post was mentioned on Twitter by Anne Petersen, Russell A. Faust and Russell Faust, Russell A. Faust. Russell A. Faust said: New Post: 5-Step Program to Eliminate Chronic Sinusitis (and 1 more) http://bit.ly/gPXBJ8 [...]
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29. Mar, 2012
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Welcome
Hello and thank you for stopping by "Ask the Boogor Doctor". This site is dedicated to helping you achieve optimal health for your children, following an integrative holistic approach to care of the Pediatric Airway: pediatric sinusitis, allergies, asthma, rhinitis, reflux, otitis, and all pediatric ENT.
Together, you and I will ... More...
Christy
25. Feb, 2011
Your website has been such a help to me in figuring out problems with my son’s health, as well as my own. Our doctors were not getting to the real root of our problems, but through internet research, and especially the info on your site, I have been able to put together what was going on, and make some changes which have been very beneficial. Thanks! I do have a question for you about nasal rinses. What about Alkalol? I haven’t seen you recommend it, and am curious to know if there is any particular reason you do not. I have some because a friend who’d had sinus surgery told me his ENT recommended it. Are any of the ingredients in Alkalol potentially harmful?
Russell A. Faust, PhD, MD
02. Mar, 2011
Hi Christy,
Thank you so much for visiting and taking the time to comment.
I have no experience with Akalol. If you have used it, tell us what you know so we can ALL learn.
Thanks again!
RF
Murray Grossan M.D.
02. Mar, 2011
Dr Faust, you might want to mention about Proetz sinus irrigation. With access to medical care becoming difficult, Proetz irrigation is ideal for kids under 5 and can be combined with medications you suggest. Costs almost pennies. I have a picture from my book you can have.
Russell A. Faust, PhD, MD
02. Mar, 2011
Dr. Grossan, Thank you so much for visiting, and for taking the time to comment! I am a fan of yours, have sent patients your way. I have no experience with the Proetz system – please tell us about is so that we can all learn.
And thank you for visiting. We’re honored.
RF (boogs)
Frank
10. Mar, 2011
Hello Doctor. My question is that can the spores in Manuka Honey cause any issues if used in a sinus rinse? Also, I wanted to mention that on another page, someone mentioned the potential for ragweed allergies to flare up with Manuka honey irrigation. I can confirm that they do not, as I have a horrible allergy to ragweed ( 4++ ), and do not get any irritation with a 4% Manuka Honey irrigation. In fact my sinuses feel better on the honey irrigation than with either pure hypertonic or isotonic rinses.
Russell A. Faust, PhD, MD
10. Mar, 2011
Hey Frank,
Thanks for that insight – yes, I feel the same – my hayfever gets better with Manuka in my saline rinses, NOT worse.
To answer your question about the spores: the only caution is ingestion of Honey (any honey) by infants less than 12 months of age due to potential for spores. Otherwise, Manuka is safe, and usually beneficial. Great stuff, isn’t it.
So glad you visited, and grateful for your comment – comments help ALL of us “boogorheads” learn from each other!
Thanks again, and please keep contributing to our community.
RF (boogs)
jsuthan
19. Apr, 2011
my son have lots of trouble and feel all started with breathing problem. Abnormal breathing, we thought it was just habit until thing take a terrible turn. He breath something as if brain insufficient oxygen – wild guess. He visual impair both eyes and matter gets even worst with brain begin to give trouble. It is a series of event that started with dairy introduce into his diet. His weight started to drop into malasbortion zone – he begin mouth breathing. We still don’t know if these all related to one to another or some major neurological problem. We confirmed he is lactose intolerance plus got positive for milk protein allergy. He was on dairy from 3 month to 14 months. He doesn’t become very ill or have any sign of trouble – except lots colic problem.
After my son was diagnose with maxillary sinus and enlarge adenoid we try daily use saline solution which actually removed hemiplegic event completely to none for a year.
