Show 1448: How to Stop Suffering with Sinusitis

If you have ever suffered with sinusitis, you know how terrible it can make you feel. Breathing is difficult; smelling and tasting anything is impossible. What are the causes of sinusitis and what can you do about it? Joe and Terry talk with a leading physician who does research on how to treat sinusitis to find out how you can stop suffering with sinusitis.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While our goal with these conversations is to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

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Why Are You Suffering with Sinusitis?

According to the CDC, almost 30 million American adults have been diagnosed with sinusitis. What are sinuses and why do they cause so much trouble? We asked Dr. Zara Patel to explain.

She let us know that we have multiple sinus cavities within our skull filled with air and lined with mucus membranes. Sinusitis indicates that there is inflammation in those membranes. It might be caused by an allergic reaction or an infection. This may interfere with the ability to smell (and consequently, to taste). It might also lead to congestion, drainage or post-nasal drip. People feel crummy. They may have brain fog or low stamina. The cardinal symptom of sinusitis is a feeling of facial pressure. The suffering from chronic sinusitis is just as severe as that from heart failure or diabetes.

Sinuses Have Their Own Microbiome:

Just like most other parts of the human body, the sinuses are inhabited. Healthy sinuses have a microbiome of bacteria, viruses, fungi and archaea that stays in balance, more or less, and doesn’t cause trouble. When that microbiome gets thrown out of whack for one reason or another, the result can be an infection. To determine that, doctors occasionally culture the drainage. That’s not very accurate, however. A PCR test works better to find out what is in there that could be problematic.

Infections are not the only cause of sinusitis, however. The mucus linings may be reacting to environmental irritants or pollutants. Small particulates such as those in automobile exhaust or wildfire smoke (PM2.5) can lead to a lot of inflammation. People who develop polyps in their sinuses may be especially vulnerable to some of these triggers.

Irrigation to Stop Suffering with Sinusitis:

One way of managing sinus problems is irrigation with clean water. (That would mean distilled water or water that has been sterilized by boiling before cooling to room temperature.)

A neti pot is a very old-fashioned way of doing this, based on Ayurvedic medical tradition. That provides a low-pressure, high-volume irrigation in which water is poured into one nostril and exits the other, washing the sinuses along the way.

For her patients with chronic sinusitis, Dr. Patel recommends irrigation with a squeeze bottle. (NeilMed would be one example.) This offers high-pressure, high-volume irrigation that can be very helpful in calming inflamed sinuses. She urges people to stay away from motorized devices. They may seem tempting, but it is far too difficult to clean them thoroughly.

Other Medications That Can Help You Stop Suffering with Sinusitis:

Dr. Patel may prescribe or recommend other medicines for her patients with sinusitis. Topical steroids such as fluticasone can be useful. Antibiotics are useful when there is an acute infection. In other cases, a medication like ipratropium could be called for.

She warns, however, that some nasal sprays are bad for people with sinusitis. Decongestants could make a chronic condition worse, even though the immediate effect feels like relief.

There are cases when sinus surgery is appropriate to help a patient who has been suffering with sinusitis. This should generally be a last resort, though. The surgeon should take into account how patients responded to medical treatment before surgery and will want to visualize the sinus with nasal endoscopy or a CT scan. The patient needs to understand that post-surgical care with rinses and sprays will be crucial for at least six months.

This Week’s Guest:

Zara Patel, MD, is Director of Endoscopic Skull Base Surgery, Director of the Stanford Initiative to Cure Smell and Taste Loss, and Director of the Neurorhinology – Advanced Sinus and Skull Base Surgery Fellowship. She is Professor of Otolaryngology in the Dept. of Otolaryngology-Head and Neck Surgery at the Stanford School of Medicine.

You may be interested in her informational YouTube videos. Here is one on how to
rinse your nose and sinuses: https://www.youtube.com/watch?v=kBIvzfx7ulo

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 13, 2025, after broadcast on Oct. 11. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1448:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:26

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Have you ever suffered from a sinus infection? It can interfere with both taste and smell. What can you do about it? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:44

Today, we’re talking with one of the country’s leading sinus experts. She’ll explain why we have sinuses and what can go wrong that results in sinusitis.

