Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

My 15 year old has 6-8 colds a year. Could she have sinusitis?

Question: My teenage daughter (15) has been challenged with recurrent colds since she was at least 3 years old. At this time she still gets 6-8 colds a year, very heavy, sometimes turning into a sinus infection. Enlarged adenoids were removed in 2012 with no improvement. No OTC meds (pain or cold) have any impact, even prescription strength pain meds offer no relief. Excessive absences from school – feels too ill to go. Very heavy mucous production. CT scan in 2011 shows focus of mucosal thickening in the right maxillary sinus. Undulation of the nasal septum. No one has suggested chronic sinusitis. Are there cases of chronic sinusitis in teenagers? Our school is looking for a medical condition for the cause of her recurrent colds and seemingly continuos sinus infection. I’m looking to improve my daughter’s health.

Answer: Thank you for your question. One would not expect a healthy 15 year old to still get 6-8 colds a year. Chronic sinusitis in teenagers is rare. While upper respiratory tract infections are quite common in children, they tend to get less frequent as they enter the teen years. If she has continous sinus infections, I would suggest looking into other factors that could be causing these .

Among the possibilities (not all mutually exclusive) are: sinus infections or a chronic low grade infection with exacerbations, allergies, or least likely a partial weakness in her immune system.

Sinusitis can certainly cause her recurrent infections. Her CT scan sounds like it showed a sinus infection. The most common cause of recurrent sinus infections in children is chronic infections in the adenoids- and this seems like it was addressed. Sometimes, though, adenoids can regrow and get re-infected. I would ask your pediatrician to have her get an ENT evaluation.

She could also have allergies- either causing what seems like recurrent colds- or as a factor causing recurrent sinusitis.

Less likely is a selective immune deficiency. Some children may have a weakness in their ability to fight off colds because they have a diminished antibody response to certain viruses. This is not in any way related to AIDs- but can cause a child to have an increased number of these URIs.

If you are in the NY area- we would be happy to see your daughter here at the NY Sinus Center…

I hope this helps clears things up

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

I have a deviated septum and a crooked nose. My surgery did not help. Is it safe to perform surgery again?

Question: I have deviated nasal septum besides a crooked nose with a minor sinus infection and had septoplasty to correct it. Nothing changed after I had treatment for a crooked nose, and sinus infection got worse from then. Will a septorhinoplasty help solve my problem? Is it safe to perform surgery again?

Answer:

Thanks for your question.

First of all, while revision surgery is quite common and may solve your problem, one should try to find out why the surgery didn’t help in the first place before having another procedure.

The septum is a dividing wall that separates the nasal airway into to separate passageways. While the septum is never completely straight, the septum can be “deviated” or twisted enough to block the flow of air through one – (if the septum is over to one side)- or through both passages (if the septum has a shape like the letter S). Straightening the septum should be expected to improve breathing through the nose, but sinus infections usually will need to be further treated – either through opening the sinuses wider, or finding out the cause of the infections and treating them medically. Fixing a crooked nose requires breaking the bones of the nose- or rhinoplasty- and is a cosmetic procedure to improve the appearance of the nose. This can be done at the time of septoplasty and/or sinus surgery- or sometimes alone. I am not sure what problems you were having before and are continuing to have.

But, we frequently are called on to treat patients who have had nasal or sinus surgery before that did not fix their problem. Usually, that is because the problem causing the symptoms was not accurately identified, and less common because the surgical results were not as successful as we’d like.

Before I would say to have the procedure repeated, I would suggest having another opinion- certainly something we do a lot of here at the NY Sinus Center.

If revision sinus or rhinoplastic surgery is needed, we have significant experience in helping.

