Why children do not need antibiotics for sinus infections

Each year in the United States, over 200 million prescriptions are written for antibiotics. Antibiotics can be disease fighting tools for bacterial infections, however for viruses such as cold and flu they may be worse than useless. According to the CDC, antibiotics don’t work for sinus infections, most coughs and bronchitis, sore throats not caused by strep, or for runny noses. Unfortunately, the public does not totally understand the proper use of antibiotics. These misunderstandings are more important than ever with the rise of drug resistant bacteria.

Recently the respected British medical journal The Lancet published the research of Dr. Jim Young of the Basel Institute for Clinical Epidemiology which summarized numerous clinical trials on sinus infections and antibiotics. Amazingly, Dr. Young and his Swiss colleagues discovered that 15 patients with sinusitis-like complaints would have to be given antibiotics before an additional patient was cured. In an interview with Web-MD, Dr. Young put it this way: “We found that overall, you would need to treat 15 patients … for one patient to benefit.” If Dr. Young is correct, 15 out of 16, or 94% of patients do not get well with standard treatment. The study was so news worthy that both CNN and the BBC aired segments breaking the story worldwide. In their report, the BBC quotes study co-author Dr. Ian Williamson who said, “Antibiotics really don’t look as if they work.”

Not only do antibiotics not work for colds, coughs, and sinus infections, they also put kids at risk for side effects. Common side effects of antibiotics include rash, diarrhea and stomach upset, and fungal infections. Each year, more than 140,000 people are rushed to the emergency room from adverse reactions to antibiotics. Sadly about half of these prescriptions are unnecessary. Still, when asked by a concerned parent, doctors will prescribe antibiotics for viral infections almost 2/3rds of the time according to a 1999 study published in the journal Pediatrics. Conditions where antibiotics are prescribed unnecessarily for kids include sinus infections, coughs, and some ear infections. In fact according to a recent study, using antibiotics for ear infections can increase the likelihood of getting another ear infection!

Nova Sinus Center offers a new way to treat sinus pain, pressure, and congestion without antibiotics. Our REST treatments are safe and effective for folks of all ages. Naturally!

-Dr Jake Felice, Sinus treatment specialist at Nova Sinus Center

Are biofilms why your chronic sinus pain won’t go away?

Stages of biofilm attachment and development

Most of us have experienced the slime covering rocks in streams or rivers. These slippery substances are biofilms. Biofilms occur in human sinuses as well. For people suffering from allergies, sinus pain, pressure, and congestion, the warm and wet regions of our sinus cavities make a perfect places for biofilms to adhere.

What exactly are biofilms? Biofilms are multilayered bacterial populations that protect themselves with a sugar matrix which helps them stay attached to sinus surfaces. In human sinuses, the slimy matrix of biofilms helps the bacteria survive and reproduce by protecting them from antibiotics, and our immune system. This is one reason why conventional antibiotics are ineffective at treating sinus infections. It is also why sinus troubles seem to return again and again even after many types of conventional treatments.

According to the Centers for Disease Control (CDC), biofilms cause up to 70% of bacterial infections in the Western world. Many naturopaths predict that when fully understood, the biofilm perspective of microorganisms will have a revolutionary effect on the treatment of bacterial infections such as sinusitis, bladder infections, and cardiovascular disease. In the current era of antibiotic resistance, the concept of biofilms is fast becoming critical information as modern antibiotics and nasal sprays have so little to offer people with chronic sinus troubles.

Nova Sinus Center’s ‘REST’ treatments are a new way to treat sinus infections as they help to directly eliminate biofilms. REST treratments can be helpful for anyone who wants to stop feeling “wired and tired” on sinus medication, as well as people suffering from allergies, sinus pain, pressure or congestion.

-Dr Jake Felice Sinus treatment specialist at Nova Sinus Center

So you think you’ve got H1N1 “swine flu”?

OK, so you’ve got a cold or flu. The symptoms are the same as any other flu you’ve ever had. Maybe this one’s a bit more severe and you wonder if you’ve got “swine flu.” Tip: the severity of your symptoms is not a reliable indicator of the type of flu you may have. A lab test is required to tell for sure if you’ve got H1N1.

Will your doctor’s treatment change by knowing? No. As with any other flu, your trip to the doctor will end with a lukewarm advisement for bed rest and fluids. Nothing is more frustrating than spending the time and money for a doctor to tell you to just “go home and get some rest.”

The CDC is not advising H1N1 testing or antiviral drug treatments (Tamiflu, Relenza) for the general population at this time. The best defense against H1N1, they advise, is proper hand washing and avoiding folks with flu-like symptoms. But what can you do if you do get sick?