Joe

00:45-00:56

Sinusitis can linger for weeks and make people feel miserable. It’s not just the congestion, headache, and pressure. Some people develop troublesome post-nasal drip.

Terry

00:57-01:01

What treatments work? When should someone consider surgery?

Joe

01:02-01:07

Coming up on The People’s Pharmacy, how to stop suffering from sinusitis.

Terry

01:14-02:17

In The People’s Pharmacy health headlines, older individuals who feel that they have a purpose in life are less likely to develop cognitive impairment. The data comes from the Health and Retirement Study with more than 13,000 volunteers over 45 years old. They all had normal cognitive function at the beginning of the study and responded to a validated seven-item survey to measure purpose in life.

Over the course of the 15-year study, 13% of the participants developed cognitive impairment. Those who scored higher on the purpose-in-life measure were 28% less likely to become impaired. Purpose can vary. For some people, it consists of spirituality or faith, while for others it may be linked to work, volunteering, or helping others. Relationships with family or close friends can also provide a sense of purpose. One of the investigators notes, it’s never too early or too late to start thinking about what gives your life meaning.

Joe

02:18-03:04

Many chronic health conditions begin long before symptoms appear. The thickening of arteries leading to heart disease can develop many years before someone has a heart attack. Neurodegenerative conditions such as Alzheimer’s disease also create changes in the brain long before people noticed cognitive impairment. Now, scientists have found early indications of rheumatoid arthritis. Three to five years before people experience swollen and painful joints, they begin developing elevated levels of autoantibodies. The authors of the study suggest that preemptive intervention in at-risk individuals might prevent or delay future tissue damage from rheumatoid arthritis.

Terry

03:05-04:17

Researchers reported a new approach to treating knee osteoarthritis can ease pain. Korean scientists compared low-dose radiation to sham treatment.

This is a type of treatment that’s already being used in Europe, but studies of low-dose radiation are scarce. In this one, investigators recruited 114 people with knee osteoarthritis and randomly assigned them to one of three groups. Low dose radiation of 3 gray, very low dose of 0.3 gray, or sham radiation. All groups received six sessions.

Four months later, volunteers rated their pain. 70% of the patients in the group that received 3 gray got significant pain relief. Almost 60% of them had improvements in stiffness and physical function as well. 58% of the very low-dose group got results. That was not significantly better than the placebo group at 42%. The researchers hoped this could help people delay joint replacement. There were no serious side effects from the low-dose radiation.

Joe

04:18-05:27

A surprisingly large number of Americans suffer chronic pain. In 2010, the most prescribed drug in America was an opioid called hydrocodone. Some of those prescriptions were inappropriate, but clearly a lot of citizens were in severe pain. Opioid prescriptions have dropped dramatically over the last 15 years.

Today, the most frequently prescribed medicine for pain is gabapentin. An article in the Annals of Internal Medicine describes the rapid increase in gabapentin prescriptions. Last year, it was the number five most prescribed medicine in America. In 2010, 5.8 million people were taking gabapentin. Last year, that number had jumped to 15.5 million. Most of the prescriptions were off-label. That’s because gabapentin has only been approved for treating partial seizures and the lingering pain after a shingles episode.

A downside to relying on gabapentin, especially for older people, is that it may increase the risk for falls. Side effects such as dizziness, drowsiness, and trouble walking elevate that danger.

Terry

05:28-06:17

Doctors have begun to worry about the long-term risks of sleeping pills, so they are looking for alternatives. A new meta-analysis of 67 randomized clinical trials shows that a technique called cognitive behavioral therapy for insomnia is effective for people with chronic disease.

Most volunteers were pleased with the treatment, which does not have adverse effects.

And that’s the health news from The People’s Pharmacy this week.

Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:31

And I’m Joe Graedon. Have you ever suffered from sinusitis? If not, you’re fortunate. The CDC says that almost 30 million Americans have been diagnosed with this condition. That’s over 11% of the population.

