5-Step Program to Eliminate Chronic Sinusitis (and 1 more)

Biofilm and Sinusitis

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 understanding biofilm and sinusitis help us 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 Sinusitis

  1. Dr. Hana Solomon's Nasopure nasal saline rinse system

    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.

  2. 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.
    Note that although they conclude that the “baby shampoo had no effect on the eradication of pre-formed Psuedomonas biofilms,” they also concluded that “60% of patients noted improvement in specific symptoms…”
    In a more recent article, this same group concluded that baby shampoo therapy “… shows in vitro antimicrobial effects with modest inhibition of bacterial biofilm inhibition.”
    My conclusion? It works. But heed the following caution:
    CAUTION: don’t use too much – it burns (I know from personal experience). A few drops in the bottle should do it.
  3. 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.
  4. 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.
  5. 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.
  6. 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 website: 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:  Stop Breathing: Your Air is Killing You
  • Also, consider buying Dr. Hana’s book, Cleaning the Air One Nose at a Time:  at http://www.nasopure.com/

_____________________________

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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Comments

  1. 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 says:

      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

      • I thank you from the bottom of my heart – I can
        honestly say I have suffered bad breath for as long as I can remember . Nothing has ever helped – only masked it . Two days ago I tried the saline ( I use FESS) I then snorted the baby shampoo in water – you would not believe the difference – the glob on the back of my throat (which I was always clearing) liquified and ran down my throat – my tongue was no longer dry. My mouth filled with healthy sputum . It is like a miracle . I keep sticking my tongue out and seeing a nice pink healthy tongue. My confidence in speaking closely to people knows no bounds. But my breath could be smelt 6 feet away ! I want to tell the world – please do this for me – no sorry – for them !!!!
        This treatment will change so many lives !!! I am so thankful to you for sharing your treatment – I know it was related to sinusitis – but it was the “biofilm” which caused my bad breath !
        Thank you thank you thank you – please share xxxxxxxx God bless you !!

        • How often did you use the treatment? And how long did it take to cure? Are you still doing this sinus wash, or are you all cured now?

      • Hi. I tried the Alkolal in the first week of my nasal rinsing. My sense of smell was lost and recovered a bit over the last 3 weeks. Some essential oils fight biofilms at high enough levels, according to scientific studies I have found online. But with nasal rinsing, I dilute everything so I can stand it.

        • Russell A. Faust, PhD, MD says:

          Agreed, Ben!
          Most essential oils are very harsh, strong irritants – especially to the mucus membranes. Better to simply put a few drops in the water in your steam vaporizer (that’s what we do in our home).

  2. 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 says:

      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)

  3. 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 says:

      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)

  4. 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 says:

      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)

      • “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.

  5. 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 says:

      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 says:

        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 says:

          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 says:

            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 says:

            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

  6. 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 says:

      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

      • Kristin says:

        Is it ok to add both the honey and the baby shampoo at the same time? Or is it recommended to add them to the rinse separately? Thanks!

        • Russell A. Faust, PhD, MD says:

          I have added both in the same rinse. Usually though, I will use a couple drops of baby shampoo in the morning rinse, and the Manuka in the evening rinse. Not sure it makes a difference. Thanks for visiting, and sharing!

          • What do you think of using manuka essential oil instead of manuka honey as an additive to the saline irrigation solution?

          • Russell A. Faust, PhD, MD says:

            Hi Carol,
            Good question.
            I try to avoid adding oils to nasal / sinus rinses simply because they don’t dissolve in water.
            If YOU try it, please leave a comment to let us all know.
            Thanks so much for visiting and sharing.

          • I have been suffering with chronic sinus issues and infections for at least 15 years now. I have tried almost everything to add to my sinus irrigation since I have chronic infections. I have had 2 surgeries and the second has helped tremendously for the left side however my right side is still terrible. It is stuffy the majority of the day and night. I take sudafed everyday.
            Lately I have been adding 100% manuka oil to my sinus irrigation. I use two packets of Neil med, a large splash of alkalol and now several drops of manuka oil in my sinus pulse machine. Straight manuka oil smells terrible by the way but I’ll try anything for relief. I have seensome results. I have felt a bit less stuffy and my sinuses don’t feel as dry. The mucus seems to drain better…maybe my chronic inflammation is reduced?
            I have been using this concoction for about a month and no visit to my ENT…yet.
            I don’t know what the long term effect would be.
            Anyone else tried manuka oil in irrigation?

          • Russell A. Faust, PhD, MD says:

            Hi Cara,

            I have NOT tried Manuka oil, only Manuka honey. Be cautious with all oils, including Manuka oil, as additives to nasal rinses: most of the essential (concentrated) oils are somewhat toxic to human mucosa cells. Manuka oil is bacteriacidal, but so is Manuka honey, and the honey is less toxic to the cells lining the nose and sinuses. In addition, the Manuka honey increases the osmolarity of the saline rinse without increasing the salt concentration; that increased osmolarity helps draw fluid out of the swollen lining tissues, helping to open up the sinus openings. And the honey has similar bacgteriacidal activity.

            It will be interesting to hear whether others have tried Manuka oil.
            Thanks so much for sharing that, Cara! And best success.

      • The baby shampoo is used for those with chronic eye infections too, or those with chronic blepharitis. It helps prevent infections of the eyes. One drop per 10 I think it is and warm compress to eyes. It helps. Tell people this they laugh but it was used by my Dad and me and by professionals in the eye field. I see a cornea specialist.

        • Russell A. Faust, PhD, MD says:

          Hi Joan:

          It’s little bits of helpful information like yours that add value to our community.
          Thank you so much for visiting, and for sharing!!

  7. Erin Anders says:

    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 says:

      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 says:

        Thanks. Can nasal washes reduce concha bullosa? Are these fairly common to see on scans?

        • Russell A. Faust, PhD, MD says:

          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 says:

            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 says:

            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

  8. 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 says:

      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

  9. 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 says:

      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

  10. 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 says:

      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

      • 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 says:

          Hila,
          Most people who use a steroid nasal spray and also do saline rinses use the steroid spray following the rinses.
          RF

  11. 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 says:

      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

  12. 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 says:

      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

  13. 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 says:

      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

  14. Clinton says:

    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 says:

      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

  15. 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 says:

      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

  16. 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 says:

      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

  17. Dear Dr. Faust,
    How can I be sure that my sinusitis is caused by a biofilm?

    • Russell A. Faust, PhD, MD says:

      Hi Yousef,
      You can’t be sure that your sinusitis is caused by biofilm. On the other hand, from research conducted over the past decade or so, it seems that biofilms are involved in nearly all CHRONIC infections, including chronic sinusitis. If you have chronic rhino-sinusitis, chances are that biofilm is involved.
      Thanks for visiting, and for taking the time to leave a question.
      RF

  18. I’ve had a problem with sinusitis for about five or six months now. Been on different antibiotics and am currently on one now. They only ease my problem. I don’t want to take any more meds. I want to go the natural way. When I read about the manuka honey I knew I have try it. My question is will it work for me even if I have no bio film and does it get rid of the bio film completely and how long does it usually take? Another thing is I don’t have alot of mucus but just alittle drip in the back of my throat. I do nasal washes twice a day. Will doing the washes daily clear up the sinuses and how long would that take? Like everyone else Im anxious to get back to my old self. Thanks for any advice you may give me.

    • Russell A. Faust, PhD, MD says:

      Hi Linda!
      Great questions.
      Manuka honey helps our immune systems kill many “bad” or pathogenic bacteria, including many that for biofilm, but honey does not seem to bother the “good” bacteria in our microbiomes.
      How long it takes depends on many factors: whether your underlying problem is allergic rhinitis; whether you have an anatomic problem (like deviated septum) that obstructs a sinus opening; whether you are a ‘carrier’ of a bacteria species; whether your bacterial species are biofilm-formers; how many and for how long you have had antibiotics; whether you take a quality probiotic; etc.
      All I can do is recommend that you read through the posts on this site, continue daily saline rinses as you are, consider adding Manuka honey to those rinses; and add a great probiotic to your daily regimen.
      Thank you for reading, and for sharing. Please do check back and let us know how it is going.
      RF

  19. Hi Dr. Faust,
    I started severe sinus problems a year and a half ago. I had continuous very thick mucus constantly draining post nasally and causing me to snort like Felix Unger. I attributed this to a new medication, that I continued to take because of other benefits (eventually stopped)
    After initial antibiotics were ineffective, ct scan showed bi- lateral maxillary sinus infection. More antibiotics, eventual sinus surgery to include repair of deviated septum, turbinate reduction and cleaning of sinus cavity. After surgery, steroids, more antibiotics, my sinuses we’re now filling up in all sinus cavities, I now had horrible headaches. Some days were much worse than others. It started to dawn on me that it was most likely an environmental reaction and I assessed changes that I made prior to my onset of sinus issues. I removed the memory foam pillow from my bed, and I started improving almost immediately. An allergy to the memory foam, who knew? Then I started reading all of the posts about the toxins in memory foam. I still have a ways to go before this is completely cleared, still doing sinus rinses and still producing too much mucus, but I am beginning to see this might eventually end.
    I just wanted all your readers to know to check their sleeping environments, as I am also allergic to feather pillows. Thank you for your website.

    • Russell A. Faust, PhD, MD says:

      Hi Marigene,
      Thanks for sharing our experience. I can just imagine the level of volatile organic compounds (VOC’s) coming from those memory foam mattresses, considering their smell. Thanks for bringing that to my attention. A search revealed a pretty nasty list of VOCs in that memory foam.
      You’re absolutely right: considering the amount of time that we spend in our beds (I wish I could spend more time there :)), this is a place that we should focus attention on reducing exposure to toxins and allergy triggers! You may enjoy a series of articles that I wrote last year, all titles starting with these words: “Better Living Through LESS Chemistry” (just search here on this site for those words). The articles reviewed ways to reduce toxins in our lives – in our air, our food, and by replacing our toxic cleaners with some great natural and safe cleaners. Enjoy.
      Thanks again for sharing,and for reading.
      boogs

  20. Hello. I have been referencing your website for some time. I am scheduled to have a septoplasty, turbinate reduction, and FESS for chronic sinusitis (4+ years). My surgery is schedule for January 7, 2013. I am leaving five weeks later for a three week international trip that I cannot reschedule. Would it be better to postpone the surgery until a later date? I know I need the surgery and the next available time I have to do it would be in June. I have a sinus wash regime, including tea tree oil and grapefruit seed extract, that keeps the symptoms well controlled…so far. I would like to get it done sooner than later, but I’m concerned about lingering congestion and all of the flights and limited medical resources during out trip. Thanks so much for any input that can help me make the best decision.

    • Russell A. Faust, PhD, MD says:

      Hi Paula,
      It sounds as though you have taken charge of your condition; good regimen. My best advice is to ask your partner in healthcare – presumably you already have a trustworthy ENT surgeon lined up? Ask them directly.
      Thank you for reading, for visiting, and sharing!
      Safe travels,
      RF

  21. Hi Dr. Faust,

    I really appreciate your blog! It is hard to find sound medical advice online. Anyways, I am a fellow sinus sufferer and also a PA student. I have noticed that some doctor’s use Azithromycin for acute sinusitis. Most of what I have read states that Amoxicilin/Augmentin are more of the first line treatment. Just wondering if you had a preference in cases of uncomplicated acute sinusitis. I have heard doctors state that Azithromycin doesn’t do a good job penetrating into the sinuses. However, several patientsI have seen (as a student) have responded very well to Azithromycin.
    Sincerely,
    -Kasey-

    • Russell A. Faust, PhD, MD says:

      Hi Kasey,
      I have always liked Zitrhomax (Azithromycin) for un-complicated acute sinusitis, but there is very high resistance in some parts of the country. That is, over 50% of the bacteria that cause acute sinusitis and otitis are resistant to Zithromax in some areas.
      High-dose Amoxicillin is a great first-line choice for acute, un-complicated sinusitis.
      Thanks for your comments.
      RF

  22. ali perez says:

    Hi Dr Faust,

    I’m so happy I found your website, you are an angel for many of us…
    My daughter is 6 and since she was 3 months has been suffering from continuous respiratory infections. Chronic cough. Diagnosed with “reactive airway” and later with “cough variant asthma”. She is sick every month. She takes Singulair, Zantac and Budesonide everyday. For the past 2 years she’s been having sinus infections. Every cold ends up in sinusitis. In November 2012 she got sick and it took a 5 week course of Augmentine to clear the infection completely. When she is not sick, she is great, very active girl. Her asthma doctor is positive she will outgrow her asthma in a couple of years because it’s only present when she has an infection. I really want to believe it. She will be tested for CF soon, even though the doctor don’t think is the case. Negative tests for allergies. I’ve been doing everything you recommend for a couple of months and I have some questions. I do the rinses with Manouka 3 times a day when I see phlegm or stuffy nose (if not I do once a day in the mornings), can I spray the Xylitol and NasalCrom after the Manouka rinse or it will be washed out? How should I do it, in what order?
    We live in Los Angeles, can you recommend me a really good doctor? I’ve only seen a ENT once, Dr Warren Line. He suggested taking her tonsils out if this continues, but she is only 35 pounds and I’m concerned with the surgery risks at such low weight. What do you think?
    Her asthma doctor doesn’t recommend a humidifiers in her room so I use boiled water with eucalyptus oil every night in her room.
    I’ve tried everything Dr Faust, NAET for a couple years, salt rooms. chiropractor, homeopathy (she takes probiotics, quercertin, vitamin D, C, B6, Selenium and Zinc. Echinacea, propolis and pellets for post nasal drip.
    Do you recommend sudafed or Phenylephrine for a 6 year old when she is congested? Her Pediatritian recommends it. The effects scare me but I’ve used it. For how many days?
    I’m so desperate to help her… and I don’t know what else I can do. Believe me all this has taken a toll on me, I am on anti anxiety pills and under psychotherapy.
    Thank you so much Dr. Faust, you are helping so many people through this website… God bless you!