Robert Pincus MD
Co-Director NY Sinus Center
________________________________________

Q & A

Pain while swallowing and turning my head after dental infection

Question: I have pain while swallowing and turning my head, what could it be? I had an abscessed wisdom tooth that caused my lymph nodes to swell and cause dysphagia several times within the last year and a half; it has always gone completely away leaving me asymptomatic. Feb of 2013 I became ill and the dysphagia began again. I was given antibiotics for suspected strep throat and pharyngitis. 2 weeks later I had my wisdom teeth extracted and developed necrosis of the bone and was subsequently put on a total of 5 weeks of antibiotics. The pain while swollowing has not gone away as of today. I have had a Laryngoscopy, Esophogram, Endoscopy, CT of the neck checking for an abscess and was diagnosed with a hetial hernia, gastritis and dyskinesia of the esophagus. My Gastroenterologist and PCP both have urged me to get a second opinion with another ENT saying the dysphagia is a separate problem. I was also sent for a Esophageal Motility Study that I was not able to tolerate. I was not able to swallow any saline without vomitting. What could be wrong for so long? I am very desperate, any info would be greatly appreciated. Thank you

Answer: Dental infections may often lead to infections elsewhere in the head and neck. Dental infections in the upper jaw (maxilla) may cause sinus infections, head and neck abscesses (pus pockets) and rarely even brain abscesses. Infections of the lower teeth can spread to the floor of the mouth- causing a potentially dangerous infection known as Ludwig’s Angina, or swollen infected lymph nodes or even potentially life threatening abscesses in the neck.

While I cannot say for sure, it seems likely that the infection of the lymph nodes you developed has resolved- or at least to your doctors’ best ability to determine. A CT scan with contrast should be able to detect any persistent infected lymph node.

The other findings that you have- a hiatal hernia with reflux, gastritis and finally dysknesia (incoordination) of your esophagus all are causes of dysphagia (difficulty swallowing). Pain while swallowing and turning the head is not uncommon when acid reflux from the stomach comes up as high as the throat- and may well be the cause of your symptoms. This can be usually be found on an ENT exam, or by testing to see if acid from the stomach does in fact come up to the throat (pH testing).

I wish I could tell you more precisely, but if you’re in the NY area, would be happy to see you here and try to better clear things up. If you make an appointment, please try to bring the results of the studies done so far and any scans.

Robert Pincus MD
Associate Professor Otolaryngology
NY Otolaryngology Group

Our office number is 212-889-8575- or you can email for an appointment request

________________________________________

Q & A

I have a bad breath odor

Question: I AM CONCERNED ABOUT HAVING A BAD BREATH ODOR, EVEN FROM JUST BREATHING. I DON’T KNOW WHAT TYPE OF SMELL IT IS, BUT I NOTICE WHEN I AM SPEAKING CLOSELY TO SOMEONE THEY WITHDREW. EVEN SITTING NEAR TO SOMEONE I FEEL A DISCOMFORT. I DON’T HAVE CAVITIES, AND I BRUSH THREE TIMES A DAY AND FLOSS ONCE A DAY, I BRUSH THE ROOF OF MY MOUTH AND USE A TONGUE SCRAPPER FOR MY TONGUE. I THINK MY PROBLEM IS INTERNALLY. IN THE PAST I NOTICE A SMALL RED SPOT ON THE ROOF OF MY MOUTH.

Answer:

Thanks for your question. This is not an uncommon problem that we see at the Sinus Center. There are many causes of a bad breath odor or Halitosis

While probably the most common one is oral- such as cavities, gum infections, dry mouth or poor oral hygiene- there are quite a few others.

Certain foods- such as garlic, onions and a few others can leave us with a bad oral odor.

We see patients with bad breath from 2 main causes-

Sinus infections can cause a fetid odor from the bacteria in the sinuses, that then may drip down into the back of the nose and throat.

Gastric reflux can cause a bitter odor if acid from the stomach comes up as far as the throat.

In children, foreign bodies lodged in the nose, as well as sinus infections and infections of the adenoids and reflux as well can cause bad breath.

Certain medications can cause bad breath, especially those that cause drying of the mucous membranes- especially narcotics, water pills (diuretics) and some antihistamines.

