In this episode of The Texas ENT Audio Blog, host Shelby Stockton sits down with otolaryngologist Dr. Garfield Johnson to delve into the intricate world of sinuses. Dr. Johnson kicks off the conversation by shedding light on what exactly sinuses are and moves on to discuss the telltale symptoms of sinus issues. From distinguishing between acute and chronic sinusitis to exploring available treatment options, Dr. Johnson offers invaluable insights for anyone grappling with sinus infections. Tune in to gain a deeper understanding of sinus health and discover potential relief for your sinus-related woes.
Shelby Stockton (00:00):
Welcome to The Texas ENT Audio Blog. I'm Shelby Stockton, and today I talked with otolaryngologist Dr. Garfield Johnson about sinuses. Dr. Johnson begins by explaining what sinuses are and then goes into symptoms of sinus issues. He educates us on the differences between acute and chronic sinusitis and the different options available for any sinus issue. If you suffer from sinus infections, there is relief. Take a listen to this audio blog with Dr. Johnson to find out more.
Dr. Johnson, welcome to the audio blog. Thanks for meeting up with me today.
Garfield Johnson (00:35):
Absolutely. Good afternoon, happy to join.
Shelby Stockton (00:38):
So today, we are going to talk about sinuses. And I want to start at the very basis. Can you tell us what are the sinuses?
Garfield Johnson (00:47):
Sure. The sinuses, and we have four paired pairs of sinuses throughout the skull and facial bones, we have the cheek sinuses, what we call the maxillary sinuses, your frontal sinuses that sit above your brow, your ethmoid sinuses that locate the space between your eyes and if you follow those ethmoid sinuses all the way back to about the midpoint of your head, you land in what we call the most posterior sinus or the sphenoid sinuses.
And the sinuses are really these air-filled spaces within the skull and facial bones. They do serve a purpose in helping give resonance to the voice and to really humidify the air that we breathe in. Unfortunately, for a great number of our patients, they also are the source of a lot of chronic infections that really impacts everyday quality of life.
Shelby Stockton (01:41):
What are some symptoms of common sinus issues?
Garfield Johnson (01:46):
Symptoms of sinusitis or sinus infections, initially, they can very much mimic symptoms that we have from a routine viral upper respiratory infection, a cough, nasal congestion, headache, even a little fever. As symptoms progress, most of our patients will typically develop nasal discharge and symptoms really referable to the sinuses involve facial pain and pressure in the frontal region, in the cheek region, for example, my patients with maxillary sinus or cheek sinus infections will often report dental pain because those tooth roots sit just underneath sinuses in that area and so that tends to be the progression of symptoms from our patients.
Shelby Stockton (02:28):
How long do sinus infections typically last and when should someone seek medical attention if their symptoms persist?
Garfield Johnson (02:36):
Yeah, I would say that the time course of a sinus infection can be variable. In part due to what you've just asked me when you seek help from a medical professional. I tend to tell my patients that certainly if you've had symptoms for five to ten days and they seem like they're plateauing or getting worse and not sort of getting better, that's typically the time.
A lot of this in the initial stages are viral infections, and if we just sort of manage the symptoms and give it three to five days, we'll find so often that we are feeling better without need for antibiotics or more involved medical interventions. But certainly, if we're getting to that five to ten day point and the trajectory of our symptoms is still sort of getting worse or not getting better, that's when I always encourage my patients to come on in and see me.
Shelby Stockton (03:25):
Can you explain the differences between acute and chronic sinusitis?
Garfield Johnson (03:31):
Absolutely. Acute sinusitis, we define as sinus infections, the acute sudden development, of a lot of the symptoms that we talked about, that we're able to resolve with medical treatment, medical interventions, typically within a period of four weeks, we would call that an acute sinus infection. One that starts and we find resolution within a generally a four-week timeframe.
Chronic sinusitis is certainly when some degree of those symptoms will persist up to 12 weeks, typically despite several courses of antibiotics, several attempts at medical management that we're able to sometimes improve the symptoms, but to a degree, some of that facial pain pressure discolored mucus will persist for 12 or more weeks.
Shelby Stockton (04:24):
Are there any surgical options available for severe or chronic sinus issues? And if so, what are the benefits and risks?
Garfield Johnson (04:33):
Sure. But before stepping into sinus surgery and what options we have there, so much of what we do before we get to that point is to try to aggressively manage things from a medical standpoint as well as we can. So many of our patients with chronic sinus issues have a lot of other underlying issues that really lead to these chronic sinus episodes.
Number one, being chronic allergic rhinitis. There's an enormous association we find with our patients who are struggling with their allergy issues leading to these recurrent episodes of sinusitis. So managing chronic allergies is a critical point in managing chronic sinusitis. Now, certainly, if we get to that point where our patients are having recurrent episodes, despite our best efforts, having chronic symptoms persisting beyond that 12-week mark, then certainly, we have some great options for sinus surgery. Some of those, minimally invasive, that we perform in the office, balloon sinuplasty, some of those are a little bit more involved and we prefer to take our patients to the operating room under general anesthesia, when the disease process is a little bit more involved.
In either case, goal of sinus procedures of sinus surgery is to really reestablish a healthy opening and patency of the sinuses to the nasal cavity and to remove any of the chronically swollen and inflamed tissue which leads to these recurrent episodes. Most of our patients tolerate sinus surgery exceedingly well in the recovery process. There of course, is some degree of crusting and healing that needs to take place, but once we get our folks healed up, our patients really do grow, and we find that it is an important part of our management, but certainly only after we've exhausted all of those medical options that we have to get our patients feeling better.
Shelby Stockton (06:32):
Before I let you go, any advice for nervous patients who they're getting the sinus infections but they're waiting it out? Because let's face it, sometimes going to the doctor can be scary.
Garfield Johnson (06:45):
Well, I think that number one, it's about finding a physician, a specialist who you feel comfortable with, comfortable having all of your questions answered and addressed. And also, it's always a good idea to speak with folks who've been through the process. I can guarantee particularly living down here in Houston, that you will know one or two or three friends or family members who've at least had to approach this scenario of dealing with their chronic allergies and sinus infections and you're likely to know someone who's gone through sinus surgery and you can get a gauge to what that experience is all about.
But I think the number one thing is really just finding a specialist who you're really comfortable with, who you feel you can get all the questions you have answered. And it's really a partnership. And I've talked to patients about sinus surgery and we end up not intervening in that regard, two, three years down the road. So a lot of it is having a discussion, really looking at and assessing all of the options and trying to get our patients in the best position to improve their quality of life.
Shelby Stockton (07:58):
That's great advice. Dr. Johnson, thank you so much for your time. We really appreciate it.
Garfield Johnson (08:03):
Absolutely. Anytime.