    Ali

    • Russell A. Faust, PhD, MD says:

      Dear Ali,
      Thank you so much for your kind, supportive comments.
      From your note, it seems that your daughter is in good hands!
      The only thing I may add is that any nasal spray medications (Xylitol spray or NasalCrom) should be used about 30 minutes after doing saline rinses. That gives some time for all the saline to wash out of the sinus and nasal passages, so you don’t wash out the medication.
      In my experience, most children with asthma and chronic rhinitis or sinusitis problems do benefit from having their adenoids removed – adenoidectomy. Tonsillectomy often does not provide benefit, unless the tonsils are chronically infected, or unless they are so large that they are obstructing the airway, causing obstructive sleep apnea – but that is another topic entirely.
      I am not a fan of sudafed or Phenylephrine in children. It is a stimulant, and I try to avoid any medication for children that may have an effect on the developing central nervous system.
      One of the most holistic or integrative ENT doctors in the world is Dr. Murray Grossan. I believe that he has a practice in Los Angeles. Try this number: (310) 657-7704, and please tell him that I sent you!
      Thank you for sharing, and please keep me updated.
      Best success!
      RF

      • ali perez says:

        Dear Dr. Faust,

        Thank you very much for your response. You are truly amazing.
        I’ll call Dr. Grossan tomorrow morning for an appointment and see what he says. The surgery scares me but we can’t continue taking Augmentine every single month. May be we should try the adenoidectomy.
        I’ll keep you posted and thanks again from the bottom of my heart!

        Ali

        • Russell A. Faust, PhD, MD says:

          Ali,
          I’m blushing, thank you.
          Please tell Dr. G that I said ‘hi’.
          And please let me know how things progress for you.
          Thanks for sharing,
          RF

          • ali perez says:

            Hi Dr. Faust,

            Here I am again! I hope you are doing well.
            I wanted to let you know how things are going with my daughter Sofi and also ask you a couple more questions.
            Since I read your web site for the first time things have change a lot for the better!! Little Sofi is off the inhaled steroids for the first time in 6 years! Her reactive airway has gotten so much better, her cough variant asthma is practically gone. It’s been 5 months since the last asthma attack or the horrible asthma cough at night. I haven’t had to use the Xopenex at all. And I thank you from the bottom of my heart for this, you made this possible…
            Ok, here are my questions. I keep doing the rinses everyday and using the Xylitol spray 30 min after the rinse and through out the day. She keeps having upper respiratory infections every single month, sometimes she’s done with a cold after two weeks of intense treatment with the manouka rinses, homeopathy, eucalyptus oil all kinds of natural remedies recommended from my naturopath doctor, daily supplements and everything you recommend and you can imagine… We also see a great Chiropractor on a regular basis, but only to have the next infection in the next 2 or 3 weeks. They come with green or yellow thick nasal discharge and sometimes with cough. She’s congested for 5 days and then it starts to clear but it can take up to an extra week to stop the yellow discharge coming out from the rinses. Then it’s clear mucus but always thick. Suddenly after a couple or 3 weeks, one day a green mucus plug comes out in the rinse and two days after…Bang! the infection is back. It always happens this way.
            The air quality in L.A. (in the San Fernando Valley) is terrible, really bad, and that doesn’t help at all.
            My husband and I are seriously considering adenoidectomy as soon as she is out of school next month but her pediatrician and her asthma doctor do not agree at all… My poor baby is sick and tired, she is so skinny Dr Faust… At least her energy levels are always great. She keeps doing gymnastics and is on fire… a super active little girl :) But is 38 pounds and 6 and a half years old.
            Her ENT (Dr. Steven Battaglia in Pasadena, CA) tells me it would be worth trying. All X-Rays, MRI, Immunology and Cystic Fibrosis Tests came back perfect. Her adenoids are not big at all though but he suspects the infection is stuck in there. He is a big supporter of the holistic approach and recommended me the same things you do on your website.
            Should we go ahead with the surgery against the doctors opinion?

            Thank you Dr. Faust. I wish you all the best and all the pure light you deserve for being our light in the dark :)

            Ali

          • Russell A. Faust, PhD, MD says:

            Hi Ali,
            Thank you so much for your follow up!! It is comments like yours that are my reward for developing this site. Thank you.
            I am so glad to hear that Sofi’s airway has improved.
            Now, my opinion, for what it’s worth. Dr. Battaglia has a fine reputation. And my experience supports his suggestion that – for children with symptoms like your Sofi – an adenoidectomy CAN make a difference. My lab at Ohio State University has discovered that the adenoid can act as a reservoir for bacterial pathogens. For some reason, the immune cells in the adenoid do not kill the bacteria – probably due to protective biofilm produced by the bacteria – and as a result, the bacteria can remain there unharmed, ready to infect again. For children with very reactive airways and recurrent or chronic infections, an adenoidectomy can be life-changing. Of course, there are no guarantees, but for children who seem to ALWAYS be getting sick, it can help. On the plus side, an adenoidectomy is usually very well-tolerated in children in this age-range: ages 4-8. MUCH less painful than a tonsillectomy, and MUCH less risk of the surgical complications that are more common with tonsillectomy.
            Again, that has been my experience, and in is not medical advice, simply for reference.
            I wish you best success, and please keep sending me updates. This one makes my whole week!! :))

  23. I LOVE this website. I have read through all of the posts and plan to try your suggestions. I am currently in my 5th week of bronchitis/cough/ sinus inflammation. I was on a week of doxycycline and am now on a 2 week dose of augmentin. I most definitely think I probably have a bio-film issue. (I actually was born with fabry disease and had a bio-film coated medi-port removed last August. It was gram positive staph. ) I have also had psudomonas UTIs.
    Anyway, back to sinuses….I have repeatedly had a maxillary cyst show up on head MRIs. Could this be causing/contributing to any of these problems? I am in Central Illinois, do you have any ENT suggestions?
    Thanks Linda D

    • Russell A. Faust, PhD, MD says:

      Hi Linda D,
      Thank you so much for your kind comments!
      Sorry to hear about the doxy, augmentin, etc.
      Here are my comments regarding your sinuses, based on the little information I have:
      1) MRI is never the imaging modality for evaluating sinuses. If there are sinus concerns, sinus-CT scan is the way to image.
      2) incidentally-discovered maxillary cysts are RARELY an issue. I have seen hundreds of them during my practice, and have never known one to cause harm.
      Illinois is not known for an over-supply of holistic ENT docs. You can probably find an ENT who practices a more ‘integrative’ approach if you search “holistic ENT Chicago”, but I don’t know how far that is to travel for you. I did search the database of Diplomates of the American Board of Integrative Holistic Medicine (ABIHM.org), but did not find any ENT diplomates in Illinois.
      Please let me know what you find, and thanks for sharing!
      RF

  24. hahaha this is funny to read, I used manukan honey in a netipot about 5 years ago when I heard they were doing a study in toronto. I have such a rough time with it that I was desperate and begun sdoing it myself for about 2 months. Although I can’t say it helped… I also have “honey sneezes” now, not sure if it was a result if the honey from years back. I bookmarked this page interested in trying the baby soap method.

    • Russell A. Faust, PhD, MD says:

      Hi Tom,
      Thanks for sharing.
      A word of caution regarding using baby shampoo in nasal saline rinses: only use a couple drops per 8 oz!! When I first tried it, I used a couple tablespoons (ouchy!!)
      Consider yourself warned. Let me know how it goes.
      RF

  25. Thank you Dr Faust. It is always good to be reassured that the maxillary cyst is probably not the issue. Hmmmm, so it is not my imagination that Illinois, especially downstate, has a desperate shortage of naturopath/holistic/integrative doctors period. I am about 3 hours from Chicago but I have gotten used to traveling for medical. I was born with fabry disease and my doctor for that is at the University of Iowa, a 3 hour drive…..sigh.

  26. Ali Perez says:

    Hi Dr Faust,

    I have another question for you.
    My 6 year old daughter’s pediatritian just told me that using Manuka Honey in the nasal rinses could be dangerous due to the spores in the unpasteurized honey. They can cause botulism in children ( I think that’s the word she used).
    I feel confused…
    I only give her the honey when she has an active infection.
    Can you clarify this for me?
    Thank you Dr Faust!

    • Russell A. Faust, PhD, MD says:

      Hi Ali,
      Honey can be dangerous for infants less than one year of age; that is according to the American Academy of Pediatrics (AAP). It is also well-established that honey is safe for anyone above the age of 1 year (assuming they don’t have an allergy to honey). So, your pediatrician is correct if we are talking about an infant. Your pediatrician should know the AAP guidelines, and not feeding you mis-information (imo). An online search can clarify further. Here is a nice article: http://wholesomebabyfood.momtastic.com/infantbotulismhoney.htm#.URYlk6XedrM
      Thanks for sharing,
      RF

  27. Hi Dr. Faust,

    Is it possible for an ENT to rule out CRS by looking into the sinuses with one of those office scope devices? I’m referring to the thin flexible articulating tube thing that’s inserted into the sinuses.

    Second, is there a simple test that can determine whether CRS or Allergies is causing sinus inflammation & illness?

    • Russell A. Faust, PhD, MD says:

      Hi Jeff,
      Great questions. I don’t have the answers. I make the diagnosis of CRS based on clinical history (mostly), and exam (somewhat), even without performing nasal endoscopy. CRS is pretty complicated, and can manifest with different set of signs and symptoms depending on the sinus(es) involved, the underlying cause of inflammation (true allergies vs environmental irritant), and mix of bacteria involved. It is NOT an easy diagnosis, and even more challenging to eliminate. There is no single, simple test. Wish there were.
      Sorry I don’t have amore encouraging reply for you.
      RF

  28. Valerie Keefe says:

    Wow! I’ve spent 30 minutes reading all of the posts and helpful answers. I definitely want to try the Manuka honey once I find out where to get it. Here is my story: I was diagnosed ten years ago with common variable immune deficiency after having sinus infections that came right back after finishing a course of antibiotics. I have monthly gamma globulin infusions that help any infections from getting worse. I still get sick and have been diagnosed with chronic sinusitis. In the last six months, my sinus infections became worse. I have been on antibiotics 3 times and have been in bed many days. Finally my immunologist
    recommended a CT scan and my sinus surgeon said I would benefit from revision surgery. So on the 27 of March he opened up all my sinuses and the surgery went well. My question is
    why am I having such intense pain two weeks later? And I’m so tired. Is it normal because my sinuses are still healing? I was having a lot of pain prior to my surgery for weeks due to inflammation and infection. I do sinus rinses, use a steroid nasal spray and saline spray. I just want to feel well again.

    • Russell A. Faust, PhD, MD says:

      Hi Valerie,
      Sorry to hear about your CVID diagnosis! Daily nasal saline irrigations will definitely help. Adding a generous dollop of Manuka to each rinse will help knock-down those pathogenic bacteria – the ones that cause chronic sinusitis by producing biofilm. The other thing to consider (if not already taking) is to add a great probiotic to your daily regimen. For myself and my family, and recommended to my patients, are the probiotic “pearls” by Integrative Therapeutics. They are encapculated so they survive stomach acid, and the probiotics get to the lower GI tract where they positively affect the immune system. Here is the affiliate link to those on my Amazon Store: http://astore.amazon.com/asktheboogodo-20/detail/B003PWDPH0
      Also consider adding Xylitol to your saline rinses, I do. Here is the article on the benefits of Xylitol: http://www.boogordoctor.com/2011/06/a-story-about-a-sugar-the-x-factor/ I carry small plastic spray bottle of saline with Xylitol, for nasal spray, and spray several times per day. Xylitol has also been shown to help kill pathogenic bacteria, and it helps prevent adhesion of bacteria to the nasal and sinus lining. If they can’t stick, they can’t infect you!
      Regarding unusual pain: ANY time you experience pain that is unexpected following surgery, contact your surgeon!!
      Glad to hear you are getting some value from my site. Thank you for your kind comments, and PLEASE keep me updated.