One must not forget tobacco- which clearly causes bad breath-

Lastly, you must also be sure that there is not a systemic metabolic cause- such as diabetes and kidney disease.

I hope this helps clear things up

Robert Pincus MD.

NY Otolaryngology Group

Co-Director NY Sinus Center

Q & A

Question: I have a strep infection and when I blow my nose, mucus comes out of my eyes.

Question:
I have cultured positive for strep in throat. The next day, my sinuses became inflamed and when I blew my nose, I had snot coming out of eyes and it also burned my eyes. Is this normal?

Answer:
While this is not what one would consider “normal”, it certainly can happen with a sinus infection (sinusitis).

Strep can not only cause a throat infection, but is a common bacteria causing sinusitis. When you get a sinus infection it is because the lining of the nose gets so swollen that the sinuses can’t drain. Typically the musus from sinusitis drains through the nose.

However, there are other “tubes” that drain into the nose, which can also get blocked in the same way. The eustachian tube drains the middle ear fluid into the back of the nose. If this gets blocked from swelling or congestion in the nose, fluid builds up in the space behind the ear drum and you can get a middle ear infection. (acute otitis media) This is quite common in children, because their eustachian tubes are shorter, more horizontal and often also blocked partially by adenoids (lymph tissue in the back of the nose). Adults can get this, of course, also.

The tear ducts are another set of tubes that drain into the nose. If they get blocked, we often tend to feel that we are making excess tears- as our normal tears can’t drain. If you blow your nose and the nose is congested- or hold the nose too tightly when you blow- mucus from the nose can go the other way- through the tear ducts and around the eye. This is likely what is going on in your case. Be careful not to blow the nose too forcefully while your nose is congested as the mucus from sinusitis can cause you to get conjunctivitis (pink eye).

I hope this clears things up.

Robert L Pincus MD

Co-Director NY Sinus Center

Q & A

My husband has Methicillin Resistant Staph (MRSA) in his Sinuses

Question:
My husband, who has had sinus problems for years (and two sinus surgeries), sees an ENT, Dr. Raymond Schettino, every three months. A recent culture showed an infection, and the doctor prescribed a nebulized Vancomycin solution. The office did not let us know the results of the culture, only that it was positive. When I discovered he was taking Vancomycin, I became worried that he could have MRSA, so I asked my husband to contact the office to find out the results. Sure enough, he does have MRSA in the sinuses. I have three questions:

1) Is Vancomycin via nebulizer known to work on MRSA?

2) Is MRSA in the sinuses highly contagious?

3) What kinds of precautions should my children and I be taking to avoid contracting MRSA in the sinuses?

4) Is MRSA in the sinuses becoming more common among healthy people:

I am upset that this office didn’t let us know that my husband had a MRSA infection. When I called and mentioned this to the nurse, she waved me off, saying that any infection is contagious.

Answer:

First of all, thank you for your question. It really poses quite a few issues about both sinus infections and MRSA.

We certainly believe strongly that sinus infections should be treated, based on a culture. However, a positive culture does not mean the same thing as an infection. We all have bacteria in our body and our nose and sinuses, especially. Staphylococcus is a common bacteria on all of our skin and in our noses. MRSA is a type of staphylococcus that is resistant to the usual antibiotics we use for a staphylococcus infection. Many today are carriers of MRSA in their sinuses and nose, without actually having a sinus infection. The difference one needs to make is clinical. – i.e. is the patient sick?

Vancomycin is a very strong medication, used for resistant organisms. The usual recommendation for MRSA carriers in the nose is topical Mupiricin ointment (Bactroban).

I know of no good studies about the use of Vancomycin as a nebulizer, although it certainly is used for this by many.

Additionally, different strains of MRSA are able to be treated successfully with more common medications. Most MRSA in the community can be well treated with Bactrim- an old sulfa medication- which would be preferable to using Vancomycin, if possible.

