Month: February 2019

Acute Sinusitis

Acute sinusitis may also be referred to as acute rhinosinusitis or more commonly as a classic “sinus infection.”  By definition, the symptoms of acute sinusitis will last less than 4 weeks in duration, rather than the 12 weeks or more necessary to characterize a sinus infection as chronic sinusitis or a chronic sinus infection.  Of note, some physicians classify a sinus infection that lasts from 4 to 12 weeks as subacute sinusitis.  The term recurrent sinusitis refers to repeated acute sinus infections but can easily be confused with a chronic sinus infection.  This distinction is particularly important to differentiate as an allergist because the workup and treatment of recurrent sinus infections is quite different than the workup and treatment of a chronic sinus infection.

Acute sinusitis is most commonly caused by the “common cold” or another type of virus.  Most of the time, the acute sinusitis is self-limited and resolves without treatment in 7-10 days.  Approximately 1-2% of sinusitis caused by viruses will result in a subsequent bacterial sinus infection.  Rarely, a fungus may be the cause of a sinus infection.  Other factors that predispose an individual to develop acute sinusitis include allergic rhinitis (i.e., hay fever), a deviated nasal septum, nasal polyps, a fixed nasal obstruction (e.g., tumor, foreign body), cystic fibrosis,  immunological deficiencies (e.g., HIV/AIDS, diabetes mellitus, common variable immunodeficiency), immunosuppressant medications (i.e., medications that suppress the immune system such as azathioprine, cyclosporine, corticosteroids, and many “biological” medications such as adalimumab, secukinumab, abatacept, infliximab, etanercept), dental and/or periodontal infections, and chemical irritation (e.g., cigarette smoke, chemical fumes).

The symptoms of acute sinusitis typically involves one or more of the following:

  • Nasal congestion
  • Discolored nasal discharge (e.g., yellow, green, brown discharge)
  • Post-nasal drip
  • Sore throat
  • Sinus pressure
  • Sinus headaches
  • Bad breath
  • Fatigue
  • Fever
  • Radiation of pain to the teeth and/or ears
  • Clogged ears
  • Cough

Complications from acute sinusitis is uncommon nowadays in the era of better diagnostic techniques and antibiotics, however, a few complications can still occur and are as follows:

  • Meningitis
  • Osteomyelitis (i.e., bone infection)
  • Cellulitis (i.e., skin infection)
  • Chronic sinusitis
  • Visual disturbances (if the infection spreads to one’s eye)
  • Decreased or loss of sense of smell

The diagnosis of acute sinusitis is usually a clinical one.  The history that the patient describes along with certain findings on physical examination in most cases is usually enough to diagnose the individual.  Other methods that are utilized by physicians may include allergy testing, rhinolaryngoscopy (i.e., small endoscopic instrument used to obtain direct visual inspection of the nose, throat, and vocal cords), radiological studies (e.g., CT scan, MRI), and/or nasal cultures.

The treatment of acute sinusitis most of the time requires no treatment at all.  This is so because most cases of acute sinusitis are caused by a virus which usually resolves on its own.  In patients who have a bacterial sinus infection or who develop a secondary bacterial infection, antibiotics may be needed to eradicate the infection, particularly if the symptoms persist, worsen, or are severe.  In addition, supplemental use of saline nasal irrigation, nasal corticosteroids, decongestants, and/or over-the-counter analgesics are quite helpful in many cases of acute sinusitis to reduce symptoms.  It is also recommended to stay hydrated by drinking water.

The prevention of episodes of acute sinusitis can be facilitated by seeing a board certified allergist, like the ones at Black & Kletz Allergy.  The allergy specialist will perform a comprehensive history and physical and if necessary will do allergy skin testing to identify if and what allergens are allergenic to the patient.  Depending on the frequency of episodes of acute sinusitis and/or allergy symptoms, the allergy doctor will prescribe different medications (i.e., antihistamines, decongestants, nasal sprays, eye drops) used to alleviate the individual’s allergy symptoms.  He may also recommend allergy shots (i.e., allergy injections, allergy immunotherapy, allergy hyposensitization) which is effective in 80-85% of patients receiving allergy shots.  The allergists at Black & Kletz Allergy treat both adults and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than one half a century.

Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  The allergists at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of acute sinusitis and other sinus diseases.  In addition, we treat patients with environmental allergies, medication allergies, insect sting allergies, food allergies, eczema, asthma, hives, swelling episodes, generalized itching, contact dermatitis, eosinophilic esophagitis, and immune disorders.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a friendly and professional environment.

Nasal Polyps

Nasal polyps (i.e., nasal polyposis) are soft tissue growths that form on the lining of the nasal passages and inside the sinuses (i.e., air-filled cavities within the facial bones).  They are painless and non-cancerous.  They are usually in the shape of teardrops and characteristically look like glistening moist grapes.  Nasal polyps generally develop when the mucus membranes of the nose and/or sinuses are chronically inflamed.  This results the tissue to swell up over a prolonged period of time.

When the nasal polyps grow large enough, they can obstruct the nasal passages and cause breathing difficulties due to the polys blocking the flow of air through the nose.  They can also block the free passage of secretions from the sinuses into the nose and predispose individuals to sinus infections.

Any condition which results in chronic inflammation inside the nose and sinuses can lead to nasal polyp formation.   Some of these conditions include:

What are the causes of nasal polyposis?

It is believed that inflammation causes the buildup of fluid within the mucus membranes.  When this buildup of fluid occurs, it results in the formation of fluid-filled growths, which over time expand to become polyps.

There is a condition known as Samter’s triad which is characterized by nasal polyps, asthma, and aspirin intolerance.  Samter’s triad is also known as aspirin exacerbated respiratory disease (i.e., AERD) or aspirin triad.

What are the symptoms of nasal polyps?

  • Nasal congestion
  • Runny nose
  • Post-nasal drip
  • Decreased or lack of the sense of taste and/or smell
  • Sinus and/or facial pressure
  • Sinus headaches
  • Snoring

How is the diagnosis of nasal polyps established?

  • Endoscopic examination of the nose
  • Imaging studies (e.g., X-rays, CT scans)
  • Allergy testing (e.g., skin testing or blood testing)
  • Sweat test to rule out cystic fibrosis (particularly in children)

What are some complications that may arise as a result of having nasal polyps?

  • Long-term or repeated sinus infections
  • Nose bleeds (i.e., epistaxis)
  • Exacerbations of asthma
  • Obstructive sleep apnea
  • Double vision (i.e., diplopia)

How are nasal polyps treated?

Corticosteroid nasal sprays are the usual first line of treatment.  Decongestants are sometimes useful to help shrink the size of the nasal polyps.  Antibiotics may be needed in the event that a bacterial sinus infections occurs due to the nasal polyps.

If the nasal polyps continue to grow in spite of treatment with various medications and/or if complications arise, the polyps may need to be surgically removed.  It must be noted, that it is not uncommon for nasal polyps to “grow back” after they are surgically removed, especially if an underlying untreated allergy causing chronic inflammation is still present.  The recurrence of the nasal polyps can be as quick as a few months after surgical intervention, however, it also may take a couple of years for the nasal polyps to return.  Some studies have demonstrated that regular use of a corticosteroid nasal sprays can reduce the chances of polyp regrowth after surgery.

How can nasal polyps be prevented?

The aggressive treatment of predisposing conditions such as hay fever (i.e., allergic rhinitis) with a combination of environmental controls [a reduction of the exposure to offending aeroallergens (e.g., dust mites, molds, pollens, cats, dogs, cockroaches)], medications, and desensitization procedures (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) may inhibit polyp formation.  Avoidance of exposure to smoke, strong odors, and chemicals is important in order to reduce nasal irritation and excessive tissue growth.

Patients with established chronic sinusitis may require antibiotics, nasal/sinus irrigations, and/or sinus surgery.  Patients with a history of aspirin sensitivity will do better after desensitization to aspirin in terms of better asthma control, as well as a reduction in recurrences of nasal polyps.

The board certified allergists at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding nasal polyps and/or allergy symptoms.  We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  In addition, the Washington, DC and McLean, VA offices are accessible by Metro.  There is also a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 50 years.