Hemiplegic happen all over again this year, after he had flu and sore throat. We had checked with his neurology and found one of his brain artery missing. Interestingly he had right maxillary sinus, he was having right hemiplegic event and one of artery on right part of brain missing. He still behave and looks like a 3 year old kid with visual impair.
The problem now – his adenoid. It is blocking his airway and doctor recommend to remove it. We request few months so that we could try on saline solution again. After reading ur notes on manuka would like to give a short on it. If we don’t see improvement over a month period surgery removal seems to be the only solution. Why we haven’t remove? We not sure if adenoid removal will improve his condition or worsen it. I believe it should improve his condition.
Russell A. Faust, PhD, MD
20. Apr, 2011
Hi Jsuthan,
Thank you for visiting all the way from Pulau Pinang Malaysia, and welcome!
I am so sorry to hear about your son’s struggles. Of course, I cannot diagnose anything, or offer any medical advice from this distance, but I will tell you that for my patients who have severe or chronic sinusitis, and for my patients who have asthma, removing their adenoids is often a great benefit. From my research on chronic tonsillitis and adenoiditis – infections of the tonsils and adenoids – it is clear that the tonsils and adenoids can act as a reservoir for bacteria. That is, bacteria can remain in the adenoids for a long time. Some of these bacteria can then break away and easily infect the sinuses, they are anatomically so close to each other.
My most important advice is for you to find a physician that you can communicate with, and one that you trust, and follow their advice. Often, parents of children with chronic and severe medical challenges will seek advice from many different specialists. That can be frustrating for both the doctors and for you, since they may be giving varied – or even contradictory – recommendations. You will have the best results if you simplify your medical care, and concentrate on the recommendations of one, or a couple, that you trust.
I wish the best for you and your son, and thank you again for visiting!
RF (boogs)
jsuthan
21. Apr, 2011
“My most important advice is for you to find a physician that you can communicate with, and one that you trust, and follow their advice” – you are right, i not able to find one that able to communicate with. I need to continue find one. How bad of a case have you seen? I don’t really see people go beyond sleep trouble with airway dysfunction – adenoid. In Asia people will start looking for alternative medicine and even worst witch doctors; for illness they don’t understand…i still haven’t done that.
Alex M.
31. Oct, 2011
I have had a four year bout of orofacial pain centered in my upper right molars. Very strong variable, but constant throbbing. It is believed to be neuropathic in nature at this point and most probably not dental. I had a sinus CT scan which showed what the ENT said where sinus issues, and were on the mild side and most likely not related to my pain problem. Sometimes I wonder. The report said bi-lateral thickeing and small air fluid level in right maxillary sinus. Thickeing is on the mild side. Deviated septum to the right. Concha bullosa on the right and right sided opacification of osteomeatal complex. I have allergies but no other overt sinus smyptoms. No pressure and tenderness. No mucous. He gave antibiotics and flonase which did not help. I am not planning on getting another CT scan. Can small air fluild levels cause strong orofacial pain? Can I resolve an air fluid level with pulse irrigator or netui pot if I have anatomic sinus issue that would prevent entry into the maxillary sinus?
Russell A. Faust, PhD, MD
03. Nov, 2011
Hi Alex,
Thanks for visiting, and thanks for your patience,waiting for my reply. I am preparing to teach a course for the ABIHM the beginning of next week, and it has me distracted.
Air-fluid levels on CT scan simply mean that – there is a fluid level. It does not tell us what that fluid is – secretions, or pus from infection. Regardless, thickening of the sinus and nasal lining, and air-fluid levels on CT scans, all suggest acute and chronic abnormalities from inflammation. That can be reduced by doing regular, daily nasal saline rinses. Note that the rinses don’t necessarily need to get INTO the sinuses to be beneficial. The rinses will also benefit by reducing the inflammation of the nasal lining, and the sinus openings – if that inflammation causes swelling (“edema”), then the sinuses cannot drain properly. Reducing that swelling by doing regular nasal saline rinses will always benefit sinus drainage, no matter what the anatomy is.