  29. Dear Dr. Faust,
    I want to thank you for the great wealth of information that you have made available on your website. I have found it to be a very useful resource, especially because chronic sinusitis has so greatly impaired my quality of life for the past year.
    I never had any sinus issues until a few years ago I had a very bad flu that left me in a state of chronic postnasal drip but no other issues. Last year I suddenly developed a chronic fatigue that I couldn’t explain, but a week or so later I developed a fever and a foul odor coming from my sinuses. That was my first sinus infection. Using antibiotics and other drugs I was only able to calm the sinus problems for a little while but the very annoying symptoms of fatigue and post nasal drip just wouldn’t quit. Having failed maximal medical therapy I went in for FESS after a CT scan confirmed significant mucosal thickening in several sinus cavities. The surgery resulted in greatly improved breathing but most of the other symptoms more or less remained. A post-operative CT scan showed a dramatic reduction in inflammation but some residual swelling of about 5mm thick in one maxillary and one frontal sinus cavity. My doctors are unsure if this would still cause symptoms. In your experience, what is the correlation between CT findings and patient reported symptoms in CRS? I have read some study that indicated that this correlation was quite weak.
    My team of doctors did some testing for a fairly small group of perennial allergens and a massive amount of other tests looking for any other medical problems I may have (everything from thyroid functions to checking for HIV, autoimmune diseases, etc). More or less everything else looks quite good.
    My allergist is wondering if my remaining symptoms of fatigue, malaise, chronic postnasal drainage, stuffiness/aching in the face/eyes (as if I had a cold) are still being caused by my sinusitis. He mentioned the fairly new idea that bacteria in biofilms may be the cause of many cases of CRS. My doctor decided to treat with a long course of antibiotics, nasal steroids and some anti-inflammatory medication. However I realize that antibiotics cannot destroy biofilms.
    After reading your site I am planning to handle my CRS with a multipronged attack. In addition to the medical treatment, I’d like to try nasal irrigation with baby shampoo (1% of total solution). I am also very interested in using honey but I have some questions about this. Which type of honey can I use? Is it safe to put honey into a saline solution and then irrigate the sinuses? We are told not to irrigate with contaminated water since it can cause life threatening infections, can the same apply to using honey? How do I know the honey is clean?
    My most problematic symptom is my draining fatigue from the sinus issues and the day time sleepiness I somehow get from CRS. In your experience, is there a particularly effective way to target these symptoms? I never had any idea that sinusitis can make one feel so tired and terrible.
    Once again I appreciate the time you have put into this website and will be sure to recommend it to my other fellow sinusitis sufferers.

    • Russell A. Faust, PhD, MD says:

      Hi Dan,

      SO glad to hear that some of this site is providing value for you.

      Regarding the honey: ALL honey has anti-bacterial activity, but Manuka honey provides the most powerful antimicrobial activity of any honey tested to date. Yes, it IS safe to use honey in saline nasal rinses. I was skeptical at first also, thinking that I would be inviting bacterial and fungal infections by including honey in my rinses. However, after reading the research studies that demonstrated the bacteriocidal nature of honey, I was convinced. You use the honey at a fairly high concentration (I use several heaping tablespoons per rinse bottle). In addition: have you EVER seen bacteria or fungus grown in a jar of honey? I never have. It is a powerful anti-microbial, for several reasons. I buy my Manuka from Amazon (affiliate link here: http://astore.amazon.com/asktheboogodo-20/detail/B000VK1DC8).

      Regarding the water: either use tap water that has been boiled, or use distilled water purchased by the jug at the store (or distilled water that you boil, even better). Special note: if you live in the Southern US, do NOT use tap water directly to make your nasal rinses! That was the cause of the “brain eating amoeba” problem that was reported last year. In the South, those amoeba are endemic in the water supply.

      The other things that have helped me with my CRS are Quercetin/Bromolain (powerful anti-histamine and anti-inflammatory), and Xylitol. The Xylitol is either purchased in bulk and added to my saline recipe, or simply used in a Xylitol-saline nasal spray throughout the day. NOT addicting, unlike oxymetazoline nasal spray. The Xylitol helps tremendously with CRS, helping to kill biofilm-producing bacteria, and preventing further infection from additional bacteria.

      My only other suggestion is that you consider adding a Probiotic to your daily regimen. Be sure to read the article that link points to, as there are reasons why so many probiotics just don’t work. Don’t waste your money on probiotics that aren’t going to help, as they are expensive. In my case, probiotics made a HUGE difference in my own life, and those of my children, by reducing the frequency, duration, and severity of our “colds.” That was important for my quality of life, because it seemed every time I got a ‘cold,’ it extended into worsening of my chronic sinusitis. As a pediatric specialist, dealing with sick kids in clinic every day, it seemed that I ALWAYS had a cold – until I started taking a daily probiotic! This is the probiotic that I take.

      I hope this helps.
      Thanks for visiting, for sharing, and for your kind comments.
      Best success!

      • Hi Dr.Faust,
        Thank you for your speedy reply. I was searching on amazon for some Manuka honey when I found some that claimed that it was medical grade manuka. I found the following information provided by the vendor:
        “What is the difference between medical grade and food grade manuka honey? -ManukaGuard Medical Grade has been sterilized with heat.2.Does sterilization affect the antibacterial, anti-inflammatory or any other characteristics unique to manuka honey?-No. Manuka honey is the only honey un-affected by light, heat, lack of oxygen, or the enzyme catalase “
        This honey is sterilized with heat. On your site you state that heat will reduce the usefulness of the honey. Is manuka honey truly an exception to this? I am suspecting that this company’s advertising may simply be incorrect.
        I recently also read your section on understanding CT scans. In your experience, do you feel that CT scans can give us any insight into the patient’s symptoms? In my own experience I found that improvement on CT did not really translate into improvement into quality of life following my surgery, and this baffles me. I went from having inflammation in nearly all my sinuses to now having a moderate area of inflammation in my right maxillary and right frontal sinus drainage path.
        I’ve already started doing baby shampoo irrigations, and will also be starting manuka honey and Xylitol soon in addition to medical therapy. I’m hoping this can finally give me some relief from the never ending fatigue and ill feeling caused by CRS. It’s just remarkable how I can appear so healthy in every other aspect of my health and yet still feel so unwell. I will be sure to post how these new irrigations work out for me.

        • Russell A. Faust, PhD, MD says:

          Hi Dan,
          I don’t want to get into an argument with a vendor’s advertising. Frankly, I don’t know what their honey does with heat, but the some of the benefits of honey are destroyed by heat.
          Re CT scans: the only reason to obtain a CT scan is when I am considering surgery. Otherwise, good policy is to treat the patient, not the scan. Too many people, in my opinion, undergo surgery unnecessarily only because their CT scan looked bad, not because surgery was actually indicated.
          I was also amazed at how ill my own CRS could make me, despite appearing perfectly well. CRS is insidious, smoldering away, waiting to recur with acute symptoms on top of the chronic problems. FYI, clinical studies tell us that CRS has a greater negative impact on quality of life (by several measures) than other chronic diseases, including diabetes and heart disease. Amazing! Bad stuff, CRS.
          I wish you the same success that I experienced.
          Please keep me updated.

          • Hi Dr.Faust,
            For the past month I have been irrigating with baby shampoo mixed into my squeeze bottle and sometimes using xylitol instead. I have had some good days but I still have many days where my symptoms are quite terrible. It seems so far I’ve had mixed results at best. I recently obtained some medical grade manuka honey (not treated with heat) and would like to start irrigating with this mixed into saline. However I’m a little confused about how much manuka honey I should use in about 60ml of saline water? I usually irrigate with 240ml but this medical grade manuka is probably too expensive for me to do 240ml per day with any meaningful concentration. I see that most of the manuka honey on the market is raw and unpasteurized which implies that it could potentially contain Clostridium spores. Is it safe to irrigate with honey that contains such things?
            I am encouraged to hear that you have achieved great success with your CRS, I hope that with these treatments I can make some progress. It just seems absurd to me that with absolutely no other health problems and no history of any major medical problem somehow I have developed such a persistent illness, it doesn’t seem like it would be possible. I hope one day we find much more effective treatments for CRS so it can become just another trivial illness.

            I am very thankful for your help,
            Dan

          • Russell A. Faust, PhD, MD says:

            Hi Dan,
            In a 240 cc/ml bottle, I would use a couple tablespoons of Manuka, in addition to the usual concentration of salt / bicarb. The result is a very hypertonic solution. This draws fluid out of the swollen tissues, helping to reduce swelling. However, very hypertonic solutions irritate the cilia, and some studies suggest that regular use of hypertonic nasal rinse can “stun” cilia and cause them to stop functioning, unless used for only short periods.
            Thanks for your kind comments, and thanks for taking time to comment. Please keep me updated on your progress.

  30. Desperate Patrick says:

    Dr. Faust
    I am in desperate need of your help, I have been facing CRS for 8 months now and am very close to losing my job. In late July of last year I woke up several mornings with pain/pressure on the top of my head that seems to gradually move depending upon which position I move my head. Some mornings I wake up and the location of the pain and pressure is on the crown of the head, sometimes directly on top, sometimes it’s towards the back base of the head, but it’s always near the top. Most of the time the pain is bilateral, but not always. The head is tender to the touch. I went for the ct scan, which of course was on a day that it wasn’t too painful, and it showed moderate sinus infection, with a small polyp in my sphenoid. I elected for the baloon sinuplasty surgery with removal of the sphenoid polyp as well as adenoid removal( which was not removed during prior toncilectomy) The surgery helped my symptoms for a few weeks, but certainly never even came close to curing it.
    These issues are unusual in the fact that I do not get the traditional allergy symptoms, itchy eyes, coughing, etc……just a full headed pressure feeling, pain on top of the head and the fatigue. It takes me every ounce of willpower I have to get through the work day. The pain almost always starts 20 minutes after waking up and usually lasts all day, if I’m lucky the pain/ pressure lessens for a few hours before bed. This last week I had a cold and during this time, and since then, the symptoms have become unbearably worst with pain everywhere in my head in all sinus cavities.
    *The anti inflammatory shot/ prednisone has been the only temporary relief for a week i have ever experienced. Head compression ( knit caps) help as well.
    * No antibiotics seem to work on me.( even cipro)
    * oral steroids do very little to help, except make my airways a little more easier to breathe.
    * I have a deviated septum, but my ent doesn’t think it’s worth surgery.
    * I have been tested and have many seasonal and household allergies, none of which have bothered me since I was a child (34 now)
    *chiro/acupuncturist hasn’t helped.
    *OTC medicine doesn’t help
    * no food allergies known, went on an anti inflammatory diet and have lost 30 lbs ( didn’t need to lose the weight) -hasn’t helped.
    * tension headaches have been ruled out.
    I have tried nasal washes with very little success. From my research I have to believe that I have some sort of rear sinus problem. Can sinus problems be isolated in one area? Is there anyway to get this area of the rear sinus cleansed? Any suggestions of help would be greatly appreciated as I’m about to lose everything I’ve ever worked for.
    Thanks!!!!

    • Desperate Patrick says:

      *The pain/ pressure is also relieved when I lay down( within minutes)

    • Russell A. Faust, PhD, MD says:

      Hi DP,
      I’m so sorry to hear about your struggles.
      Of course, I simply cannot offer medical advice without seeing you as a patient, performing lengthy questioning and examination.
      I did have a couple questions: you say that ‘tension headaches have been ruled out.’ How were headaches ruled out? The reason I ask is that, in my experience, migraine headaches are the most common cause of headaches in rhinitis patients. I have seen many people who have rhinitis (allergic rhinitis or not), where their rhinitis triggers their migraines. I have also seen people with deviated nasal septums whose nasal nerve endings were stimulated (by septum touching lateral nasal wall), and that in-turn was triggering their pain (and possibly triggering their migraines). It can be especially difficult to separate rhinitis with sinusitis pain from rhinitis with migraine pain, and even more confusing are those people who have true chronic rhino-sinusitis AND migraine headaches, that may be triggered by their CRS. The only true diagnostic test that I have been impressed by, was when one of the older physicians in our practice (had seen and done a lot over the years, when high-tech medicine – CT scans – was not the norm) was examining a challenging patient who complained of chronic headaches. This doc simply sprayed some lidocaine into the patient’s nose, and left the room for 10-15 minutes. Upon returning, he asked the patient how his headache was doing. Amazingly, the patient replied, “It’s gone!” According to that doc, the patient’s deviated septum was irritating the nerve endings of his lateral nasal wall, triggering a chronic migraine. The lidocaine deadened that stimulation, and voila, no more headache.
      I’m not suggesting that you have a similar cause of your symptoms, just to say that this is one area of medicine that is complicated, and that most of us (docs) do not understand as well as we would like.
      My only other suggestion is that you consider visiting with an ND – that is, a Doctor of Naturopathy. They are incredibly patient, thoughtful, and well-versed in traditions of medicine that are often overlooked by the “mainstream” physicians. My own personal physician is an ND, and she is awesome!
      Thank you for visiting, for reading, and for sharing!
      And please keep me updated.

  31. I’m so excited to try your steps and very glad I came across this! I’ve lived with chronic post nasal drip for as long as I can remember. I live in East Tennessee so I’m blessed to live in a beautiful area, but suffer with horrible allergies. I had my tonsils removed when I was 20. I’m now 28. I started allergy shots about 3 years ago and I take Allegra everyday. I still suffer from post nasal drip and bad breath every day. I get my teeth cleaned twice a year and use proper oral hygeine habits everyday. I even scrape/brush my tongue everyday so I feel the bad breath has to come from my sinus area. I’ve never asked my doctor about the bad breath problem because I’m so embarrassed. I have so much post nasal drip that I can feel me swallowing it every time I swallow. I had a CT scan when I was younger and don’t really remember anything they told me except I had what they called an air bubble in my nose, but it shouldn’t cause me any problems. They said to come back if I experience bad headaches. I’m wondering now what that was and if it could be causing my trouble. The allergy shots seem to help a little. When I bend over it doesn’t make my head feel like it has one million tons of pressure in it like before I started the shots. I don’t have any headaches or sinus pain only post nasal drip, bad breath, and a stuffy nose constantly. I have a few questions I hope you can answer. I used the Netipot a little while back and experienced severe dizziness so I went to the doctor. When she looked in my ears she said I had fluid in them and told me not to use the Netipot again. Is it possible that rinsing sinuses can cause fluid in ears and if so how? I’ve been told I have a deviated nasal septum plus that air bubble thing. Could that cause my sinus problems? I tested positive to 20 something of the 30 something things they tested me for when I had my skin test. Have you seen that allergy shots really help someone like me? It seems like cheese and yogurt make my saliva in my mouth and back of my throat thicker. Why is this? Also I don’t know if my adenoids where removed when my tonsils where. Is it common to remove both in a twenty year old? Antibiotics don’t seem to help my sinus problems, but I was wondering when you mentioned antibiotics if I suppose to dissolve an antibiotic (like an amoxicillin) in the water to rinse with or just use honey? You seem like you are very intelligent and great at what you do so I’m praying you can help me because its awful living like this. Thank you!