Terry

06:32-06:42

How would you know if a sinus infection were causing your symptoms? Could your stuffy nose and head pain be allergies or a cold instead of sinusitis?

Joe

06:42-07:17

To learn more about sinuses and the trouble they can cause, we’re talking with Dr. Zara Patel. She’s professor and director of endoscopic skull base surgery at Stanford School of Medicine. She’s also director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship in the Department of Otolaryngology Head and Neck Surgery at Stanford. Dr. Patel is also director of the Stanford Initiative to Cure Smell and Taste Loss, something more important now than ever before thanks to COVID.

Terry

07:19-07:23

Welcome back to The People’s Pharmacy, Dr. Zara Patel.

Dr. Zara Patel

07:24-07:26

Hi there. Thank you so much for having me again.

Joe

07:27-07:49

Well, we’re delighted to be able to talk to you about something that affects millions and millions of people, sinuses. What are they, where are they, and–after you’ve given us a little anatomy lesson–we’ll ask you what they do. So first of all what and and where?

Dr. Zara Patel

07:50-09:45

Sure. So the sinuses what we also call the paranasal sinuses are these pockets of air-filled cavities that are basically in the face and And the reason we have them has been debated, but what they do is they pneumatize or create air spaces in the head.

And what that does is it creates a potential crumple zone if your head ever had trauma that could absorb the impact of that trauma before your brain gets hit with that trauma. That’s a lot of people’s theory as to why we have these air-filled spaces around our nose and in our facial skeleton.

There’s also other theories as to why we have them, which have more to do with other sort of evolutionary theories, such as it makes our heads lighter. And that may have been a crucial component in what allowed us to start standing up and walking as a way of getting around.

And finally, there’s some theory that the sinuses lend more resonance to our voices, and that led to improved and more complex communication between human beings. So all different evolutionary theories as to why we have these sinuses.

Now, the final theory is maybe the most important, and probably we’ll talk a lot about today, And that is there is a local immune system in the lining of your nose and sinuses that is a crucial component of your overall systemic immune system. And that is one of the first leading defenses of keeping your body healthy when you breathe in any sort of potential irritants or allergens or toxins in the air.

Joe

09:46-10:16

Dr. Patel, pretend that I’m really, really dumb. And I think sometimes Terry would attest to the fact that that’s probably true. But when it comes to the anatomy of these sinuses, first of all, how many are there? And where precisely? You say around the nose, the face. I assume they sort of protrude up into the brain. But can you give us a little bit more of an anatomy lesson?

Dr. Zara Patel

10:16-12:33

Sure. So if you were to look at the face, beneath the surface of the skin are muscles and bones. And beneath those bones are the air-filled pockets. So you have the frontal sinuses, which are in your forehead region. You have the ethmoid sinuses, which is a little honeycomb of little cells and septations, so multiple cells, but we call them one group of cells, the ethmoid sinuses, that are kind of between your eyes.

And the maxillary sinuses, which are in your cheek region below your eyes and on the sides of your nose. And then at the very deepest point, which is kind of located right in the center of your head, are the sphenoid sinuses, the deepest sinuses.

And these sinuses are most of the time paired, although there is some anatomic variation where some people won’t develop frontal sinuses or just develop one. But most of the time people have bilateral, meaning on both sides of their head, these paired sinuses. And they all open and drain into the nasal cavity. And that is how they aerate also with air coming through the nasal cavity.

And I make a point to make sure you understand that they’re not directly under the skin. There is that layer of muscle and bone because sometimes people will say, oh, I’m swollen. They touch their face underneath their eyes or on their cheeks and they say, oh, my sinuses, I’m swollen. That’s not your sinuses.

What you’re feeling in that sort of moment is the soft tissue of the skin and subcutaneous tissue itself, which can swell due to things like allergy, but that is not directly from your sinuses. Only when a sinus infection gets really, really bad and actually can break through the bone, that’s the only time that you would have a swelling related to sinusitis. And that’s very, very rare. And you would know that you’re having a major problem at that point.