A trip to see a primary care naturopathic doctor (ND) at Nova Sinus Center will not only give you peace of mind but will shorten the duration and severity of any flu (including H1N1). How? By using an effective, soothing, and natural treatment to slow down viral replication inside of airway cells.

REST, or Respiratory Suite Treatment, will shorten the duration of any flu – including H1N1. How? By slowing down viral replication inside of airway cells.

You may be surprised to hear that “antiviral” drugs do not actually kill viruses. In fact, there has never been (or will there likely be) a true virus-killing drug. Viruses mutate rapidly and they’ve developed a crafty way to reproduce. The best a drug treatment can do is slow down the machinery that a virus uses to make copies of itself. The REST treatment does something similar – naturally. And it does so without the high risk of drug resistance, expense, and side effects of antiviral medications.

While many doctors are asking their patients to “stay home” and are slow to prescribe antivirals except for the most severe confirmed cases of H1N1, Nova Sinus Center offers an effective, soothing, and natural treatment you can use anytime. Don’t stay home. Get in for a REST treatment today.

Killer bees from Africa, Pacific coast tsunami’s, and asteroids on a collision course with Earth – no doubt, we’re disaster junkies.

While there are some groups at higher risk for developing H1N1 complications – be sure to check out the CDC website for the most up to date info – most Americans will simply “get the flu” and never know if it was H1N1 or not.

My best advice to both current and new patients is: Don’t just stay home and “get some rest” – Give your flu a REST with a treatment at Nova Sinus Center.

 

How nasal sprays create a vicious cycle in sinus infections

Nasal decongestant sprays such as Afrin and other decongestant sprays are frequently used to treat nasal congestion, sinus infection, and allergies.  These sprays are safe and effective when used as directed.  However, a quick look at the instruction pamphlet of these sprays shows the following message: “Do not use for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.”

What most people don’t know is that drugs in these sprays such as phenylephrine, neo-synephrine, oxymetazoline, and xylometazoline can create damage to the sinus tissues after only 5 days.  Each time the spray is used, the medication squeezes shut the blood vessels of the nose, just like a tourniquet to a leg squeezes off blood to the foot.  This “chemical tourniquet” lasts about 12 hours before it wears off.

Frequent use longer than 5 days starves the nose of oxygen and nutrients.  Eventually, the nose develops edema and even physical damage.  This is called “rhinitis medicamentosa”.  To fight this “chemical tourniquet” our bodies start to try to increase the blood flow to the nose to fight against the damage.  The increase in blood results in even more severe nasal congestion and obstruction (rebound phenomenon).  A vicious cycle is created, forcing the patient to keep using more and more spray to get rid of the symptoms.

This addiction occurs with nasal decongestants and not with steroid and other types of nasal sprays.  Like any addiction, the withdrawal process is unavoidable and can be truly miserable for the patient.  Nova Sinus Center specializes in relieving sinus pain, pressure, and congestion naturally without the use of addicting nasal sprays.  Unfortunately, the discomfort of withdrawal will be experienced by all sufferers of rhinitis medicamentosa, however our REST treatment protocols are a gentle and soothing way to blunt the severity of this withdrawal period.  Once healed, REST treatments also provide a healthy way to maintain healthy sinuses throughout cold, flu, and allergy seasons.

-Dr. Jake Felice, Sinus treatment specialist at Nova Sinus Center

Do I have a sinus infection?

Congestion , sinus pressure and headaches can make you feel miserable, and they could signal a sinus infection.   One of the most common complications of a cold or flu is a sinus infection, also known as ‘Sinusitis’.  Symptoms of sinus infection include fever, facial pain, headache, pressure, cough, congestion and nasal discharge.  Patients with an increased risk of developing chronic sinus infections are those who’ve recently had a cold or flu, those with a history of sinus problems, patients with weak immune systems, those with asthma and allergies, smokers, the elderly and children.  Sinus infections need a physical exam to properly diagnose the illness.  Schedule an appointment at Nova Sinus Center if you develop any of the symptoms of sinus infection.  Our REST treatments include a physical exam as well as a soothing treatment that get you back on track fast.

-Dr. Jake Felice, Sinus treatment specialist at Nova Sinus Center

Why are sinus problems so hard to treat?

Why are sinus pain, pressure, and congestion so hard to treat?  This video shows the intricate nature of the turns and spirals of our nose and sinus cavities. These turns and spirals combined with the warm moist nature of the nose make an ideal breeding ground for bacteria and biofilms to grow and resist antibiotic and other natural treatments.

With it’s specially designed REST treatments, Nova Sinus Center offers a new way to treat sinus troubles.