If you are not already, consider nasal saline rinsing for optimal nasal and sinus hygiene. The system that I use for myself, for my own children, and that I recommend for my patients, is the Nasopure.com system.
Thanks for visiting, and please keep us updated on your progress!
RF (boogs)
Alex Mook
04. Nov, 2011
Thank you for your gracious reply. I was wondering if I could ask a couple of follow-up questions? Is it common to see air fluid levels on a CT scan that are more incidental in nature and that have little or nothing to do with a patients particular complaint? If air fluid levels are on the small side, is it unusual for them to cause pain in the upper teeth area? I can understand if a patients whole maxillary sinus was filled, but a small air fluid level? Can one tell via CT if the fluid is infected or from secretions? Thank you.
Russell A. Faust, PhD, MD
04. Nov, 2011
Hi Alex!
You are encouraged to ask questions.
In my experience, looking at head CT scans for trauma patients – with no history of sinusitis – there is not a high incidence of air/fluid levels (unless the sinus is involved in their trauma, and there is acutely loos in the sinus). Usually, if there is an air/fluid level in the sinus, there either IS a current infection, or there HAS BEEN a recent infection. However, there is no way to Know for certain the nature of that fluid. It appears gray on the CT scan: meaning, not air, not bone. CT scans are not optimal for discerning soft tissue or fluid; they are optimal for looking at bone structure.
If that sinus is actively inflamed or infected, it CAN be felt as tooth pain in nearby maxillary teeth (upper jaw). In fact, that is where I feel my own sinus pain, personally – in my upper teeth.
You will be well advised to seek expert ENT help. When the time comes to have surgery to open my own sinuses, I will be Looking for “Balloon Sinuplasty”. Take a look,at some,of the articles on this site for more I nformation, and for some helpful links and videos.
Thanks again for visiting, and please do keep us updated on your progress. I hope my ramblings have been at least a little helpful,
RF (boogs)
Alex Mook
05. Nov, 2011
Thank you again. A year after this orofacial pain condition started which is very intense throbbing in the upper right maxilla, I saw an ENT doctor that did a Xorantech Mincat CT scan. He noted a small airfluid level in the right maxillary sinus and some thickening…but I had no sinus symptoms, other than vaugue pain in the teeth/gums. He gave me an antibiotic and flonase which after 10 days did not help. He said he thought it would have been unusual for this fluid level to cause the pain that I was experiencing. He wasn’t to keen on doing surgery, since the cause of the pain is not clear. He did go on to say that we could do surgery to drain the fluid, but he did not think that would resolve the pain issue. I then went for a second opinion with another ENT who looked at my CT scan and confirmed a small airfluid level. He was fairly adamant that it wasn’t causing my problem, thus leaving me confused. I am now seeing a orofacial pain doctor and a pain management doctor. Also having this pain for 4 years I would think other sinus issues would arise and the pain would not be as constant for this long.
Russell A. Faust, PhD, MD
05. Nov, 2011
Welcome back, Alex!
I agree with your ENT doc’s assessment completely. It would be unusual for a small air-fluid level to be the cause for the symptoms that you describe. Please let us know how the orofacial pain expert does for you – I hope they help. You might also consider consulting with an acupuncturist. They can often help alleviate pain that conventional med folks find mysterious. Just a thought.
RF / boogs
Ramesh
07. Dec, 2011
How many drop of baby shampoo or honey can i add to the 8oz of saline water for the nasal rinse?
I read from other post that you recommend Manuka honey. Can i add Manuka honey in my nasal rinse if yes how many drops?
I also enjoy going through your amazon store. Found some really good stuff in it.
Russell A. Faust, PhD, MD
08. Dec, 2011
Hi Ramesh,
Only use one or two drops of baby shampoo per 8 oz bottle of saline rinse. I have used more for my own chronic sinusitis, and it BURNS at higher concentrations. The Manuka honey, on the other hand, can be used at a very high concentration without any unpleasantness. And research suggests that it is a very effective antibiotic.
