Get Your Head In The Game. Matthew Voorman, MD Hutchinson Clinic March 21, 2016

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1 Get Your Head In The Game Matthew Voorman, MD Hutchinson Clinic March 21, 2016

2 About Me Otolaryngology Head & Neck Surgery Geisinger Medical Center General Surgery University of California San Francisco Medical School University of Southern California

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5 Allergies Allergic Rhinitis (aka hay fever ) Food Allergies Atopic Dermatitis Asthma Anaphylaxis

6 Allergic Rhinitis (aka hay fever ) Affects million Not caused by hay No fever either

7 Symptoms Runny Nose Itchy eyes, mouth, throat Puffy eye lids Sneezing or cough Stuffy nose Blocked ears Trouble sleeping

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10 Why should I care? Extremely common Affects 10-30% of people each year 31 million annually the United States Expensive 22 million office visits Direct medical cost $11 billion 12.5 million lost work days, 60 million restricted work days

11 What are the Sinuses? Hollow spaces in the facial bones Connected to nose through small, narrow channels Air enters, mucous drains Lined with respiratory mucosa

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13 What do they do? Produce mucous and get infected Decrease the weight of the head Resonance for voice Protection (crumple zone) in trauma Temperature regulation / insulation

14 What is Sinusitis? Inflammation of the nose and sinuses Swelling of sinus lining Increased mucous production Blockage of the drainage channels Often leads to bacterial or fungal infection in the sinuses This can become a chronic problem

15 New Guidelines (2015) Based on evidence Multiple specialities Otolaryngology Head & Neck Surgery (ENT) Pediatrics Infectious Disease Family Medicine Dermatology Allergy & Immunology

16 Official Diagnosis of Acute Rhinosinusitis Purulent nasal drainage PLUS Nasal obstruction or Facial pain/pressure/fullness

17 Official Definitions Viral Rhinosinusitis Less than 10 days, not worsening Acute Bacterial Rhinosinusitis More than 10 days, or worsening symptoms Chronic Rhinosinusitis More than 12 weeks Recurrent Acute Rhinosinusitis Four or more acute bacterial rhinosinusitis infections in a year

18 What Causes Sinusitis? Viral infection (aka Colds) Allergies Structural problems Other irritants

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20 Can I Prevent Sinusitis? Break the cycle Control Allergies / Irritants Improve nasal function Address structural problems

21 How Do I Control Allergies? Avoid exposure Allergy Medication Immunotherapy

22 Seasonal Allergies Trees Early spring Big blooms are better, Female trees Grass Late spring, early summer Weeds Late summer, early fall Molds Temperature / humidity dependent

23 Perennial Allergies Dust mites Pet hair / dander Cockroaches Mold

24 How do I avoid outdoor allergens? Stay indoors during peak pollen counts Worse with wind 5 10 am and dusk Keep windows closed Avoid window fans Wear a pollen mask Don t dry clothing outdoors

25 Pollen and Mold Counts (there is an App also) They measure the total pollen collected in previous 24 hours.

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27 What about indoor allergens? Keep windows closed, run A/C Mite-proof covers Wash in hot water Keep humidity low (30-50%) Keep bathroom / kitchen / basement clean

28 What about pets? Wash hands / clothes after contact Keep pet out of bedroom Wash pets to reduce dander

29 Other Irritants Smoke Dust Perfumes, Hair Spray, Fumes Laundry Detergents

30 Nasal Saline Rinse / Irrigation Helps clear the nose of mucous Removes small particles, bacteria and viruses Moisturizes nasal lining Decreases inflammation

31 Which way works best? More pressure More volume Isotonic Baking Soda Other additives

32 Easy

33 How can I make my own? 1 Quart Water (distilled, boiled, purified) 1 Teaspoon salt (iodine free, no preservatives) 1 Teaspoon baking soda Additions Drop of apple cider vinegar Grapefruit seed extract Xylitol Other essential oils

34 What about medicines?

35 Antihistamine Rapid onset Decrease body s response to allergens/irritants Decrease mucous, sneeze, itchy Low side effects Can be taken long term Cheap OTC

36 Nasal steroid spray Gradual onset (better for prevention) Decrease inflammation Congestion, mucous Low side effects Can be taken long term OTC

37 Oral Steroids Rapid onset Decrease inflammation Reduces congestion Significant side effects Prescription

38 Decongestants Rapid onset Decrease congestion (by decreasing blood flow) Moderate side effects Can become tolerant / dependent Cheap OTC

39 Nasal Cromolyn Gradual onset, preventative only Stabilizes immune cells Low side effects Can be taken long term Cheap OTC

40 Nasal Anticholinergic Rapid onset Dries nasal secretions Low side effects Temporary blurry vision if you get it in your eyes Can be taken long term Prescription

41 Mucolytics Rapid onset Thins mucous Easier for cilia to clear Actually increases the volume Moderate side effects Cheap OTC

42 Antibiotics Variable speed Kill susceptible bacteria Side effects vary Can develop resistant bacteria Price varies Prescription

43 How do you treat an infection? Symptom control Resolve the infection

44 Viral Rhinosinusitis (aka head cold) No cure for common cold Antibiotics not recommended (0.5 2% chance of becoming bacterial) Treat symptoms Nasal saline irrigations Nasal steroid sprays Pain Relievers

45 Acute Bacterial Rhinosinusitis Antibiotics vs watchful waiting 70% will resolve on their own Treat symptoms Nasal saline irrigations Nasal steroid sprays Pain Relievers

46 Reality Many people want (and get) antibiotics right away

47 Chronic Sinusitis Typically not responsive to medication Surgery to address the obstruction and clear infection Medication to reduce infections

48 Surgery Approximately 350,000 sinus surgeries per year

49 Functional Endoscopic Sinus Surgery Performed through the nose Remove bone to create wide opening into sinuses Performed in the operating room (fully asleep) Can address all sinuses Also perform septoplasty, turbinate reduction

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51 Balloon Sinuplasty Performed through the nose The natural sinus opening a dilated using a balloon No tissue is removed. Can be performed in office (sedation / local anesthesia)

52 Balloon Sinuplasty

53 Comparison Functional Endoscopic Sinus Surgery Remove obstructing tissue Raw surfaces need to heal General Anesthesia 5-10 day down time Pain meds: 5 days Balloon Sinuplasty Dilate natural openings No raw surfaces Can be done under local hour down time Pain meds: 1 day

54 Other Surgeries Inferior Turbinate Reduction Septoplasty

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56 Questions?

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