-Dr. Jake Felice, ND; Sinus treatment specialist at Nova Sinus Center

UW ENT Grand Rounds March 25th, 2009

6:30 am – Patricia Oakes, MD, Acting Instructor, Neurology “Chronic Headaches and Facial Pain”

In one of the UW meeting rooms where OTO-NHS Grand Rounds are held there is a fire door with a sign that reads, “Do not block.” It seems each Wednesday morning, a folded side-lying table creeps further and further in front of this emergency exit. This morning, it was completely blocking the way out. Fantasies of 20 residents and faculty tripping over each other to get out as fire licked at the main entrance flickered in my mind as I sat and gazed into the texture of the table. I began thinking this is an interesting metaphor for what happens in the nose and sinus passageways. 

The emergency exit can be compared to the rhinosinus outflow system known as the ostiomeatal complex. This is the point where the frontal and maxillary sinuses normally drain into the nasal cavity. Obstruction here produces inflammation of the affected sinuses and is routinely treated with anti-inflammatory drugs and endoscopic sinus surgery. One of the great benefits of the REST treatment offered at Nova Sinus Center is that it promotes clearing of the ostiomeatal complex by supporting muco-ciliary drainage. When this emergency exit is clear, flow from the sinus ostia (openings from the sinuses into the nose passages) is enhanced. REST combines this benefit with microbicidal and biofilm reduction leading to prevention or resolution of ostiomeatal blockages. Next week, I think I’ll take some initiative and move that table out of the way.  

Dr. Patricia Oakes was on hand today to present some pearls on headache of neurologic origin. She reviewed the ICHD-2 (International Headache Classification, 2ed) and placed special focus on migraine identification and differentiation of migraine from headaches of sinus origin. Dr. Oakes presented a study that concluded 86% of patients who thought they had sinus headaches actually had migraines. Despite Dr. Oakes’ admitted potential for diagnosis bias, this study was a real eye-opener for me. She went on to present differential diagnosis including the more dangerous causes of headache like stroke and artery dissection. In the end, I discovered a more refined appreciation of the causes of headache and when neurologic consult is indicated.

UW ENT Grand Rounds March 4th, 2009

6:30 am – Ernest Weymuller, Jr, MD “Revision Sinus Surgery” 

Dr. Weymuller emphasized two themes of interest this morning: Use surgery only when necessary, and use rational medicine strategies first. In his introduction, he invited his audience to “learn from failures and misadventures.” While his talk was on sinus revision surgery, Dr. Weymuller spoke from over 40 years experience to say that “medicine does work.” A 21-day oral prednisone taper plus broad spectrum antibiotics was his medical strategy of choice. Dr. Weymuller offers the patient the option of surgical revision when symptoms recur within a 3 month period – that is, a “try and fail” after prednisone taper and broad spectrum course.

A few things come to mind. I’m fascinated by the notion that oral or even nasal steroids are curative – that is, eliminate the cause of the illness. Besides the concern of immunosuppression with oral delivery, there is the well-known phenomenon of receptor “up-regulation” with nasal sprays. This is also referred to generally as drug “tolerance.” The flip side of tolerance is what happens when the drug is removed. As alpha-1 / alpha-2 adrenergic agonists, decongestant sprays like Afrin® and Neo-Synephrine® cause their counterpart receptors to become “hungry” for the drug when it is removed. This results in a more troublesome congestion than before use as the receptors “seek” the drug that is no longer there.

It is well known that nasal decongestant sprays cause “rebound congestion” when the spray is discontinued. Because of this, the manufacturer’s advised use is less than 3 days and physicians will often prescribe the “less addictive” nasal steroids (Flonase®, Veramyst®, Rhinocort®). This presents a curiosity. Does this mean when nasal steroid sprays are discontinued there won’t be rebound congestion? Not exactly. Nasal steroids act by a different mechanism which reduces inflammatory cells and mediators like eosinophils and leukotrienes. While the precise mechanism is unknown, it is known that removal of nasal steroids causes some rebound congestion. That is, the congestion is worse as compared to before starting the nasal steroid therapy. In fact, I have witnessed this troubling phenomenon in my own patients over the past several years with any medical intervention designed to suppress immune response or reduce inflammatory mediators. Until I encounter a better explanation, I can only conclude that something like receptor modulation is the cause.

Just recently I asked a client in the 5^th treatment of her REST-6 program if her symptoms were better or worse after Flonase® taper (I had her gradually reduce the drug during her REST series). She mentioned at first, the congestion was much worse. I suspect that in the absence of REST intervention her congestion would have continued to worsen until the receptors down-regulated. Today, without Flonase® she is confident that the REST is a better choice for her. She is now better-than-baseline without receptor or immune modulation (i.e. without Flonase®). I conclude that the REST program is giving this typical client a symptom-reduced quality of life while offering a natural, “receptor-independent” (a.k.a. non-addictive) solution to her sinus trouble.

