FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

READER SHOULD SEE AN ALLERGIST ABOUT LINGERING SINSUS SYMPTOMS

Question: Last year I had sinus surgery to remove a polyp and a pocket of infection. I'm certainly better, but I still have problems with the right side of my nose being blocked. I've been back to my ENT surgeon several times, and he has given me different medicines that, unfortunately, haven't made much difference in my symptoms. He says that my surgery was a success, and there isn't anything more he can do. I certainly don't think the surgery was a success. What else can I do for my blocked nose?

Answer: Scientists debate the evolutionary reasons for the presence of air cells within the bones of the skull -- the spaces we call sinuses. Some think it allows the adult shape of the human face without increasing the weight of the head as would occur if the bones were solid. Others think the sinuses have a contributing role in the resonance of the voice and also a minor involvement in the important roles of humidifying and warming the air we inhale. Personally, I think the sinuses exist principally as a source of misery.

Facial pain, pressure sensation, nasal discharge and often fever are symptoms of sinus infection -- what most of us call sinusitis. These symptoms are responsible for about 12 million doctor visits each year! (Substantiating evidence for my assertion about the reason for sinuses.) Most sinus symptoms are caused by blockage of the sinus openings, which, in turn, results in pressure within the sinus spaces as well as an accumulation of fluid. Most often the blockage is due to a viral infection (a common cold) or an allergy.

Most colds clear up without serious problems ensuing, but sometimes a bacterial sinus infection develops. Bacterial infections are treated with at least a two-week course of antibiotics. Usually this is successful in stopping the symptoms and eliminating the underlying infection. In individuals who have polyps or extensive damage within the sinus space -- this would be the pocket of infection you had -- surgical intervention is necessary to bring about resolution of the infection.

Sinus surgery is effective in about 80 percent of individuals. Successful, as you have noted, can mean different things to you and to your doctor. You were expecting total resolution of your nasal symptoms. He was expecting removal of the polyp and clearing of the extensive infection within the sinus that you called "removing a pocket of pus." He, therefore, thinks the surgery was a success because his goals were achieved, but you
rate it as less successful.

Obviously, you two had different expectations from the beginning. Which reminds me -- I've noticed over my years of practice that it is much easier to talk than it is to communicate. Be sure to communicate with your doctor!

You mentioned in your letter that your ENT doctor now thinks that you have non-allergic rhinitis. This is fancy doctor-speak for a congested nose that is not due to allergy. This is certainly possible, but I doubt it in your case. I say this because you had a nasal polyp, which is almost always due to an underlying allergy.

I'd suggest that you see a board certified allergist for evaluation of your condition. Hopefully, this will reveal both the cause of your chronic nasal congestion and an effective treatment for it. If on the other hand no allergic cause is identified, you will certainly have earned the diagnostic label "non-allergic rhinitis." This chronic condition is quite annoying for both patient and physician since there are only a few treatment methods that help. Unfortunately, the success rate for them is substantially lower than it is for those with allergic rhinitis.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.