Thanks for visiting, and thank you for your kind comments about my Amazon Store – I list only those quality-products that I use personally in my own home. Enjoy.
RF
Erin Anders
27. Dec, 2011
If somone has a small air fluid level and thickening in the maxillary sinus like the person above, how does one eliminate that? Will a pulse irrigator fix that issue? I am thinking of using a pulse irrigator or neti for chronic sinusitis in the maxillary sinus. I also have something called a concha bullosa? Is that normal to have. I do have seasonal allergies, pretty severe and that is what prompted me to see an ENT doc in the first place.
Russell A. Faust, PhD, MD
29. Dec, 2011
Hi Erin,
An air-fluid level usually implies an acute infection, whereas thickening of the lining implies chronic inflammation. Please take a look at a couple articles on this site, including the one about how to read your sinus CT scan, and the one about complications of sinusitis.
Both of those problems – acute sinus infection, and chronic inflammation – can benefit from nasal rinses. My own personal favorite for nasal saline rinses is the squeeze-bottle method from Nasopure.com, but the pulse irrigator also works. I also have seasonal allergies, and recurrent / chronic sinusitis, and daily nasal saline rinses help keep my nose and sinuses healthy.
A concha bullosa is a “turbinate” that has an air cell in it. These can become infected (uncommon), or can obstruct the sinus openings (more common) because of the thickness of the turbinate. Take a look at the nasal and sinus anatomy article for more information.
I hope that helps, Erin.
Thanks for visiting, and especially for sharing your experience. Please stop back and leave a note to let us know how nasal rinses are working for you, and leave any tips that you might have from your experience with allergies and sinusitis so that we can all learn!
RF (boogs)
Erin Anders
29. Dec, 2011
Thanks. Can nasal washes reduce concha bullosa? Are these fairly common to see on scans?
Russell A. Faust, PhD, MD
29. Dec, 2011
Hi Erin,
No, there are no rinses or medications that will reduce a concha bullosa – that is an “anatomic variant,” and therefore can only be reduced through surgery. Not that I am recommending surgery, not unless the concha bullosa is obstructing the outflow of nearby sinuses.
boogs
Erin Anders
10. Jan, 2012
One thing my CT scan said was the my “osteomiatel complex”(spelling?) was opacified on the right. Maybe this has caused the small fluid level? How can one deal with a fluild level that is sitting at the bottom of the maxillary sinus…sinus irrigation? Wouldn’t gravity prevent it from draining from the opening of the maxillary sinus since the opening is higher up? I can always stand on my head when doing the nasal irrigation!!! Thanks.
Russell A. Faust, PhD, MD
12. Jan, 2012
Hi Erin!
The “osteomeatal complex” is an area beneath the middle turbinate, a place that several of the sinuses open into: the ethmoid sinuses, the maxillary sinuses, and the frontal sinuses. “Opacification” on a CT scan doesn’t mean very much – it simply means that there is something on the CT scan that is gray in density – meaning not bone (white) and not air (black). It could be swelling of the mucosal tissues, it could merely be secretions. Snot. Whether it is important to the function of your sinuses needs to be evaluated in the context of the rest of your CT scan, but more importantly, in the context of your clinical history.
Regardless of what that “opacification” signifies, it CAN be improved by daily saline nasal rinses. Those rinses will rinse away secretions, allergens, virus, bacteria, and mold spores. Saline will also help reduce inflammation and reduce swelling of the mucosal tissues. That will help open up the sinus openings.
You are absolutely correct in recognizing the paradox of maxillary sinus anatomy! I did not design them. If you were to design the maxillary sinuses, you would place the opening at the bottom so that the secretions could easily drain out, and your would make the openings large enough that they would never become obstructed. As they are, the secretions must be swept upwards, against gravity, and out through a very small opening. That means that the secretions must be thin enough for that sweeping mechanism (ciliary clearance) to function properly. Anything that thickens those secretions, and anything that causes even slight inflammation and swelling of the sinus openings, can result in trapped secretions, and sinusitis.