As a final note, I would agree that medicine for rhinosinusitis is effective. It is my opinion that the REST program is a rational medical strategy that avoids immune suppression and receptor-driven dependency. I propose clients use the REST program as a “try and fail” before using receptor-modulating or immunosuppressive remedies. Clearly, these drugs represent “plan B,” and Surgery is agreeably “plan C.”

Editor’s note: Curiously, Flonase® also has a progesterone-like activity, the clinical effects of which to my knowledge have not been investigated.

UW ENT Grand Rounds February 18th, 2009

6:30 am – Scott Manning, MD “Allergic Fungal Sinusitis & Update on Pediatric Sinusitis” 

Dr. Manning began with the notion that chronic rhinosinusitis (CRS) is not a disease but “an endpoint of many interacting conditions.” Allergic rhinitis, GERD (acid reflux), eczema, migraine, and otitis (ear infection) are several conditions he mentions that add up to what the everyday patient calls “sinus trouble.” At Nova Sinus Center, we take this idea to its logical conclusion to teach patients that the rhinosinuses are often an “LED indicator” of overall inflammatory burden.

Just think of the game Operation. The playmate patient’s bright red nose lights up as the “surgeon” tries to solve other seemingly unrelated health problems. What does “water on the knee” for example have to do with CRS? Both are evidence of inflammatory processes. No one would argue that edema and effusion point to inflammation – whether in the nose or the knee. In fact, Dr. Manning observes that world is becoming “more allergic and more inflamed.” Urbanization, air pollution, high fat diet, and early introduction of food antigens are just some of the contributing variables he references.

In other words, what Dr. Manning may be saying is “where there’s smoke there’s fire.” That is, if one inflammatory process is being observed and treated, we can assume there are others. I treat the rhinosinuses as if they are the “red light” indicator of overall health. It would seem reasonable then, that treating immediately and routinely with steroids is like pulling the plug on your car’s warning indicators. Just because the light’s not on doesn’t mean your engine won’t be crashing from lack of oil.

One cause of chronic rhinosinusitis that comes up time and again during ENT rounds is primary ciliary dyskinesia (PCD) - a genetic defect causing a reduction of mucus clearance from the respiratory tract. This condition appears so often in clinical conversation that it would seem my ENT colleagues believe it’s prevalent even in the absence of biopsy-demonstrated PCD.

The REST treatment at Nova Sinus Center is designed to amplify and assist ciliatory motility resulting in improved discharge of noxious elements. Dr. Manning confirms a prevailing notion that ciliatory motility is a key factor in rhinosinus health. Clearly, anything that can be done to facilitate ciliatory motility will help reduce rhinosinus distress and inflammation. The REST treatment appears to be a missing link - a first line defense - preferable to covering up sinus trouble with steroids or moving straight away to invasive surgery.

UW ENT Grand Rounds January 14th, 2009

6:30 am – Tanya Meyer, MD, Assistant Professor; Director, Voice and Swallowing Center, University of Maryland “Airway Stenosis – Breath of the Matter” 
    
7:30 am – OTOLARYNGOLOGY-HEAD AND NECK SURGERY/RADIOLOGY ROUNDS – Robert Dalley, MD

Dr. Tanya Meyer presented the pathophysiology of airway stenosis – a common problem when trauma to the airway happens. Trauma may be caused by chronic inflammatory disease, benign neoplasm (growths), malignant neoplasm (primary or metastatic cancers), and collagen vascular diseases. The most common cause of laryngotracheal stenosis continues to be trauma, which can be internal (prolonged endotracheal intubation, tracheotomy, surgery, irradiation, endotracheal burns) or external (blunt or penetrating neck trauma). 

Apparently according to Dr. Meyer, “rabbits have beautiful airways.” She previewed a film demonstrating tracheal electrocautery of the rabbit. The resulting stenosis was treated with balloon dilation. In my journal studies of the upper airways, I tend not to look at animal models since #1, such lab practices are inhumane, and #2, lab animals don’t exhibit the human variable of “volition toward wellness.” That is, humans are uniquely known to “will and command” wellness by adjusting intention, attitude, and behaviors. 

Perhaps most importantly, airway stenosis is most often iatrogenically caused – that is, by physician intervention. As a preventive medicine enthusiast, it’s my mission and hope that patients “will and command” their wellness so as to reduce their chances of succumbing to prolonged intubation, from cardiovascular surgery for example. 

Next, a real treat from Dr. Dalley who described normal and variant radiographic anatomy of the nose and sinus passageways. Most intriguing was the observation that septal deviations are more of a variant than a pathology per se. After seeing the radiographic evidence of paradoxical curvatures, deviations, and polyps I mused to myself that the REST treatment can be put to great clinical use to reduce mucoid retention symptoms related to these common anatomic variants.