    • Russell A. Faust, PhD, MD says:

      Hi Alison,
      Yes, Eastern Tennessee is beautiful country. And yes, there are plenty of allergens there. You should know that the field of “allergy” in medicine is still evolving, and there is a wide range of practice philosophies. I spent the last couple years training in the basics of allergy diagnosis and treatment, and my deepest impression is that we don’t know very much. For example, we see many people who “obviously” have classic allergic rhinitis, but who have completely “negative” allergy test results. On the flip side of that coin, we see people with strongly positive allergy test results, but who report minimal symptoms. In my own opinion, that paradox means that we are not really testing the right things; that the things we are testing are not directly involved in the allergy mechanism, but are a distant manifestation. In other words, we don’t truly understand how allergies work yet. In my experience, in any area of medicine where that seems to be the case, a more “holistic” or “integrative” approach provides better results. The naturopathic doctors that I have known have a very holistic approach to allergy. For example, they focus on your description of reactions – for example, your insight into your response to yogurt and cheese – and they review your entire life and physiology to determine the problem. I think that you have access to some excellent NDs (naturopaths) in Knoxville, for example. You might also look at the Doctor-Search function on the website of the American Board of Integrative Holistic Medicine (http://www.abihm.org/search-doctors) for someone who is ABIHM-board-certified. They are holistic, integrative docs, and may provide a valuable opinion.
      Thank you so much for visiting, and for your kind comments.
      Best success!

  32. What about ear biofilm?? You can’t put honey or salt in there! Well?

    • Russell A. Faust, PhD, MD says:

      Isotonic saline – salt water – is perfectly safe for ears. And what is it about honey that you think is dangerous? Honey is used in the newest treatments for open wounds. So these are great ideas to treat ear biofilms. Thanks for the suggestion.

  33. Dear Dr Faust,

    First a very big thank you for your excellent site and all the helpful advise! I also suffer from chronic sinusitis (with exacerbations) in the left maxillary sinus, since more than two years back. I have no previous history of sinusitis or allergies and I have no polyps, my sinus problems started after a nasal trauma in which the septum shifted and it made breathing on the left side of the nose impossible. I had a septoplasty 10 months after the nasal trauma, which definately did help take away the worst part of the sinus problems and helped my breathing. However, I still have remaining sinus issues in the left maxillary sinus. It seems, once the problem develops, it is very difficult to get rid of it. I have had many antibiotics and steroids, they do help, but only temporarily. I have taken a very holistic approach to it too and try to live as healthily as I can. I have had the best help from daily saline rinses (2-3 times daily with baby shampoo or just saline). I also have tried Manuka honey in rinses.
    Another very helpful addition has been taking freshly made vegetablejuices from anti-inflammatory vegetables such as broccoli, fennel, cabbage etc. I have also left out mucous producing dairy products.
    I am still now thinking of undergoing some form of a sinus surgery as symptoms have continued for more than two years. My CT scan shows that the osteomeatal complex on the left side is narrowed (too narrow) by a relaltively large Haller’s cell (I don’t have this on the right and no problems there either). Some doctor’s wanted to remove the uncinate process and the floor of the Haller’s cell to create more space on the left side. Other doctors suggested leaving the Hallers cell alone and only do a (partial) uncinectomy on the left, which would be a very conservative approach. Another doctor suggested a balloon sinuplasty on the left maxillary sinus only.
    I can’t seem to decide decide which approach would be the best (if any) – safest, but at the same time effective.
    I read a study (done on children) in which it was concluded that in case of “osteomeatal narrowing by a Haller’s cell”, balloon sinuplasty might not help, as the balloon sinuplasty usually does not affect/fracture the Haller’s cell? Is balloon sinuplasty likely to be uneffective due to this?
    I also worry, if I have an increased risk for middle turbinate lateralization due to the Haller’s cell, in case I would have a balloon sinuplasty, as “the other side” will fracture before the Haller’s cell? Before the septoplasty, I had a large bone spur pressing on to my turbinates on the left side which created a serious pain problem, this was eliminated by the septoplasty and removal of the spur, so I would not want to have anything putting pressure on the turbinates again after a possible surgery.

    These are quite specific questions, but I would be extremely thankful for any advise or comments.
    I don’t know if a mini-FESS with a (partial) uncinectomy only or a balloon sinuplasty would be the best approach at this time? I have waited more than two years and tried pretty much everything, so I am starting to feel that a small surgery would be worth a try (however, as I have already had a quite lot of bone and cartlige resected due to the septoplasty (SMR) I would want to keep the surgery quite conservative).
    Many thanks in advance if you are able to provide any thoughts on this. I just want my life and my health back to be the best possible mum for my children.

    • Russell A. Faust, PhD, MD says:

      Wow, Sarah,
      Where do I begin? First, thank you for your kind comments.
      Other anti-inflammatory compounds that you may benefit from (I do), include the combination of Quercetin/Bromolain (the bromolain helps absorption of the quercetin), or Iso-Quercetin alone. Both sold through my boogordoctor Amazon Store. Also try to get your hands on some fresh, organic, ginger root. Use it minced in salads or for cooking, or simply use to make an herbal “tisane” (tea) by mincing and steeping in water. Use organic, because ginger root is one of those that picks up any of the chemical toxins (herbicides, pesticides) in the soil; those are not used for organic farming.
      My own preference, when possible, is for very minimal sinus surgery, when surgery becomes necessary. Specifically, I am a huge advocate of balloon sinuplasty. But you want to see an ENT doc who is very experienced with this relatively ‘new’ method. Most of the ENT docs see this as a gimmic, and do not use it routinely.
      The other thing you might consider is a naturopath, or Doctor of Naturopathy (ND). They are much more holistic in their approach, and for people with chronic inflammatory disorders of the airway (allergies, asthma, sinusitis), they can be beneficial.
      Thanks so much for your thoughtful comment, and for sharing.
      Best success!

  34. I very much appreciate you blog, and your 5 step treatment. At least you talk about biofilms.

    I do not have think I have sinusitis, but I used to get very sick in the winter when I cooked. Still, if I cook much, I have post nasal drip, and tears. Maybe biofilm.

    What gives me constant agony and horror is my leaky teeth. It is clear non-stopping drainage, that gets worse when I eat. It catches food like jello holds fruit. I have to be pretty hungry, with stomach pain, to eat now days. It is getting worse every day. No doctor I have seen, all specialties, will say I have this leaky infection. I get comments like, “… not my ‘specialty.’ I won’t treat it.” “There is nothing there.” “You need to exercise.” I will not let them put their hands in my mouth (of course they usually wear gloves, and I make them wear a mask), and I do stop breathing if they examine my mouth. I do not want to be “Typhoid Mary.”

    I have tried everything I can think of … bleach (that is extreme), peroxide, salt, digestive enzymes, all kinds of mouth wash, including plax that only turn my teeth green. I have tried much more than this.

    I am going to try some of your steps. I am afraid of the honey because this “stuff” tastes sweet at times, and I think it held together by polysaccharides. Not trying to be an authority, I just think that is what is holding it together. I floss around my teeth all day long. When my teeth and other tissue start getting sharp pains, I floss even more.

    I have been diagnosed with Lyme, and was treated 3-4 years, and I felt well, but new I was not cured. My last LD told me I was not sick. Then he called my husband and told him I was just crazy. I was devastated, knowing how sick I was going to get.

    Another DVT, more blood clots, a pretty bad TIA (doctors called it a brain attack), and this runny mouth infection. I am very sick, but the symptoms that have not come back, are as interesting as the horrible new symptoms and things that have come back.

    You can tell I have been searching everywhere.

    • Russell A. Faust, PhD, MD says:

      Wow, GMD: Sounds pretty horrible. Sorry I don’t have the answer, but I have found that ND’s (doctors of naturopathy) are better at sleuthing-out these difficult, even crazy-sounding, issues. They are more “integrative,” and will consider the whole person when figuring things out.
      Thanks for sharing, and best success on your path to wellness!

  35. Hi! Someone in my Facebook group shared this website with us so I came to
    take a look. I’m definitely enjoying the information.
    I’m book-marking and will be tweeting this to my followers!
    Great blog and terrific style and design.

  36. Hi,
    I have been sick about 4 months with problems with my sinuses. My first ENT concluded that it was just allergies. My symptoms are clogged nose and post nasal drip. I don’t cough, spit or blow anything up and if I blow something it’s clear. After recently getting my a/c checked out, my a/c guy found black mold in my window unit in my office. He said no wonder you been sick! I recently went to another ENT and he ran an allergy test on me, all test came back negative. He said all he can see wrong is that my nose is very inflamed and I have a post nasal drip. I told him about the mold and that it was in my office where I stay most part of the day and night and asked if that was my problem, he said after they killed the mold and treated the whole house ( which they did) I should have gotten better. I am on triamcinolone acetone ( been on 6 weeks) and Azelastine Hydrochloride ( been on it for 3 weeks) Also using Neilmed Nasa Mist Saline Spray. I feel like I am better at times but at other times ( same problems) clogged nose and post nasal drip. Do you have any advice for me? Anything you can suggest what else I can try that might help me clear that inflamed nose and post nasal drip? I just can’t figure out why I can’t get better.? I appreciate your advice! Thanks!

    • Russell A. Faust, PhD, MD says:

      Hi Pam,
      First, thank you for visiting, and for sharing your experience.
      Next: there is simply no way that I can provide medical advice over the internet. Although you are welcome to peruse this website (use the search box in upper right column), success with your individual issues will require a face-to-face chat, a full examine, and mutual education and agreement on a treatment plan.
      My best advice: find a doc who uses a more holistic approach, someone that you trust, someone who will listen to you, and work with them to achieve health!
      Please let me know how it goes.

  37. it has been awhile since i last posted your page seeking advice. Today, I would like to share weird finding and don’t know if this will work for others. Strangely, the mosquito net has some positive effect on our 5 year sons sinus. His nightly abnormal breathing reduce to none, let not hope this isn’t placebo effect. Why mosquito net? we have no idea.

  38. My son, after coughing almost continually for years, was diagnosed with pseudomonas ae in his sinuses. He was diagnosed after sinus surgery which was supposed to help clear up the coughing. Prior to that he tested negative for allergies. He went to an infectious disease specialist who put him on a month of cipro; which worked while he was on it but it came right back. Then another ids put him on an inhaled antibiotic which also worked while he was on it.

    Since then we have discovered he has a gluten intolerance, probably why his immune system was compromised in the first place as his body wasn’t processing his food sufficiently.

    To date, he is still coughing constantly. I will use the steps for irrigating you suggest, but am wondering if I can add an essential oil like cassia or oregano to the mix (after reading studies that those essential oils can reduce or kill pseudomonas.

    • Russell A. Faust, PhD, MD says:

      How old is your son?
      Does he cough at night?
      Does he cough mostly at night, or worse at night?
      Does he cough so hard that he ‘throws up’?
      Does coughing wake him up at night?
      A “yes” to any of these makes me suspect reflux in a child!

      • My son is now 19. He coughs continually, not just at night. He doesn’t cough so hard he throws up. His cough is a response to a tickle of the pseudomonas “slime” coming down the back of his throat. His ENT said he could see it “draining.” He doesn’t have reflux. His diagnosis was originally fungus and underdeveloped sinuses supposedly causing the cough. So he had surgery and medications for fungus to no avail. Since he was still coughing after the surgery, the ENT swabbed his throat which tested positive for pseudomonas ae. ENT said since he is a competitive swimmer, that he probably picked it up in the water or possibly in a hottub on vacations, or possibly in surgery; but since we went to the ENT for the coughing in the first place, probably not through surgery. Haven’t been able to try the irrigation yet as he is away in college.

        • Russell A. Faust, PhD, MD says:

          At 19 years old, he should be able to manage using a squeeze-bottle (Nasopure.com) for saline nasal rinses, at college or at home. No reason not to. And yes, swimmers and hot-tubbers are especially prone to pseudomonas infections. Pseudomonas is a great biofilm-former, making chronic pseudomonas infections challenging to get rid of. Best practices include nasal saline rinse, with: low-concentration baby-shampoo; Manuka honey. Please let me know how this turns out, and thanks for sharing.

          • Thank you. We started the rinses Nov. 26. I also added one drop of essential oils cassia and eucalyptus (therapeutic-high grade) after reading several studies on the effect of essential oils on biofilms including pseudomonas. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346404/. We are also using a negative ion diffuser with a combination of essential oils: eucalyptus, cassia, orange, rosemary and clove oils. We’ll see. As this has gone on for about 8 years, I’ll try anything.

          • Russell A. Faust, PhD, MD says:

            Thanks for the link! My only advice: use caution when adding essential oils to nasal rinses – they can be very irritating or even toxic.
            Thanks for visiting and especially for sharing! Please come back with an update.