Again, saline nasal rinses can help restore and maintain nasal and sinus health.
Please take a look at the sinus anatomy article here:
http://www.boogordoctor.com/2010/04/nasal-and-sinus-anatomy-and-histology/ ,
and also the article on how to “read” your sinus CT scan:
http://www.boogordoctor.com/2010/12/testing-ct-imaging-the-sinuses-pediatric-ent/
Thanks so much for visiting, and for your astute observations about sinus anatomy.
And thanks for sharing.
boogs
Mary in California
26. Jan, 2012
Hello, and THANK YOU for this blog, it is very helpful! My daughter Allissa is 7 and has Cystic Fibrosis. She has severe chronic sinusitis. In the past she has She has colonized psuedomonas and staff via her sinus and not lungs. I am fearful that if we can not resolve her sinusitis, these bugs will colonize her lungs and we will see a decline in her lung function.She has had 2 ESS (one 2 yrs ago and the latest 3 months ago) and does 2 sinus rinses with sterile saline daily, (3 at times of acute illness). She has had nasal polyps removed with both surgeries. She uses Omnaris twice daily, however most all other nasal sprays have caused severe and frequent nose bleeds. I like your advice on the honey and will be discussing this with her team. She is currently admitted with both sinuses fully impacted and her ENT is recommending ESS again. With the extreme pain and constant infection since the last surgery, I am hesitant (she has been on repeated and continuos courses of augmentin after the last surgery). I am afraid that the repeated ESS will open the sinus so much that the secretions that will naturally form will drain to her lungs and therefor spread the infections to her now clear lungs. They are also removing her adenoids during admission and are on the fence about tonsils, my thinking on this is that to remove them would mearly be a precautionary act. If we take them out we are essentially removing another place for bacteria to hide, am I correct or misguided in my thinking? Any advice or suggestions would greatly be appreciated. Thank you for your time, help and efforts. Mary & Allissa
Russell A. Faust, PhD, MD
26. Jan, 2012
Hi M&A,
It sounds like you are in good hands, although I am sure it is profoundly frustrating to live through these challenges. Your daughter is likely to have many more sinus surgeries if she has (as many people with CF have) nasal and sinus polyps. One of the problems is that every sinus infection has the risk of extending to her lungs. The “cleaner” you can keep her nose and sinuses, the healthier will be her lungs. Not an easy thing to do, because the normal process of muco-ciliary clearance does not work normally in children with CF. You are helping with nasal rinses. Some of my CF patients have included antibiotics against pseudomonas or staph. in their rinses during acute exacerbations. Ask your Pulmonologist and ENT. Some of these kids do benefit from removing the adenoids and tonsils, as they can be a potential reservoir for bacteria – a “place for them to hide” as you say; the adenoids more so than the tonsils, in my experience. If you do consider that, tonsillectomy is better tolerated before the age of 10, and simply becomes more painful by the year after about age 10. I wish you the best success! And thank you for your kind comments about this site, I appreciate your visit, and thank you for sharing.
RF
Sara
06. Feb, 2012
Our daughter is 3 1/2 and has been plagued with chronic sinusitis and a chronic cough that her pulmonolgist has termed”cough variant asthma”. We have recently started usuling the nasopure to irrigate her sinuses. This couugh has,become life consuming. Coughing every 10 to 15 seconds for days at a,time. She coughs until she vomits. Multiple midnight trips to the ER to try to get her some relief. Over the last 2years she has had a BMT,T and A and they actually did a sinusvsurgery because a CT scan showed “concrete” in her sinuses. She will finish a course of antibiotics and within a week will again have thick green nasal drainage and fevers. Please help!!! We are desperate for relief for our daughter!!