Terry

12:34-12:35

It definitely sounds terrible.

Joe

12:37-13:17

So, Dr. Patel, you are a professor of otolaryngology and head and neck surgery, and that means that you have performed surgery on a lot of people’s sinuses. I’m guessing that anyway. And I have a good friend who says he has giganto-sinuses and gets terrible, I mean, just unbearable sinus infections and sinusitis. and we’ll get into all of that in a minute, but you’ve probably seen a lot of variability in the size of people’s sinuses, or am I making that up?

Dr. Zara Patel

13:18-14:26

Yeah, so I think when people say they have giant sinuses, that may be because they have actually seen a CT scan of their own sinuses, and they know they’re really big, but although there is some variability in size, that’s not the thing that varies most.

The sort of complex pattern of cellular septations and drainage pathways, that’s where the variability comes in most. So the size is not that variable, but the complexity of the pattern of drainage and pneumatization in the face of that bone, that is very individualized.

And yeah, I’m a professor of otolaryngology, head and neck surgery, but even more specifically of rhinology, which is, you know, the subspecialty of just the nose, sinuses, and skull base above, that bone that separates the sinuses from the brain. And so I have done, you know, over 6,000 of this type of surgery. So yes, I’ve seen a lot of different sinuses and a lot of different variability in sinusitis, but the size is not the thing that varies most.

Terry

14:26-14:41

Well, let’s talk about the sinusitis. What is sinusitis? We know that generally speaking, if we put itis on the end of a word, we’re talking about inflammation. So is that true for sinusitis?

Dr. Zara Patel

14:42-16:31

Yes, that’s exactly right. So sinusitis, or what we sometimes call more specifically rhinosinusitis, which includes the nose in that inflammation, is really this end state of mucosal inflammation within those sinus cavities and often the nasal cavity.

And that can come from many, many different etiologies or reasons. We used to think of sinusitis, and I think a lot of people and even general practitioners may still think of sinusitis as sinus infections. But that’s only one small reason why people end up with sinusitis, an infection that causes swelling of the lining and mucous production, that that’s one reason why you might lead to that end state.

But there’s also a lot of reactivity that goes on to our environment now that leads to that end state of inflammation. So whether that’s reactivity to true allergens in the air, as people sort of are familiar with thinking of allergens like pollens or grasses or weeds, but also reactivity to non-allergens, but things that are irritants.

So there’s about a zillion things in the air now. There’s pollution, there’s particulate matter from forest fires. There’s a whole field of study and research on PM 2.5 that stands for particulate matter that’s 2.5 microns, because that very tiny size of particle can enter into your respiratory pathway and sort of land in both the upper respiratory path, which is the sinuses and nose, as well as the lower respiratory path, which is your lungs, and cause a lot of inflammation, which we’re just starting to learn more about.

Joe

16:32-16:41

Dr. Patel, how would someone know that they were suffering from sinusitis? What’s the number one most common symptom?

Dr. Zara Patel

16:41-17:21

The number one most common symptom of true sinusitis is facial pressure. So there’s also other cardinal signs like loss of smell and taste, really foul smelling, thick drainage, nasal drainage, and nasal obstruction or congestion. But a lot of symptoms can overlap in whether it’s just the nose that has that inflammation or the sinuses. And so facial pressure is really the most specific sign of sinusitis that you can sort of look for.

Terry

17:22-17:47

You’re listening to Dr. Zara Patel, professor and director of endoscopic skull base surgery in the Department of Otolaryngology Head and Neck Surgery at Stanford School of Medicine. Dr. Patel is director of the Stanford Initiative to Cure Smell and Taste Loss. She’s also director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship.

Joe

17:48-18:02

And Terry, it’s nice to know the key monitor is facial pressure, you know, in that area of the sinuses. Well, after the break, we’re going to find out what it’s like to have sinusitis.

Terry

18:03-18:08

Does the congestion mean you have an infection, or, you know, could it be something else?

Joe

18:08-18:20

What steps does Dr. Patel take to diagnose the cause of sinusitis? What are the different kinds of sinusitis? How does the microbiome of the nasal sinuses affect inflammation?