          • Well, we sent him back to college this morning armed with the new squeeze bottle, baby shampoo, distilled water, honey and the essential oil drops. He is using one drop of the oil, which is diffused in the water by the drop of baby shampoo, along with the salt packet that came with the bottle and honey. I know we have to be careful with the oils, and that most shouldn’t be taken internally. For use in the sinus rinse bottle I combined oregano, thyme, cassia and clove oil (NOT eucalyptus). Since they are so concentrated, figured one drop should be enough. I think his cough is responding. He is also ill with a cold but I can tell the difference between a chest cough and his clearing the throat type pseudomonas cough, and I only heard the chest cold cough. If pseudomonas can truly be eradicated by essential oils, we will hear a cry of relief across the country! Or at the very least, if through the use of baby shampoo and essential oils the biofilm can be penetrated, perhaps the antibiotics will start working???

            Here is another link to a promising study. It is a different strain of pseudomonas, but if that one responds maybe other strains will: http://www.bioportfolio.com/resources/pmarticle/101518/Antimicrobial-Action-Of-Essential-Oil-Vapours-And-Negative-Air-Ions-Against-Pseudomonas.html

          • Russell A. Faust, PhD, MD says:

            Thanks for that link, Beth!
            Note: although many of the essential oils have antimicrobial activity against patogenic bugs in vitro (in the lab), most have not been tested in people. Also note that most are very caustic or toxic to tissues. So, the “one-drop” approach probably is best.
            Please keep me posted.

      • Dr. Faust,

        Just thought I’d catch you up. Nothing seemed to work for my 20 yr son until this summer when he was diagnosed with cystic fibrosis. His lungs are very healthy since he is a competitive swimmer, but nonetheless here we are. He is being treated by the Baylor Pulmonary Clinic with nasal rinses twice a day, an albuterol inhaler, then inhaled sodium chloride, then inhales tobramycin (one month on and one month off) and takes ciprofloxacin orally for two weeks. The cough is gone for now. The cough was coming from his lungs and not from his sinuses like we thought.

        • Russell A. Faust, PhD, MD says:

          Wow, Beth: So sorry to hear that. On the other hand, I’m sure it’s a huge relieve now to finally have a real diagnosis to deal with! Now you know what to expect, and how to optimize his health to prevent problems.

          I wish him (and you) the best success.
          Thanks so much for sharing, and for the update. And please do keep me updated.

          • It is a relief of sorts. We have a marvelous Nigerian pulmonologist in the Houston area to thank. Apparently, when you have a patient who is underweight, has a cough and a known pseudomonas infection, who is of northern European descent, you should automatically do a sweat test. We had an earlier lung doctor who suggested he was faking his cough or that it was a nervous tick and told us that everyone has pseudomonas.

            The clues were; persistant cough, nosebleeds due to polyps, stomach aches, underweight as enzymes were not getting from the pancreas to the stomach to help him digest, slightly clubbed fingers, pseudomonas infection.

            Through the use of enzymes for his stomach he can eat whatever he wants instead of trying to avoid gluten, so he’s a happy college student.

          • Russell A. Faust, PhD, MD says:

            Hi Beth,
            Those are very suggestive signs and symptoms that you describe.
            Is that the diagnosis? Cystic fibrosis?
            If so, you can expect an ongoing battle with pseudomonas infections (sinusitis and bronchitis/pneumonia).
            I wish you and your son the best health and success.

          • I’m stunned that no one has mentioned haritaki, the east indian herb that has been proven in studies to break up biofilms and kill pseudomonas. A simple solution discovered by a pre-med student in 2007.

            And there are also reports that rinsing the sinuses too often is not a good thing as it removes lactoferrin from the mucosa, among other things.

            Maybe time to update this blog? :)

          • Russell A. Faust, PhD, MD says:

            Hi Kelly,

            Thanks for suggesting haritaki, an herb long used in Ayurveda remedies.

            I completely agree with you that performing saline nasal rinses too often may do more harm than good – in fact, I published a post on this blog 5 years ago saying exactly that: http://www.boogordoctor.com/pediatric-sinusitis-allergies-allergic-rhinitis-saline-rinses/

            Thank you for the opportunity to emphasize that point!

            And I hope that your comment about updating means that you are willing to contribute to this blog: greatly appreciate the offer! Please email me any time with your preferred topics; perhaps a review of Ayurveda herbal remedies?

  39. Adam's Myth says:

    Nearly all chronic sinusitis is fungal, according to a 1999 Mayo Clinic study. Mayo’s result was reproduced by a study at ENT University Hospital in Graz, Austria.

    http://www.mayoclinic.org/departments-centers/otorhinolaryngology-ent/minnesota/research/chronic-sinusitis

    If Mayo is right, then honey in nearly all cases will do no good. In fact, to the extent that eliminating bacteria can promote fungal infection, it may do harm.

    • Russell A. Faust, PhD, MD says:

      Hi Bill (aka Adam’s Myth):
      Yes, I’m aware of the Mayo’s claims, and I’ve worked with the originator of this claim (Dr. Jens Ponikau). However, in my experience, most people with chronic sinusitis do improve while they are on antibiotics. Sure, it usually returns within a week or two. But while they are taking antibiotics against bacteria, their symptoms improve – that would not be the case if their sinusitis were due to fungus (antibiotics don’t have any effect on fungus). Again, in my experience, most people with chronic sinusitis (myself included) are infected with bacteria that form “biofilms.” Those biofilms are tenacious and difficult to kill.
      Yes, I believe that fungus does play a role in the microbial mix for many people with chronic sinusitis. I also believe that nearly everyone who struggles with sinusitis has fungus present in (and on-) them, but I do not believe that fungus is causing the infection in all people with sinusitis. Finding fungus and making the leap to conclude that fungus is causing the infection are not the same thing.
      If you want to read more about this, do a search on “jens ponikau.” He is now practicing in Buffalo, NY. Good physician-scientist. Tell him I said “yo!”
      Good link, though, and thanks for sharing!

  40. Lindsey says:

    Why did you say that baby shampoo helps dissolve biofilms, but then the study you linked says “Baby shampoo had no effect on the eradication of preformed Pseudomonas biofilms.” Is there something I’m missing?

  41. I read the ingredients on the baby shampoo bottle and it lists “fragrance”. Do you have any thoughts on substituting fragrance free liquid castile soap? Castile soap is used for soap suds enemas and I am thinking it would be more gentle on internal membranes.

    • Russell A. Faust, PhD, MD says:

      Peggy, I think that nearly any “soap” that acts as a “surfactant” will work. It’s just that baby shampoo is one of the most gentle, so burns less than most soaps. Please let me know what works for you.

  42. Hello Doctor,

    Thank you for creating this great website.

    I have a pretty serious concern. My Many years ago I started to have sinus congestion problems. Of course, I went t an ENT and it was chocked up to allergies. Several years later it turned into issues with my Eustachian tubes, too. Again, the various doctors I saw said allergies. The problem was that it seemed my allergies were contagious upon contact. I would kiss my daughter and she would have an ear ache the next day. My middle child went through several courses of antibiotics when I finally decided I could no longer kiss her. While my wife and stepson did not get earaches, they developed “allergies” as well. I have done nasal rinses and nasal steroids for years. I have had sinus surgery, including removal of the adenoids. Still I have problems with my sinuses and my Eustachian tubes.

    I have recently started treating with Manuka Honey and baby shampoo. The symptoms seem to be subsiding. However, I am concerned about what is actually the source of the problem and whether there is any solution to eradicating it, if it is truly some type of contagious bug that may be easily passed. I am especially concerned, and quite frankly guilt-ridden, over the fact that my family is struggling with these sinus problems which may or may not turn into serious issues. My middle child has type 1 diabetes. I hope it is not as a result of the recurring infections and the accompanying courses of antibiotics.

    Doctor, based on my past dealings with general practitioners and ENTs, they all seem to think it is allergies and that any idea that this is somehow contagious is in my head. The reality seems as though it may be one of these infections related to staph or some other bug. Can you tell me how I might address the subject with my doctor to get my doctor to run tests for these bugs? Also, are there any other courses of action you would suggest?

    Thank you again,

    Rob

    • Russell A. Faust, PhD, MD says:

      Hi Rob,
      I can feel the frustration as I read through your note.
      Without visiting with you face-to-face, gathering a thorough medical history, and examining you, I simply can’t comment or give advice. You may be a “carrier” of a strep or staph infection, or some other bacteria or virus. It would be useful for you to know that information.
      My only advice is to find a Naturopath to visit. In my experience, ND’s will take the time to evaluate and treat the whole person – holistic, or truly “wholistic.”
      Thank you for your kind comments regarding my website; it is meant as an educational resource.

  43. Hi,
    My right nostril gets blocked every night and wakes me up. My mother (70) has the same issue. Must be genetic? I’m not sure why this happens but it’s becoming quite distressing. Do you think the baby shampoo rinse will help or should I see a specialist? Or both? I just don’t want to put up with this for the next 30 years like my mother and rely on sprays (which can cause rebound congestion) to get a good nights sleep. Bless you.

    • Russell A. Faust, PhD, MD says:

      Hi Janine,
      Anatomic abnormalities can be genetic, but unlikely. Your best option is to see an Ear, Nose & Throat specialist.
      Thanks for sharing.

  44. I ‘ve got rid of my chronic rhinosinusitis and postnasal drip with monolaurin ecological formulas 600 mg, 2 capsules in the morning and 2 at night time, after meal.2.400 mg dosage a day need to do the treatment for 3 month.I had nasal staph infection and went into my sinuses and now it is my lungs.I am half way with the treatment and got rid of the bacteria in the sinuses and now I am working on lungs,along monolaurin taken supplement with garlic 1000mg (3Xday),oreganol P73 (6 caps a day) ,respivax an immunomodulator for my immune system ,and I chew 3-4 times a day calamus root to clear my lungs.Also I ordered some badger fat I wait to receive I heard that is v good for lungs infection.I have been ill for 12 yrs and I hope this will be the end of this bacteria,apart of vancomycin I tried everything.nasal rinse,with garlic,with salt and bicarbonate ,with oregano,bactroban,led with blue light 460nm,colloidal silver,olive leaf extract,accupuncture,bacteriophage,I kept a diet but a wrong one,I just find out now that I have to exclude all the strarch from my diet,all the carbohidrates,sugar,sucrose etc,I hope this is helpful for you people.Wish you health !!

    • Russell A. Faust, PhD, MD says:

      Hi Vera,
      Thank you for sharing!
      Please keep me updated, especially on your experience with colloidal silver.

  45. Rencontres Sexe Paris says:

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  46. HI there Dr Faust. Thank you for such a wonderful site. I had polyps removed 9-30-14 from my right sinus and fungus removed from my left sinus along with the balloon procedure. Would the 5 steps to stop sinusitis work for someone like me? I’ve had sinus issues for the past 15 yrs. Allergies to weeds,grass, trees, and mold. I can’t seem to get nasal inflammation under control. I’m desperate not to go through this again because i have such sever panic attacks when I can’t breath through my nose. Any advise is appreciated

    • I forgot to ask if there is a safe nasal spray that can be used for nasal swelling.

      • Russell A. Faust, PhD, MD says:

        I regularly use the nasal spray from Xlear.com – available from Amazon here: http://goo.gl/d9Gp6K (affiliate link). It is entirely safe, and helps rinse the nose and sinuses, and helps prevent bacterial colonization. NONE of the “decongestant” nasal sprays are “safe” to use for more than a few days, due to the “rebound” effect: you can end up even more miserable than when you start.

    • Russell A. Faust, PhD, MD says:

      My only advice is general (not medical advice): daily nasal rinses with saline can have huge benefits for folks with your history. Take a look at this site, do a search for “saline rinse” for the many articles on nasal saline rinses. Also check this out: http://www.boogordoctor.com/nasal-saline-rinses-to-treat-sinusitis/

  47. Hi,

    I find this site very informative. Really appreciate the good work you are doing.

    I have a question in preparing nasal rinse solution. While honey and baby shampoo are effective in fighting biofilm, is it okay to use them both in your nasal rinse?

    I was planning to put the following – non-iodized salt, honey, Johnson’s baby shampoo. Is it the right way? Please advice.

    • Russell A. Faust, PhD, MD says:

      Hi Ashok,
      Yes, I have added both to my saline nasal rinses. But NOTE that the baby shampoo should be used cautiously, as it can be very irritating! Manuka is okay to use generously. I also use Xylitol generously – 10-15% of the solution to be effective. Please do check all the articles on this site regarding saline nasal rinses, baby shampoo, and Xylitol.
      Thank you so much for visiting, and for sharing.
      Please keep me updated on how it goes for you.

  48. Hi,
    I’ve definitely written hear before when my sinuses were a mess a few years ago but I seem to have everything under control. I have pseudomonas biofilm. I’ve had 2 sinus surgeries (one with septoplasty) and currently use a sinus rinse with budesonide and baby shampoo twice a day. I used to use manuka honey. I found it soothing but I didn’t see much results with it added into my rinse, so I only use it if I have an infection. I’m also definitely pro-acupuncture and used to go regularly. I also drink a lot of ginger tea which is a natural anti-inflammatory

    Every time I catch a cold, it seems that after a few days I get a sinus infection. My post nasal drip then gets a little out of control for the next month- at least- even with antibiotics or a course of prednisone! I usually use a humidifier every night to see if it would help. The link about xylitol above doesn’t work and I was wondering if you think it may help if I feel a cold coming on?

    Thanks!

  49. Marianne Prince says:

    Dr. Faust, I can see how removing the biofilm from the lower sinuses is going to help me with chronic sinusitis. I have started today with baby shampoo, xylitol (xlear) and manuka honey and I feel better already. My question is: How is this going to help with the upper sinuses which are not receiving the rinse? Do they have biofilm as well?