Russell A. Faust, PhD, MD
10. Feb, 2012
Hi Sara,
So sorry to hear about your daughter’s troubles. I wish I could treat her at a distance, but there is no substitute for a good relationship with her doc. Your IP address that shows up suggests that you are in the Washington D.C. area – if so, please consider getting her to the Washington Children’s Hospital ENT group. They have some outstanding pediatric boogordoctors there! Be prepared with the information on this site – questions about the possibility of reflux being a contributing factor, possibility of ciliary dyskinesia, etc.
Thank you for visiting, and best success!
RF
Hila
05. Mar, 2012
Hey Dr. Faust,
For the past year and a half I have had HORRIBLE sinus issues. I underwent 2 sinus surgeries (one septoplasty), have changed my diet, got inhalation medication through ASL pharmacy and have turned to acupuncture for help! Not to mention I sing opera! I’ve had a lingering cough and horrible thick phlegm- although it is way better than it was when I started out. I also have been tested multiple times for allergies and have none whatsoever. Recently it’s been decided by my doctors that i have Biofilm and I am adding baby shampoo to my daily rinses that I already have that contain antibiotics. I’m going to add honey to it as well to see if that will help with anything. Do you have any other suggestions? I’ll be sure to check in, in a few weeks to post how I’m doing. I’m so happy to have stumbled upon this site with more holistic options. I really don’t want to have surgery again- and I will try anything to help get this post nasal drip under control!
Thanks!
Hila
Russell A. Faust, PhD, MD
06. Mar, 2012
Hello Hila,
Please be careful with the baby shampoo for your sinus rinses. I have done that for biofilm and chronic rhino-sinusitis, but I added too much baby shampoo – VERY uncomfortable! I have achieved better results with only tiny amounts of baby shampoo, but adding Manuka honey. The Manuka is soothing, increases the osmolarity of the rinses – very beneficial for swollen tissues – and Manuka has strong anti-microbial activity against pseudomonas species. These are common biofilm-producers that are often present in biofilms that cause chronic rhinosinusitis. The key to successfully avoiding more surgery is to keep your nasal and sinus cilia healthy. Nothing too harsh. I have found that saline rinses with Manuka to be well-tolerated and very helpful for eliminating those chronic biofilms.
Best success to you, and please let us know how things are going for you.
Thank you for visiting and for sharing!
RF
Hila
06. Mar, 2012
Can I put Budesonide in the rinse with the Manuka? Or should they be 2 separate rinses?
Also the bacteria I have is the pseudonomas species so this is all good to know!
Thanks again!
Russell A. Faust, PhD, MD
14. Mar, 2012
Hila,
Most people who use a steroid nasal spray and also do saline rinses use the steroid spray following the rinses.
RF
Clinton
11. Mar, 2012
Hello Dr. Faust,
Great website! I am currently suffering from what I think is a post-viral sinus infection. However, I almost have zero congestion. My glands at the base of my head on the back of my neck are tender and the post nasal drip is more post nasal sludge (not really any dripping going on). The worst part is that my lungs/bronchia have seized up causing quite a lot of fatigue in the legs and arms. I can actually taste the infection in my mouth so I know something is there. I’ve been doing sinus rinses for about a week now with no relief. Could this be an infected adenoid since there is no feeling of congestion? I’m going to keep rinsing, but starting to worry about how long this thing is going to keep me down. Thanks again for this community…..it’s inspiring and uplifting for those of us who suffer from these problems.
Russell A. Faust, PhD, MD
14. Mar, 2012
Hi Clinton,
Thanks for visiting, and for sharing. Thanks also for your kind remarks.
From my perspective, adenoids can cause virtually ANY respiratory symptoms, especially once there is chronic adenoiditis. That can seed recurrent rhinitis, sinusitis, otitis (ear infections), tonsillitis, and asthma exacerbations. Yuk!!
I will say that the URI bug that has gone around this late cold-and-flu season has been tenacious, and I have friends who have been fighting it for a couple months now. Keep at the rinses, and see your friendly neighborhood ENT doc!