MRSA is not especially contagious. The problem is that we (docs) usually treat infections with antibiotics that will not work against MRSA, and we may not realize it is MRSA until the patient gets sicker on medications. Today, we will often treat initially with medications that work against most MRSA.

In order to avoid getting MRSA, like any infection,- wash your hands frequently and cover your mouth when sneezing.

MRSA is becoming quite common in the community, today, in normal healthy individuals- replacing the previous types of staphylococcus. If your husband had MRSA- either as a healthy carrier- or as a cause of infection- I would suggest that you and your family members see your doctor for a culture. Most infectious disease doctors would probably not treat an MRSA carrier unless you are working in health care or are closely in contact with a newborn or someone with a weakened immune system. However, should you develop an infection in the future, we would know to treat you with something that would cover MRSA.

Robert L. Pincus MD

Associate Professor Otolaryngology

Co-Director NY Sinus Center/ NY Otolaryngology Group

Q & A

My daughter has had ear tubes and an adenoidectomy was recommended

Question: My daughter is 6 years old and suffers from eustachian tube blockage (dysfunction). She has chronic fluid in her middle ear. She had a third ventilation tube put in her left ear in June 2012, and that ear is doing fine. Her right ear had a fungal infection which caused its second ventilation tube to fall out and created a perforation that lasted for nearly a year. The doctor thought it would not heal on its own, however, in December 2012 the perforation had closed.

The right ear now has a retracted eardrum. It is not a pocket, but rather the entire eardrum is retracted. The recommendation is to place a ventilation tube in that right ear and also remove the adenoid. I’d like to know if the retraction should be corrected with a vent tube or if this will cause an increase in the possible recurrence of the retraction. What is a safe amount of time that we can monitor a retraction if we choose to observe, rather than surgery?

Also, have any studies been done that can conclusively say that removing the adenoid will decrease the middle ear fluid? I would love to read current studies and recommendations for children with middle ear fluid.

Thank you!

Answer:

Thanks for your question. Unfortunately, your daughter has had a lot of trouble with her ears, but the good news is that she and you should get through this fine.

We place ventilation tubes through the eardrum to drain the middle ear in children (and adults) whose own normal drainage through their eustachian tubes is not working well. In these people, fluid builds up behind the eardrum and can cause infection and hearing loss. Only if the fluid fails to drain, do we recommend drainage tubes. They tend to stay in about 6 months, and then come out on their own. You usually don’t feel the tubes, or when they come out, but they should help in terms of middle ear infection and bringing back any hearing loss caused by the fluid. Putting in tubes doesn’t really get to the cause of the eustachian tube blockage (dysfunction) but usually allows time for your child to “grow out” of the problem.

Studies by Maw in England showed that if children needed a second set of tubes, an adenoidectomy if done at that second time, would lessen the need for a third set of tubes by almost 50 %.

Paradise in Pittsburgh showed that if an adenoidectomy were done at that second set of tubes, children spent 47% less time with fluid the first year after and 37% less time with fluid the next.

Usually, one would suggest doing an adenoidectomy should your daughter need tubes again. We do recommend putting tubes in for eardrums that are getting “retracted” or sucked back. The hope is that the tubes allow air to get into the middle ear space and push the eardrum back to its normal position. Once an eardrum is scarred in a retracted position, there may be a persistent hearing loss. I don’t know of any study saying how long one can observe a retraction, as I believe the development of scarring in that position is quite variable. I would discuss this with your doctor.

The good news though is that she is already 6, and most children are aging out of the problem about this age. There always is a possibility that this will resolve without further intervention, but it is hard to predict.

Robert Pincus MD

NY Sinus Center

NY Otolaryngology Group

Q & A

My Nose Has Been Congested For 6 Months

Question:
I have been congested (stuffy nose) for over 6 months now. At first I thought I was getting a cold but when my cold meds weren’t working, I figured it was just allergies. After trying Claritin, nasal sprays, and the neti pot, I was realized nothing was working. My doctor also suggested that it was allergies, but I know that it is something more than that. I have chronic congestion, and it is keeping me awake at night, and its taking a toll on my life! I’ve tried online research but am not having any luck. Can you plase suggest some chronic congestion relief?