    • Russell A. Faust, PhD, MD says:

      Hi Marianne,
      The straight answer is: I don’t know. On the other hand, in my experience, even though nasal rinses probably don’t reach the most “hidden” sinuses, those sinuses clearly benefit by improved nasal hygiene; by improved function of the nasal cilia; by ridding the more-accessible sinuses from chronic infection by microorganisms. Bottom line: even though I don’t know precisely how nasal rinses clear those hard-to-reach sinuses, I do know that it works, even if there is biofilm.
      Thanks so much for writing and sharing. Please stay in touch.

      • Marianne Prince says:

        Dr. Faust, Thank you for your prompt reply. I appreciate your candor about not knowing. Sincerely, Marianne

  50. Marianne Prince says:

    I would like to try the ultrasound treatment for chronic sinusitis. Do you have any suggestions for how to go about that?

    • Russell A. Faust, PhD, MD says:

      Hi Marianne,

      I have no direct experience with the ultrasound therapy for chronic sinusitis, but there are clnical studies that are published in peer-reviewed medical literature that report positive findings: http://goo.gl/eXQrf9
      Please do keep me / us informed here on this blog about your experience. Thank you for visiting and for sharing!

  51. Thanks so much. I’ve had a long history of terribly embarrassing bad breath and been to many dentists who could find nothing wrong. I could not speak to people without a mint or gum in my mouth – they would still cringe and move away. I thought I was doomed to have this forever. After reading your advice, I tried the saline irrigation using baby shampoo and straight away there was a huge difference. I’ve brushed my tongue and gums and the insides of my mouth with the baby shampoo as well and it’s even better now. Thank you – I’m sure you know how much this has meant to so many people.

  52. Dear Dr. Faust,
    what a wonderful webpage you have built up over the years! Thank you so very much for sharing all this helpful information and for your honest comments. Your work is truly inspiring.

    I am suffering from a sinusitis that has troubled me for almost 9 months now. It developed after a strong upper airway infection. I have seen different doctors and tried different therapeutics, among them antibiotics, cortisone spray and antiallergic drugs. Unfortunately none of them provided much relief. May I ask you two questions?
    1. On the application of Manuka honey: I came across your page in search of more information on manuka honey and how to use it. And the good news is: It is the first thing that really makes me feel better, after only 2 days of use :-) So thank you so much for all the good instructions advice! I have added it to my saline rinse and that works pretty well. Other places on the internet I found recommendations do drop a strong solution into the nose while lying down and blocking the opening to the throat, then one should turn the head in different directions so that the solution could run into the sinuses. What do you think of this method? Is it effective at all? Is it maybe even dangerous to get so much liquid into the sinuses?
    2. On identifying an infectious cause: The doctors seem to think that my sinusitis now is basically a chronic inflammation without any persisting infection. However I am afraid that a biofilm might be the underlying cause, as the onset of the sinusitis was directly linked to an infection and I sometimes find yellow mucus in the mornings, even though it is mostly clear the rest of the day. Is that suspicious or would you agree that it does not necessarily point to an infectious problem?
    3. On sports: I understand you might not feel comfortable answering this as you haven’t seen me as your patient, but do you have some general advice on doing sports with a cronic sinusitis? Is it dangerous? It would definitely give me a great mental boost, but I’m too afraid to worsen any infectious problem.

    In return, I’d like to share some more ideas – you are welcome to comment on their medical sensibility!
    – Infrared lamp. I’ve been treated with this for ear infections when I was a child, and I tried it now for my sinusitis. I experienced it as a comforting warmth that gave me some relief for frontal headache and that possibly made the mucus more runny and thereby easier to clear out.
    – Sauna. Certainly not during an acute infection, but during the chronic phase it helped me clearing out mucus from the nose and sinuses and provided some head pressure relief for the next few days.
    – Plant extracts such as Sinupret (various herbs), Soledum (cineol from eucalyptus), GeloMyrtol (eucalyptus and other herbs). They claim to make the mucus more runny, to improve ventilation and to have an antiinfective effect. Unfortunately, they did not help me this time, but some people seem to be very happy with these.

    Once again thank you very much for all your work and effort that goes into maintaining this wonderful resource of information!

    • Russell A. Faust, PhD, MD says:

      Hi Corinna,

      Thank you for your kind comments, and for your thoughtful questions! I’ll do my best to answer them:

      1. Yes, Manuka honey is wonderful stuff. It’s okay to put drops in your nose while supine (lying down, face up), if you tolerate that. Most people choke when doing that. For toddlers, this can be the only way to get something into their nose, however; I placed drops in my children’s noses while changing their diapers, and that seemed to work well.

      2. The challenge with biofilm-forming bacteria is that it can be nearly impossible to culture them: they are “dormant” while in the biofilm state, and do not culture well. They are also extremely resistant to antibiotics and to our immune cells when in the biofilm state. For example, studies have shown bacteria in their biofilm state can tolerate a 100-fold higher concentration of antibiotics that would otherwise readily kill them. It’s an impressive protection mechanism. So to answer your question: it’s nearly impossible to tell whether your chronic rhinosinusitis is the result of a chronic infection, or simply an ongoing, chronic inflammation. And, frankly, it may not matter with regard to successful treatment. That is, once you have completed an appropriate course of antibiotics, the best treatment is saline rinses – perhaps with some of the additives such as Manuka honey. Manuka has strong antimicroial agents and is particularly effective against biofilm-forming bacteria.

      3. Most sports will not affect sinusitis. The main exception is swimming, which can cause non-infectious sinusitis from the chemicals used to treat pool water; can also cause infectious sinusitis from various biofilm-forming bacteria that love pools and hot-tubs (pseudomonas, serratia, and other gram-negative bugs). Yuk. Otherwise, I can’t think of a sport that will bother sinusitis. Doesn’t mean they don’t exist; I just can’t think of any others.

      I have tried most of the herbal remedies that you name, and did not achieve huge benefits. The most effective remedies that I have found are saline rinses, Manuka honey, and Xylitol.

      I hope some of this helps.
      Again, thanks so much for visiting, and for taking the time to share your thoughts! Please share the blog with friends :)

      • Dear Dr. Faust,
        a belated but nonetheless sincere thank you for your thorough reply! It was very much appreciated. Learning to understand the background of it all helps me a lot to accept the illness and to remain optimistic about the future. It is wonderful that you take your patients and readers so seriously.
        P.S.: I will definitely recommend your blog :-)

  53. Cynthia Cary says:

    Waiting for reply

    • Russell A. Faust, PhD, MD says:

      Hi Cynthia,
      I replied to your inquiry by email yesterday. If you did not see it, please check your SPAM folder.
      Thanks

  54. Dear Dr.Faust I had chronic rhinosinusitis for about 13 years and staph infection deep in my nose near throat ,I took so many antibiotics some of them was fluoroquinolones and I had severe bad reaction from them I was almost disabled .Finally I got rid of the biofilms with baby Johnsons shampoo but the staph infection is still there and the post nasal drip.Do you know MSM (Methylsulfonylmethane ) ?Somebody suggested MSM to me,said is good to close the open wounds.I was thinking if I do close the wound the staph bacteria will go.You can read one testimonial here:
    http://grannygoodfood.blogspot.co.uk/2012/09/staph-aureus-msm-and-gods-mercy-in.html
    MSM is a sulfa drug.My question is, it is safe to do a nasal rinse with it ?and do you think will work ?
    I forgot to say I tried everything,manuka honey,essential oils,bacteriophage from Russia ,garlic,bactroban..etc
    Thank you

    • Russell A. Faust, PhD, MD says:

      Have never tried MSM. My online research suggests that MSM is fairly benign and non-toxic. If you try it, PLEASE let me know what you think. Thanks so much for visiting and for sharing.

  55. Really enjoyed all the info and have shared with friends and family…
    Just curious if vitamin C would not be helpful to add to the irrigation protocol to help the immune system. And…I read the yucca extract is supposed to be effective in breaking down biofilm (among other great benefits).

    • Russell A. Faust, PhD, MD says:

      Don’t know, never tried it. I do know that many bacteria are able to use various vitamins, so adding vitamins to nasal saline rinse may not be the best idea. If you give it a try, please let me know your thoughts! Same regarding the yucca extract!

  56. Sorry,
    Should have been clearer, I meant to say, taking vitamin C separately as a supplement, to help the immune system. I tried the Yucca extract with honey & salt. Had to let it sit a bit as the extract had a tad of alcohol in it. It burned a little but got better results. Iodine is also recommended to break up biofilm, interesting thread here: http://www.curezone.org/forums/am.asp?i=1729465
    Another suggestion I will try; is to follow up with an irrigation using probiotics (without fillers). To reestablish the good bugs.

  57. My 4 year old son has chronic ear infections during the fall and winter. Is there any chance nasal irrigation could help him? How much baby shampoo or honey would you use for a 4 year old? My doctor thinks he will need tubes in his ears, but I’m looking to see if there are any alternatives I could try this upcoming cold and flu season. Thanks!

    • Russell A. Faust, PhD, MD says:

      Hi Corey,
      Although sinus disease CAN result in recurrent and chronic ear infections, it is more common that chronically-infected adenoid tissue is the culprit.
      Please take a look at two items – the first is my recent reply to a father regarding recurrent ear infections in his 7-year-old son, at this link (here on this site): http://www.boogordoctor.com/guided-imagery-sinusitis/
      Next, please go over to the right-hand column of this blog, find the SEARCH BOX just below “search this site here”, and type in “adenoid.” There will be several articles on the anatomy of the nose, ears, and adenoids; articles on understanding CT scans; and some others. The articles that you may benefit from are on the topic of “The Unified Airway.” I hope I didn’t write them too technical, and that they are understandable without a medical degree :))
      But start with my reply to the father of boy with recurrent ear infections. Bottom line: probiotics and xylitol will help! We went through this with both our boys from age 2 or 3 through 6 or 7, and I’ve managed thousands of my own pediatric patients with recurrent ear infections – keeping most out of the operating room (for ear tubes) with this approach.
      Best success, thanks for visiting, and please keep me updated.

  58. Hi
    Many thanks for your informative website. I’ve been suffering from repeated sinus infections for over a year now and although having polyps removed has improved my symptoms, the main one that remains and the one I’m keen to get rid of is a bad odor emanating from my nose. I’ve tried almost everything I’ve found on the Internet but nothing works apart from a short course of prednisone. Do you think this smell, which other people can smell, is somehow related to biofilms?
    Many thanks
    Jules

    • Russell A. Faust, PhD, MD says:

      Hi Jules,

      There’s no way for me to know without a thorough nose and sinus exam. Your ENT clinic should be able to help with this. In my experience, nearly all people who have been through sino-nasal polypectomy (nasal polyp removal) will have some post-surgical scarring of the lining of their nose and sinuses. As a result, the normal ciliary clearance of secretions cannot function, causing chronic infection (including biofilm infections) and foul odor.

      I have yet to meet someone who has undergone polyp removal who does not benefit from regular (daily) saline nasal rinses. You should consider this if you are not already doing so.

      Thank you for sharing your experience; I am sure there are others out there who are reassured to know they are not alone in this experience. And please keep me updated on how things go for you.

  59. Hello Dr. Faust,

    Very good site. Well done. I have developed chronic bad breath and tried many solutions. I seem to have the most success with different nasal washes but my question is this. When it’s really bad you can tell because people react. Often though it’s not terrible but still unpleasant and people may not react so obviously or at all. Is there a reliable way to test your breath throughout the week. I’ve tried the tongue scrape drying on the back of your hand and never smelled anything offensive. Only if I see tonsil stones or feel them irritated, then swab the tonsil and smell it, there is a clear foul odor. I’ve heard of the ‘halimeter’ but haven’t found a commercial product. Does it even work? Any suggestions you have would be appreciated.
    Thanks Dr. Faust
    Andrew

    • Russell A. Faust, PhD, MD says:

      Hi Andrew:
      I have no idea; have not heard of the halimeter. My best suggestion is to keep searching online.

  60. I use the Mcneil power rinse bottle with: 2/3 bottle of warm water; 1/3 bottle of Alkohol sinus rinse product; 2 drops of Johnson’s baby shampoo; 1 or 2 drops of oil of oregeno; 1/4 teaspoon salt/baking soda mix. Work’s great for me. Haven’t had a sinus flareup in 3 1/2 years. No discharge. I use it only 1x per week now.

  61. I love this site and will spend more time navigating it. I finally found out I have cough variant asthma. I went through months of coughing, colds, exercise induced coughing, some wheezing. Finally, my doctor heard the wheezing and I was put on two inhalers for several months as well as Flonase. It did give me a chance for my lungs to rest and recover for which I was grateful. I was concerned about several side effects and told my doctor I wanted to try going off of the inhalers. First, I went off the Flonase and started using Nasalcrom. It is a nasal spray which prevents the allergic reaction before it occurs. I found this on my own and was amazed how well it worked for the ongoing post nasal drip I get (allergies, etc). If you research it children as young as 2 years old can use it and there are virtually no side effects listed. I went off the inhalers over about one month’s time. I have had no side effects from the Nasalcrom. I carry inhalers in case I should ever need them but so far have not used them(6 months no asthma). I just came through a cold and was amazed how I weathered the storm. I think the post nasal drip because of sinus problems contributed to the asthma and coughing. Nasalcrom was a lifesaver for me. I have cut back on the use of the Nasalcrom now. I use a saline nasal rinse one to two times/day. Switched to green cleaning supplies while cleaning houses and went to goat milk because of dairy intolerance. All the best to everyone… Feeling blessed.