And thanks again for your kind comments. Please visit again and let us know how you are doing, and what works for you.
RF
Allen
13. Mar, 2012
I realize this is probably not the appropriate place to post this on the website, but it is where I ended up, so here I go. My oldest daughter, Reagan, was born in March 2006. At that time we heard words from the OBGYN no parents want to hear. “I have never seen that before.” She had a large growth on the mid line of her upper gum that prevented her from feeding. The doctors in our town had never seen anything like it before and referred us out. The day after she was born, I drove Reagan to St. John’s in Detroit with a feeding tube in her nose. To make a long story short, Dr. Faust made a special trip to St. John’s to care for Reagan. Early the next morning he removed the tumor without complication. We only had one follow up and all has been fine since. Dr. Faust was fantastic with our family. Not only did he successfully remove the tumor, he made sure the hospital staff got my daughter off the vent and feeding with a bottle asap after the procedure.
Thank you again.
Russell A. Faust, PhD, MD
14. Mar, 2012
Hi Allen,
Of course I remember your little girl very well. I’m so glad that everything worked out so well. Thank you for sharing your personal story, and for your flattering comments. I hope your family continues to grown and continues to be healthy!
RF
Clinton
21. Mar, 2012
Update: After getting to the ENT, he prescribed an antibiotic. Within a few days I was back on my feet and feeling great. However, the last day of my dosage, I started to feel a slight cough reflex. By that night it was hard to breath again, along with the fatigue. I went back to the ENT and he has since put me on an anti-inflammatory, nasal spray, and syrup for my bronchial problems. Sadly, I feel little to no relief. I’m still doing the daily sinus cleanse but am now afraid to impair my cilia or irritate my sinus membrane. It’s to the point where I feel like there is really nothing I can do to get my life back. It’s especially difficult because I’m such an active person. I can feel pulsating pressure in the soft spots above the temples on my head, as well as swollen glands at the base of the back of my head. The constant symptom seems to be the post nasal drip…..and, like before I have no congestion. This is so frustrating! The sinus cleanses have always worked up until now. Very frustrating indeed.
Russell A. Faust, PhD, MD
29. Mar, 2012
Hi Clinton,
Things to consider: if you are developing CHRONIC rhino-sinusitis, that is most often the result of some bacterial species making “biofilm”. There are a few things to try for eliminating biofilm. Try searching “biofilm” on this site in the search box. Also search “Xylitol” or “Manuka”. Best success. Thanks for sharing, and please keep us updated.
RF
Clinton
02. Apr, 2012
UPDATE #2: Yes, I believe that it was some type of infection, but the reason I was unable to get relief is because it was induced by tree pollen. Though I know I have seasonal allergies, this year the pollen started blowing in late February, early March, and I didn’t have the typical sneezing fits. Apparently pollen allergies can manifest themselves in various ways, and in my case it started with a slight itch in the back of the throat followed by constricted bronchial tubes and sinus inflammation, which of course caused copious mucus production, resulting in a bacterial infection. I found relief through homeopathic allergy drops under the tongue several times a day. The claritin helps as well, but if it’s hard to breath, the drops work in about 5 minutes…..amazing! These little suckers can be debilitating, so if you have been to your ENT or GP several times without relief, I’d consider the possibility of tree, grass, or weed pollens. It caught me by surprise because it usually hits in late April, but in this case it hit in early March. And keep doing the saline rinses to clean the pollen out! I hope this helps some others who are afflicted by the same “mystery.”
Russell A. Faust, PhD, MD
02. Apr, 2012
Hi Clinton,
Again, thanks for visiting, and for sharing your experience here.
There is an MD who practices homeopathy in Ann Arbor, has an appointment at the U of MI School of Medicine where he teaches. He is one of the most evidence-based practitioners of homeopathy! His name is Edward (Lev) Linkner. Smart, smart guy! I have some training in homeopathy from him, but don’t yet feel qualified to practice.
Anyone else out there with experience with homeopathy and sinusitis?
