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From: cvw@alice.UUCP (Chris Van Wyk)
Newsgroups: net.med
Subject: More on sinus problems and remedies
Message-ID: <2665@alice.UUCP>
Date: Mon, 26-Mar-84 13:18:29 EST
Article-I.D.: alice.2665
Posted: Mon Mar 26 13:18:29 1984
Date-Received: Tue, 27-Mar-84 03:08:00 EST
Organization: AT&T Bell Laboratories, Murray Hill
Lines: 60

Ihor Kinal's message included a lot of tips about treatment of sinus problems.
Here are a couple more.

I have had nasal polyps for almost twenty years, and ten years of allergy shots
had no effect on either the polyp growth or the accompanying runny, stuffy head.
So I have had to resort to medical and surgical relief.  I don't know if any of
my experience applies to people with sinus conditions other than polyposis.

First, the medical remedies.  I take the decongestant pseudoephedrine
hydrochloride (Sudafed) and the antihistamine chlorpheniramine maleate
(Chlor-trimeton) every day.  Without them, I'm a goner.  I take them early
in the morning and them go back to bed for two hours; about half the time
this keeps my sinuses at bay all day.  It is also a nice way to cooperate
with the drowsiness that accompanies taking the antihistamine.  The principal
bad side effect of the decongestant is its effect on blood pressure, so I
have mine checked frequently.

I also use beclomethasone (Beconase) nasal spray.  As Ihor said, it's a
steroid that reduces swelling in the sinuses.  Since it's applied topically
it doesn't have many of the bad side effects associated with steroids; I
also find I can get by on about 1/8 to 1/4 the recommended dosage, which
reduces even more the worry about side effects.  Last year, however, I
came down with a horrible case of thrush (the Beconase literature warns of
occasional localized Candida albicans infections); imagine your throat and
uvula covered with large canker sores--that's thrush.  It won't kill you
directly, but I think I lost about ten pounds because it hurt so much to eat.

Once I had a sinus infection that was getting serious (with polyps that's
not hard), and my ENT doctor prescribed a big dose of antibiotic along with a 
systemic steroid called Medrol.  Medrol comes in a blister pack; you take 6 pills
the first day, 5 the second, ..., 1 the sixth.  Its effect on my sinuses was
miraculous:  I didn't need to take anything else, and by the third day I could
even smell things.  Unfortunately it's really only for emergencies, since it
is a powerful steroid.

There are also several surgical remedies.  Most frequent are polypectomies,
which are just an office procedure in which a few polyps are removed with a
wire snare under local anesthesia.  I usually even sit through the operation,
although the occasional polyp will excite the vagus reflex upon removal,
forcing me to lie down to avoid fainting.  Polyps removed this way grow back
pretty fast (say, within six months), and have stronger roots of scar tissue.

I have also had an ethmoidectomy, which means scraping out all of the sinus
tissue and some of the bony parts of the ethmoid sinus.  I had it done in a
hospital under general anesthesia; I don't think it's done any other way.
The polyps came back a few years later.  The ethmoid is between the eyes and
during the operation some nerve was disturbed, leaving me with an incredible
black eye for about two months.

My doctors told me that if polyps come back soon after an ethmoidectomy they
would plan to do a maxillary antrotomy, which means scraping out the maxillary
sinuses through an opening in the upper jaw.  So far I have not had to resort
to this.

I suppose it is unnecessary to repeat that if anyone knows a better way than
all of this to deal with sinus problems, there are a lot of people who read
netnews who would like to hear about it.

Chris Van Wyk
ihnp4!alice!cvw