    • Russell A. Faust, PhD, MD says:

      Hi Lori,

      I’m a huge fan of Nasalcrom. And yes: “going green” for all your household (and office, and auto) cleaning supplies can make a big improvement in your quality of life. Next, consider slowly weaning from plastic to glass and stainless for all of your food and drink items. In other words, detoxify!

      So glad to hear of your success. Thank you so much for visiting, and for sharing! And please take a look at SacredHerbals.com for more healthy living guides.

  62. Giancarlo Nappi says:

    Hi Russell, how are you? I’m reading this site and readers’ comments and would like to give my testimony. I am a pharmacist and I had gastritis and sinus problems for many years. A few years ago I made a hiatal hernia surgery, which greatly improved my stomach problems, however, continued with the sensitive stomach. I researched various supplements that could be beneficial and among them, I used the calcium alpha ketoglutarate, which helped me a lot in my gastric sensitivity. Seeing the action profile of this compound, I decided to test whether it could improve my sinus problems and bang !!! The effects were immediate !!! I decided to use my mother as a “guinea pig” because she has severe sinusitis and asthma and bang2!!! She also improved significantly!!! The way that I use is by mixing some of the powder in saline solution (NaCl 0,9%) and stirring until the powder is suspended (it does not dissolve) and then applying a few drops in each nostril so that the suspension is retained in the nasal cavity. The calcium alpha ketoglutarate is very cheap and very easy to be prepared for nasal application and, moreover, it is non irritating even if the powder is aspirated pure in each nostril!!! I really recommend using it for inflammation of the nasal cavities, it really works!!! Forgive me for my poor English.:^)

    • Russell A. Faust, PhD, MD says:

      Hi Giancarlo,

      I will take this opportunity to emphasize that this website does not provide medical advice, and is merely a reference resource for information, and should not take the place of a physician.

      Having said that, I thank you for sharing your experience: this is how we all learn.

      Please visit again to give us all an update in 6 months or so.
      Thanks, and best success!

  63. Dear Dr. Faust: I found your site by looking for info on probiotics in sinus rinse. Very interesting and very helpful. I have a deviated septum and get sinus infections easily, altho I warded them off successfully for 4 years – and a week ago we drove through a fierce Southwestern US dust storm – and almost instantly the facial pain began (more below my right eye rather than in my forehead), ,a 101.2 temperature for a day and a visit to my family doctor in of a bacterial infection. He insisted it was viral – two days later I was back feeling worse. He still said it was viral but gave me an Rx for an antibiotic, but I’m trying to avoid it and feel I’m being successful. Each day is better, but there’s still a lot of yucky discharge that I’ve been flushing out with NeilMed Sinus rinse. As advised by my family doc, I’ve been taking decongestants, anti-inflammatories, and rinsing at least twice a day. Today, not finding a definitive answer to probiotics in sinus rinse, I put half of a probiotic capsule in my saline rinse. It really flushed out some yuck. I read about the baby shampoo and honey. What is the ratio of honey to the saline rinse? I am a faithful probiotic user, saline sinus rinser, and have been using Ponaris Oil drops for a couple of years to keep my sinuses from drying out in this arid climate. Has worked well . . . til the dust storm. I would like to hear from you. Montana7

    • Russell A. Faust, PhD, MD says:

      Hi M7,
      Thanks for your kind comments regarding my medical education blog site. I add 3-4 generous tablespoons of Manuka honey to a 500ml bottle of saline. When added to the usual saline packet, the added honey increases the osmolarity (concentration of solutes – dissolved molecules) in the solution. This helps pull fluids from the swollen tissues, helping to decrease swelling.
      You may find that adding Xylitol also helps moisturize the nasal lining when added to the nasal rinse solution. Be sure to read the article here on Xylitol.
      Thanks for taking time to write, and best success!

  64. My just turned 4 year old daughter has had chronic sinusitis for most of her life. It has been a very long, frustrating, road for us advocating for her needs and not being able to help her…she had severe sleep apnea and had her tonsils/adenoids removed in 2014. They discovered at that time she had both a sinus and adenoid infection. After we didn’t see any improvement we sought another sleep study and ct of her sinuses. The sleep study showed moderate apnea, and the ct showed left maxillary and sphenoid disease. The ent felt endoscopic sinus surgery was necessary and it was performed in August. When she was in surgery they discovered her adenoids had regrown very large into her nose and sinus cavity and removed them again. Four days after the procedure she was admitted to the hospital unable to move her head or neck. A ct showed swelling In the soft tissue of her neck, behind her throat. The ent insists the two events were unrelated and refused to even follow up with her. She never cultured the infection in her sinuses. She was on iv antibiotics In the hospital and 10 more days at home. We initially saw some improvement, but the mild fevers, dark circles, fatigue, and coughing are back. She recently completed s month long regimen of antibiotics with no improvement….We also recently did a follow up sleep study that showed no apnea! We’ve been waiting four months to see a pediatric ent at an out of network hospital. Do you have suggestions for advocating for her going forward? Thank you in advance.

  65. Katherine says:

    Hello,
    I really hope that you can help me. I am desperate. My chronic sinus issues started over 5 years ago which led to sinus surgery which helped stop my chronic sinus infections…until last year. Even after the surgery, I always had issues with dizziness and headaches, pressure in my sinuses, pressure in my ears which has caused constant ear ringing. I have always had bad allergies and even did allergy shots for a year and a half. The shots didn’t really help all that much.
    Three months ago it got worse. The pressure behind my eyes has gotten so bad that they are constantly puffy and swollen. The left side of my sinus seems to have the most pressure and my left eye constantly waters. Even with these symptoms, I still had have not had any green drainage or discharge. I am not stopped up in my nose, and I can breathe through my nose. My ENT took a culture after the first round of antibiotics didn’t work (amox) which came back showing I had pseudomonas. He prescribed Cipro for 20 days with a nasal rinse (twice a day) of a compounded drug consisting of 2 Gentamicin, Mupirocin, and Mometasone. I am finished with the Cipro, but still have about 10 days of the rinse.
    I am so frustrated because some days I feel like I am getting better, then others I feel worse. Today I woke up with another horrible headache and what is worse, is that I am extremely dizzy from the pressure. Seems like I am constantly dizzy and lightheaded. The pressure to my ears and the ringing is awful. My head feels like it could explode from the pressure..but I can breath through my nose just fine! My doctor said that even though my infection may have cleared, the pseudomonas could have left toxins behind and that is why I am having these symptoms.
    I have tried Allegra D, Sudafed, Singulair, Zyrtec, Claritin 24, and nothing seems to help.
    Thank you for taking the time to read this.

  66. Hi Doc, Great site, thankyou for being here!

    I’ve suffered with severe bouts of sinus pain for many years, it’s not so much about a nasal drip…But I get a hell of a pain over the bridge of my nose and around my eyes.

    It sometimes gives pain in my temples and across my head, down into the back of my neck then becomes a migraine where I’m often physically sick.

    I struggle to get to the doctors (Sorry) as I’ve suffered with clinical depression since I was a kid. But when I last had the ENT (Ear, nose, throat) doc take a look he said there wasn’t too much he could see, slightly deviated septum, and a little phlegm at the back of my throat. This was maybe 5-6 years ago though.

    I’ve started using a NeilMed sinus rinse, which has actually held it off for some time now, but as I write this I’m in severe pain, feeling like my eyes, nose, head are under real pressure. I always tend to go red over my nose and up onto my forehead, and feel the areas feel hot when this happens? Sign of infection?

    Would you suggest I try and have a scan of some sort? The pain is pretty debilitating, which makes things extremely hard with my mental illness that already controls my life.

    Thanks, N.

    • Russell A. Faust, PhD, MD says:

      Hi N:

      Note that there are people (many) who have some combination of allergic rhinitis or sinusitis and migraine headaches. The biggest diagnostic challenge is for those with nasal or sinus inflammation that triggers their migraine – then they have both nasal inflammation and a terrible headache, but no sign of sinusitis (infection).

      The symptoms that you describe, including pain in the temples and down back of neck, are rarely the result of sinusitis; more consistent with migraine origin, or other neuralgia.

      Unfortunately, you are not going to resolve your issues over the internet: you must seek professional help with someone who can obtain a thorough medical history and perform a detailed exam.

      Thanks so much for sharing, and best success!

  67. Hi,

    I recently read that Triphala tea made by boiling 1 tsp of triphala powder in 1 cup of water and rinsing nostrils as well as gargling will help with infections. There is a study where they are saying it busted dental biofilms. I tried the above concentration with my 5 year and it hurt. Will try lower concentration. But for now she will only gargle and do the simply saline nielmed bottle.
    Also has anyone tried d-host from orthomolecular for kids. Does that reduce swelling of adenoids if they are not infected but just enlarged due to allergies. It contains nettle, vit c , quercetin and bromlain.
    Best regards

    Pdj

  68. Your website is fantastic and it’s so nice of you to respond to everyone. I swore I had tried everything, but I was wrong. I had never heard of honey or baby shampoo in the irrigation. I’m wondering if you might be able to help me. I just ordered some honey and will pick up some shampoo, but in the meanwhile, you seem like you might be able to help. For over a decade, I’ve had thick green nasty stuff coating my throat. Every day. It often looks rope like and I can actually reach back and grab it sometimes because it’s so thick. This then can pull more stuff down from behind my nose. In addition, nearly daily I am choking on it and have to cough hard to get out a chunk of what can only be described as a ‘C’ or dome-shaped cornflake looking (usually the size of a quarter) thing of dried mucous. Sometimes it’s just that and other times when I cough it out, it has a long tail of green crap. I have seen allergists who said I was allergic to everything and put me on meds. No help. I have been to multiple ENT’s, had a CT scan, and have been on 9000 different kinds of antibiotics. It goes away when I’m on the antibiotics, but always comes right back so I stopped taking them. Even with cultures that said what bugs were in there. I lost my voice completely for awhile from what the ENT described as the mucous irritating my vocal cords as if kerosene had been poured on them and lit on fire. Steroids helped the voice, but I ended up with surgery to remove the adenoids. Didn’t help. Within a day, I coughed up the same little dome thing, but it was a little bloody instead. I am never stuffed up or have a runny nose. I can breathe easily. I do get sinus headaches and my face always has pressure. I also have pain in my upper teeth. I have a sinus irrigation system which I kinda gave up on too, but maybe I was not diligent enough about it. Twice a day for a couple weeks and nothing. Then I’ll get back to it and have no results and give up again. Plus it never feels like it’s getting to where the problem is, so I started holding one nostril shut and low and behold, stuff would come out my mouth, but never my nose. Maybe that’s bad to do because I could be messing something up. I do feel like my ears have pressure too, but no pain. I am hoping so much that you might have some answers for me. I would be forever in your debt. I have spent thousands of dollars on treatments, doc appts, surgery, etc and hours scouring the net for ideas and just came across this tonight. Thank you in advance for any help!

    • Russell A. Faust, PhD, MD says:

      Hi Bree,

      Only a couple words of caution: first, if you try adding baby shampoo to your saline nasal rinses, go easy! If you add any more than a couple drops per rinse it can be very irritating! Second, if you have been on any antibiotics, it is important that you help your microbiome to repopulate with a healthy group of bacteria: take a daily probiotic. And note that if you take probiotic in capsule, powder, or liquid form, most of it will be killed by your stomach acid. In order for most of the probiotics to reach the small intestine, where they can bind to receptors on the “gut-associated lymphoid tissue,” or GALT, the probiotics need to be “enteric coated.” There is only one brand of enteric-coated probiotics that I know of: Integrated Therapeutics Probiotic Pearls. That is the one that I take personally (my family, too). Here is the link to buy: http://www.boogordoctor.com/?s=probiotic&post_type=product
      Thanks so much for sharing, and best success!

      • Thank you! I do take probiotics, eat fermented food, etc. I’m on the paleo autoimmune protocol diet and have been for 9mos+. Do you think my case just sounds like a difficult to cure chronic sinusitis? Lastly, I have started doing more regular rinses again with just the usuals and I feel like my sinuses are mad at me. I’m not stuffed up, but they feel swollen and irritated. This is just with saline. Last night I could feel my pulse in my face when I would lay down. It’s uncomfortable, BUT if this is just what happens as you heal, I can deal. Does it sometimes get worse before it gets better? Thank you again for your time. I really appreciate it.

        • Russell A. Faust, PhD, MD says:

          Hi Bree,

          ALL cases of chronic sinusitis are difficult to heal.
          That sensation you describe is due to the swollen nasal and sinus lining. The rinses are irritating, especially at first. Personally? I HATE doing the rinses, but regular saline rinses were the only thing that cured my own chronic sinusitis.
          Hang in there! And best success.

      • Dr. Faust,

        Speaking of microbiome, I have a couple of questions. Maybe they’ve been answered elsewhere on your blog, but I didn’t see them, so bear with me if they have.

        This article mentions a study that suggested that if one rinses their sinuses on a regular basis, then it disrupts the microbiome of the sinuses and results in more frequent infections:

        http://www.bottomlinepublications.com/content/article/health-a-healing/how-nasal-irrigation-increases-sinus-infections

        I’m wondering if you could comment on that. And along the same lines, have you ever recommended introducing probiotics into the sinuses? Apparently there are a couple that have shown some benefit.

        Thanks in advance,

        Kelly

        • Russell A. Faust, PhD, MD says:

          Hi Kelly,

          Thanks for your thoughtful comment.