Thanks!
RF
Hila
12. Apr, 2012
Hey Dr. Faust,
It’s been a month now, and though i see a little bit of results from the Manuka Honey, I still have a chronic cough from a post nasal drip. However, I am less phlegmy when I speak and it goes away more easily now. I’m hoping that means it’s thinning out. I feel great during the day but every morning I have all these problems and it takes about 3 hours until the phlegm really disappears and the post nasal drip gets out of my way. I put a steroid into my sinus rinse every time and sometimes a drop of baby shampoo in my sinus rinse bottle! I rinse my nose out twice a day. I’m not really sure if there’s anything else I can do- or f it will take a few months or the manuka to really work. Also, recently when I blow my nose it’s been a little bloody- which it never was before.
I’ve been doing Chinese acupuncture and she says I’m doing better- my energy level is up and I am sleeping better- but that I just have a chronic problem that will be hard to get under control. I’ve just been suffering with this for a year and a half and my problems just seem to stay the same.
Do you have any other suggestions?
Thanks,
Hila
Russell A. Faust, PhD, MD
28. Apr, 2012
Hi Hila,
Sorry to hear of your struggles with rhinitis. I also have this problem, and I find that doing nasal saline rinses first thing in the morning (I do mine in the shower so I don’t make such a mess splashing around the sink) helps tremendously. Acupuncture is also helping me. The only other recommendations are to track down your triggers – what things are making the nasal and sinus linings inflamed? Allergens? (pollen, molds, dust mites, etc.), Pollutants? (smoke particles), Infectious agents? (viruses? bacteria? molds?), Chemicals? (chlorinated pool water? exposures at work? new carpeting?), irritation from Reflux? (GER/GERD?). If you are able to determine the cause(s), elimination may greatly improve your quality of life! Best success.
RF
Mac
13. May, 2012
My son is 14 years old and has numerous sinus infections. He is seeing an allergist and has been getting shots for 6 years. He is currently doing a saline rinse, taking fluticasone nasal spray, taking claritin D 12 hour and singulair at night. He recently had blood work done and 9 out of 14 pnumecal? on his blood work said he was low. He was given a pnumecal vacination 4 years ago to boost his levels. The doctor said it was too early to do another vacination. We were told he doesn’t have an immune deficiency. The CT scan he had done recently said he basically had blockage on the left side of his sinuses and mucus thickening. It was worse than the prior CT scan he had done before. He is now going to take a low dose of antibotics for 6 months. We are than going to readdress his health. The doctor said he would do sinus surgery on him when we are ready.
What would you recommend? How many sinus surgeries in children are successful? Do you think we are missing a piece of the puzzle?
Russell A. Faust, PhD, MD
15. May, 2012
Hi Mac,
I wish I could help treat your son through the ‘digital world’. Unfortunately, that’s not possible. My strongest recommendation is to find a sinus expert that you can trust, that will listen and hear you, and who you connect with. When you have that, you and your doc will be ‘on the same page’ and you will be able to work your way back to health, and to maintain that wellness. That connection, communication, and relationship is the biggest factor in your son’s success, in my opinion.
Sinus surgery in children can be very successful – both based on my own experience, and based on medical literature reporting clinical results. However, if the underlying cause of mucosal disease is not identified – the reasons WHY the nasal and sinus lining is so inflamed – then the chance of success decreases, and the probability of future repeat surgeries increases. I will say that for children, my opinion is that Balloon Sinuplasty is the best approach by far. Please search that term here on this blog for a description, and for links to other informative sites. My approach has been approximately 80-90% successful in eliminating sinus disease in my pediatric patients. But for those few for whom all else fails, my go-to approach has been Balloon Sinuplasty, with great success.
My advice? It is always a good thing to obtain another opinion for a difficult-to-treat problem, especially when someone is leading you toward surgery. If you email me to to tell me where home is for you, I may be able to recommend someone to give you another opinion.
Best success, and please keep us up to date!
RF