Answer:
Thanks for your note- It seems unlikely that your symptoms are from allergies, alone. Usually with allergies, a patient will have at least temporary relief of congestion with antihistamines. We certainly are proponents of using a neti pot- but if your congestion is persisting for 6 months, you should have a more thorough evaluation than your primary care physician can offer. Your chronic congestion may well be a sign of a low grade sinus infection, nasal polyps or other treatable problem. Sometimes, medications taken for other problems can cause nasal congestion as a side effect.

I would suggest that you have a thorough ENT evaluation which includes a complete history, but also looking at your nasal airway with a lighted telescope. This is an office procedure which will allow a doctor to find the cause of your problem and a treatment specifically for chronic congestion relief.

Robert Pincus MD
Co-director NY Sinus Center

Q & A

Post Nasal Drip Problems

Question: I have had post nasal drip problems since May. Every doctor I go to tells me they don’t know what’s wrong and cannont find any relief. I’ve been prescribed Nasonex and Augmentin, but both made the problem worse. I have a sore throat, my tonsils hurt, and my post nasal drip is worsening. Even as I write this email, I’m hocking up mucous to spit out. It won’t stop… If you have any thoughts, please let me know. I will greatly appreciate it.

Answer: As you know, to really give you an accurate diagnosis would require your being seen and evaluated. However, we have found that many patients with continuos post nasal drip problems have a post nasal drip due to acid reflux. We call this “silent reflux” when stomach acid reaches the back of the throat and the nose, causing irritation and post nasal drip even if patients don’t have heart burn. The body then makes mucous in response. You can see more about it under sinus treatment on the nysinuscenter.com website. This can often be diagnosed on examination alone, but at times we recommend pH testing. This is a test in which a thin wire that measures acidity is placed into the back of the nose.

Treatment for silent reflux includes following an antireflux diet (not eating 3 hours before bedtime, limited caffeine, chocolate, alcohol, fatty foods, peppermint and a few others) and 6-12 weeks of antacid therapy (usually 2 OTC prilosec or prevacid 30-60 minutes before breakfast)- Sometimes evaluation of the esophagus is needed to make sure there are no more worrisome problems in patients with silent reflux.

Other evaluations I would suggest, if not done, include nasal endoscopy, culturing any nasal discharge and perhaps imaging the sinuses by CT scan to make sure there is not a persistent sinus infection or other such cause of your symptoms.

If you’re in the NY area, please make an appointment, and I think we should be able to help. If not, please see an ENT doctor who specializes in sinus problems near home and ask about the above possibilties..

R Pincus MD

Associate Professor Otolaryngology

NY Sinus Center

Q & A

Health Benefits of Nasal Washes Are Limited

The Wall Street Journal looks at the value of nasal washing and the benefits daily use brings. While there are many different techniques, SaltAire is featured for its ease of use and effectiveness for airline passengers trying to fight off colds caused by germ-filled cabin air. Regular nasal washing can relieve congestion and other symptoms associated with chronic sinus problems and reduce the need for medication and natural brands (with only salt water), such as SaltAire are shown to be as effective as those with added active ingredients, such as xylitol.

sinus infection Archives - Page 2 of 2 - The New York Otolaryngology Group

My 15 year old has 6-8 colds a year. Could she have sinusitis?

I have a deviated septum and a crooked nose. My surgery did not help. Is it safe to perform surgery again?

Pain while swallowing and turning my head after dental infection

I have a bad breath odor

Question: I have a strep infection and when I blow my nose, mucus comes out of my eyes.

My husband has Methicillin Resistant Staph (MRSA) in his Sinuses

My daughter has had ear tubes and an adenoidectomy was recommended

My Nose Has Been Congested For 6 Months

Post Nasal Drip Problems

Health Benefits of Nasal Washes Are Limited