          Dr. Nsouli, an allergist, has a good point, although I would be much happier if Dr. Nsouli had backed up his opinion with published clinical studies. Even so, I agree with his opinion that saline rinses “… should be used only when specifically needed …”

          I completely agree with that opinion. That is, I only recommend saline nasal/sinus rinses for those with sinusitis or chronic rhinitis. All articles on this topic here on this medical education blog site are for that population of people. I apologize if that was not clear.
          Saline nasal irrigation is not a remedy for everyone to use every day for no good reason.

          EVERY remedy represents a balance of potential benefit vs. potential harm. For those with chronic sinusitis, especially chronic sinusitis that is resistant to “standard medical treatment,” the potential benefits from saline rinses far out-weigh the potential harm.

          Again, thank you for sharing!

          • Hello again Dr. Faust,

            Thanks for your kind reply. And while I’m on the subject, I have to say you have got to be the most polite and good-natured doc that I have ever ‘met’ online. Seriously. You’re always so patient, so polite. You could teach a class on how to completely disagree with someone and win them over at the same time! :)

            I’ve been really sick for almost 18 years with ME/CFS, and severely so for the last 3-4 years or so, to the point of where I can barely walk, and need a wheelchair or walker most of the time. Thanks to the pseudo-alzheimers that often goes along with this illness, or ‘brain-fog’ as it’s typically called, I had no idea that I had posted earlier in this thread (back in November) about haritaki and biofilms. And worse, here it is five months later and I have yet to try it myself! Sheesh…

            Anyway, I’m going to try and get some, maybe some triphala as well (since it contains haritaki and also helps with overall digestion issues and helps kill off some bugs/destroy biofilms as well). I figure that if I have chronic inflammation in my sinuses, I probably have it throughout my digestive tract as well, especially with all the thick post-nasal drip that’s going on. I guess I’ve had the sinus infection for so long I’ve taken it for granted, but just realized that the overall worsening of my health has coincided with the worsening of my sinus issues, so will give these things a try, along with twice daily rinsing — and promise to bookmark this thread and report back in the next few months.

            One question I have about the honey: My hba1c numbers have worsened over the last 3 years — not diabetic — but too high IMO, and along with messed up triglycerides, etc. Have you heard of anyone having blood sugar issues when using honey in the sinus rinses?

            Also, back to ayurvedic remedies: They suggest using oils in the nose, especially for very dry sinusitis — and mine is typically very dry, especially first thing in the morning. Have you ever tried that in any of your patients?

            Thanks in advance.

  69. users,please I need an urgent reply,thank
    you a. 18 now but has had bb since I was 15,I
    have visited the dentist used different mouth
    washes,toothpaste,herbal methods to cure my bb
    to no avail,when I talk family and friends tell me
    my breath doesn’t smell but they inhale
    deeply,cover their nostrils,use robbs to prevent
    inhaling the smell, but extended families and
    friends avoid me,some don’t allow me play or
    carry their babies to avoid breath transfer ,I think
    ,when I visited the dentist he washed my mouth
    but told me I had no bb ,so also an ENT doctor I
    visited recently,an x-ray was conducted and I
    was told I had opacified maxillary sinus
    suggestive of sinuses but the ENT doctor told
    me it wasn’t something serious I should wash my
    mouth with lime and chew orbit chewing gum
    which I have started everyone thinks I don’t take
    care of my mouth hygiene especially families,I
    don’t go outing,don’t talk ,don’t make
    friends,even trusted friends tell me my breath is
    fine which I know is nothing but a lie,symptoms:
    1.bad breath,lasting bad breath which doesn’t
    stop even after brushing 2.jaw pain and swelling
    3.I have tonsil stones which were once white but
    now yellowish and ENT doctors says they aren’t
    swollen 4.post nasal dripping,mucous dripping
    from throat 5.painful tongue and headaches
    which can last for 2-3days 6.excessive mucous
    in mouth when brushing 7.pain in top of nose not
    always though,just noticed once 8.white coated
    tongue 9.sometimes I smell the bb from my
    nostril when covered between my hands not
    always and its smells irritating and sometimes in
    my mouth too 10.I get irritated often maybe
    because of excessive mucous My question can
    all this symptoms be because of opacified
    maxillary sinus of both sinus or what,please reply
    and can amoxicillin treat opacified maxillary
    sinus?thank you

  70. Hi, Can someone tell me what the relationship between alcohol and sinusitis is? If/when I drink and it doesn’t matter how little or how much the next morning I bring up all matter of coagulated mess which I have a suspicion is related to a biofilm. I’m clear for a few days until it builds up again and if/when I have a drink it all happens again. I’ve asked doctors and can’t get an explanation. So has this happened to others and what’s going on. Thanks all…..

    • Russell A. Faust, PhD, MD says:

      Hi Russ: try doing a search on “alcohol consumption and sinusitis” – some pretty interesting sites, including LiveStrong.com

  71. Hi Dr faust,
    I’ve been suffering with sinusitis for around 6 weeks now. Pain in the cheeks, behind the eyes, in the temples, ears throbbing feeling of pressure, fatigued! The thing is my nose is Clear, no mucus or phlegm etc this is in combination with a sinus Headache I guess to the inflammation etc? It’s been horrendous, ive had to stop playing sport and working for a few weeks, all this Started after a viral infection and a tooth abses I had! I’ve been swimming 4 times a week for 2 years so think the toxins in the pool may have contributed to this or maybe a result if post viral, either was I’ve had 3x weeks if antibiotics and a steroidal nasal spray given by my GP, really seen little change and I was losing all hope until I was informed to try a solution of crushing 2 garlic cloves in boiled water into a watery paste and Leaving it to marinate, then putting it into a misting nose Sprayer and snorting it 3 times a day just 2snorts of the Garlic Water mist! Apparently it’s got antifungal antibacterial anti inflammatory and antibiotics properties and after 4 days I’ve noticed a big help, is this safe to do and would you have any suggestions to whether I had acute or subacute sinusitis? Thanks very much
    Chris from England

    • Russell A. Faust, PhD, MD says:

      Hi Chris: I don’t know whether garlic extract will be irritating to your nasal lining or not, but it should not be toxic. Six weeks of sinusitis would be considered subacute, but I suspect you know that (or you wouldn’t already know the terms “acute” and “subacute”). I urge you to find a specialist to help you with this – more than two weeks is a red flag, and warrants a physicians help to diagnose and treat.
      Thanks for visiting and sharing.

  72. Hi Dr. Russel,
    Thank you for blog.
    I am wondering though, why don’t you reply to comments or questions concerning chronic bad breath? Kindly.

    Warm regards,
    Henrika.

  73. Anne Munir says:

    Hi Doctor
    I am overdue for a follow-up visit to my ENT for chronic sinusitis. I have delayed because I have had SVT with heart rate 150 to 180bpm on occasion even while taking Betapace. Is there a decongestant that won’t cause tachycardia that can be given prior to examination of the sinuses by endoscopy ? I asked the cardiologist and he just evaded the question. I’m sure others have tachycardia with chronic sinusitis. What other options are there in lieu of decongestants?

  74. Hi Dr. Faust,

    thank you for your blog. I have suffered from recurrent/ chronic sinusitis for the past 3.5 years. Despite my sinus surgery and RF to shrink my turbinates, I still have very bad sinusitis every month. I had more than 10 courses of antibiotics each year for the last 3.5 years. My ENT doctor said my case is likely caused by the biofilm. I will try to use the baby shampoo and honey wash as suggested in your post. I just want to see if you have come across treatment with antibiotic added directly into he nasal rinse? If I use the honey and baby shampoo to break the biofilm, will it be even more effective to add the antibiotic directly in the nasal rinse? The huge amount of oral and IV antibiotic is severely affecting my body but if I am not taking it, each sinusitis episode will cause me high fever and I will be sick in bed for at least 2-3 weeks. I am still in my 30s and I really need to find a solution to this problem. By the way, my ENT warned me that prolonged use of baby shampoo in the rinse may impair my smelling, is that true?

    Thanks very much.
    Edna

    • Russell A. Faust, PhD, MD says:

      Hi Edna:

      A strong word of caution: VERY little baby shampoo (a few drops in a Nasopure squeeze-bottle); too much and (1) it burns!! and (2) it will irritate the respiratory cilia and prevent their normal clearing secretions and (3) can damage olfaction – reduce sense of smell.

      In my experience, I used Manuka honey and Xylitol in my saline rinses to finally eliminate chronic biofilm infections.

      Thank you for your kind comments, and best success.

  75. Dr Faust

    Ive had sinus problems for slmost abyear straight, every morn i wake my sinuses are clear, in the afternoon my nose is leaking and i hsve postnasal drip in the evening i feel generally unwell my nose is usially clogged at this time, then around 12 midnight my sinuses clear up again snd i feel great, do you have any idea what could be going on?

  76. Mark Andrizzi says:

    Hi Dr. Faust! Thank you for your endorsement. Since health insurers have nearly stopped reimbursements for physicians treating CRS topically with compounded medications due to the “experimental” aspect of topical medications, do you have an opinion whether insurers would be more apt to cover such treatments if the specific upper respiratory bacterial/fungal infection is determined and the specific anti-bacterial/anti-fungal medication is prescribed? Thank you!

    • Russell A. Faust, PhD, MD says:

      Great question, Mark. I think that having data is always good ammunition when dealing with the insurance “ogre at the moat.”

  77. Hi Dr. Faust,
    I suffer from post nasal drip since almost 2 decades, went to a few ENTs at first but they couldn’t help me, so I gave up as it isn’t too severe, a little runny nose (clear like water) and a bit of thick mucus in my throat every day I have to clear or cough up, but no pain, maybe sometimes a little bit on the bridge of my nose but nothing that makes me feel bad. The real problem is it’s infective. I gave it my ex with who I lived together for several years, went to ENT but he didn’t believe, said coincidence as this isn’t infective and I belived him, because I didn’t give it any other woman. Then a year ago a real tragedy happened as I infected my 4 years old daughter. There was a situation when she pressed her nose against mine while I exhaled through my nose and since then she has the same issues. 2 months later her mother and sister also developed the same condition, later I learned she was also pressing her nose against theirs. I tried like everything but nothing really helped until I found out about Marcons. I wonder if you have some experience with Dr. Shoemakers work, couldn’t try the BEG spray as I’m from Germany, but the alternatives like neti pot with a few drops of Biocidin or Argentyn 23 nasal spray were the first things which reduced the post nasal drip but didn’t completely stop it. Now I use a 50/50 mix of Argentyn 23 and Xlear as with Xlear it doesn’t sting and heard it also has some biofilm busting properties. Want to use it now for at least 6 months as before I gave up after 2 months and I’m also planning to visit a Shoemaker certified physician to make the Marcons test when I saved enough money.

  78. I had surgery on my sinuses over ten years ago, and I’ve been doing a saline lavage every morning since then. In the year after my surgery, my ENT had me add some Mupirocin to my lavage because a blob of greenish-yellow snot came out of my sinuses every afternoon. The Mupirocin got rid of it, and I had little trouble with my sinuses after that. I would sometimes get the daily blob again when I had a cold, but it would resolve on its own after the cold went away. This winter, I got a cold, and the daily blob returned, but it didn’t go away when I got better. Also, it had a distinct odor like tortillas, so it seemed like a serious blob. After three or four weeks, I decided to try a Mupirocin lavage again, but when I researched online, I read about the baby shampoo treatment, and I thought I’d give that a try first. I started it a week ago. The daily blob was gone after three days, along with the tortilla odor. I’m still doing the shampoo treatment, though, to be safe. I’d be interested in your opinion of how long I should continue it and whether I should have any concerns now that it’s gone.

    • Russell A. Faust, PhD, MD says:

      Hi Kurt:

      The baby shampoo addition to nasal saline rinses should only be considered as a last resort, since it is easy to go overboard and use too much. Even when using the “correct” amount of baby shampoo, the cilia on your respiratory epithelium are not very fond of the baby shampoo, so it’s best to limit its use to a few days instead of weeks. Addition of baby shampoo to nasal saline rinses is intended to help eliminate chronic infection with biofilm-forming pathogens.

      Best success!

  79. Hi Dr. Faust,
    I have been doing saline rinses since November.3 2016. At first for sinus infection. but I have had a PND cough for 2 years. So I have kept it up using honey, baby shampoo, xylitol. I think the cough is getting better. My husband bought me a MyPurMist. But I can only use distilled water in it. It is a personal steam inhaler. So before I open it I wondered what you think of them.

    I think I will get the steam vaporizer you recommend for nighttime use. But what is your take on this or any use of steam….I have boiled water in a pot and breathed it in for sinus infection in the past in order to avoid antibiotics

    • Russell A. Faust, PhD, MD says:

      Hi Pam,

      I like the “steam inhalers” if they are truly steam, not “cool-mist” ultrasonic-misters. Steam is great because the heating process kills any microorganisms in the water (and tap water is NOT sterile!).

      My reco is to use the additives to nasal saline rinses sparingly, and usually not in combination. That is, probably best not to use Xylitol AND baby shampoor AND honey all at once.

      Thanks so much for sharing, and best success!

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  1. […] Before even considering sinus surgery for a child, I insist that a strong, integrative holistic medical approach has been tried, and failed. All other options must have been exhausted.  This includes doing daily sinus rinses. Really doing them.  Really.  Check this link for my 5-Step Program to Eliminate Biofilm and Chronic Rhino-Sinusitis. […]

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