Terry

18:21-18:25

What factors determine if the sinusitis is acute, recurrent, or chronic?

Joe

18:25-18:31

Could old-fashioned treatments like a neti pot or inhaling steam vapor be helpful?

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Terry

20:18-20:21

Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

20:21-20:39

And I’m Joe Graedon.

Terry

20:39-20:49

Today, we’re talking about the holes in our heads. We call them sinuses, and they’re essential for good health. They play a critical role in our immune function.

Joe

20:49-21:01

What happens when our sinuses become inflamed or infected? Pathogens like bacteria or fungi can take up residence in our sinuses and make us miserable.

Terry

21:01-21:41

We’re talking with Dr. Zara Patel. Dr. Patel is professor and director of endoscopic skull base surgery. She’s also director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship in the Department of Otolaryngology Head and Neck Surgery at Stanford School of Medicine.

Dr. Patel is director of the Stanford Initiative to Cure Smell and Taste Loss. We spoke with her about loss of smell and how to treat it back in March. You can find that interview as show number 1422 on our website, peoplespharmacy.com.

Joe

21:42-21:59

Dr. Patel, what’s it like to have sinusitis? I’ve had it once or twice. And yes, I feel the pressure and I’ve lost the sense of smell and pretty much the sense of taste. And it’s awful.

Dr. Zara Patel

21:59-21:59

Yeah.

Joe

21:59-22:36

But you deal with people who get frequent sinus infections and sinusitis and they are miserable. I mean, when my friend comes down with it, he’s not fun to be around. He’s just in not just pain. He’s just awful. He just wants to go hang out in a cave someplace until it gets better.

So tell us what the subjective feelings of sinusitis are like and then how to distinguish between an infectious type of sinusitis and then some of the other things that can trigger it.

Dr. Zara Patel

22:37-25:14

Sure. So there’s actually quite a lot of variability in how people experience sinusitis and whether it’s an acute sinusitis, an acute flare of chronic sinusitis or chronic sinusitis actually changes the way that a person experiences that disease process. So what you’ve been even describing is acute sinusitis or flares of acute sinusitis, where you feel a lot of that really bad pressure in your face, a lot of this nasal drainage, the loss of smell, and people often just feel overall crummy.

They feel like they’re just not functioning at their optimal best. People will often have sort of a sensation of brain fog or just not able to focus, low stamina, not able to work out the way they normally would, and just feeling not so great. That can happen with both acute sinusitis as well as the chronic sinusitis.

There’s so many different forms of chronic sinusitis. There’s the infectious type that we’ve sort of touched on where infection can lead to this inflammation and people have a lot of pus draining out. But there’s also the much more inflammatory type where people develop polyps that fill their sinuses, completely block the sinuses, and then eventually if it goes on long enough can just block the nose self. Interestingly, those people, although when you look at their sinuses, it looks much worse, they often actually don’t have as extreme or severe of symptoms. Sometimes all they feel is nasal obstruction and loss of smell because it’s just developed over such a long period of time that they’ve kind of gotten used to it. And so there’s a lot of different ways that people experience the disease.

What I can say sort of across the board for all patients with chronic rhinosinusitis is that we know that the amount of sort of suffering or how much it impacts their daily life, how well that they can work or have to miss work, how well that they can go about doing their normal daily activities is on par with some of the sort of most significant chronic diseases that we are familiar with, things like heart failure or diabetes, chronic rhinosinusitis factors up in those levels when you think about health utility scores. And so it is highly impactful on people’s quality of life.

Terry

25:15-25:40

Dr. Patel, how does a specialist like yourself diagnose the cause of the sinusitis. So how can you tell if someone is having a sinus problem due to, oh, wildfire smoke in the area, or maybe they have an infection? And what type of infection? How do you make that diagnosis?

Dr. Zara Patel

25:41-28:54

Yeah, it’s not always easy, I’ll say. A lot of the understanding of what has led to that end state of sinusitis has a lot to do with careful history taking more than anything else. That’s where the art of medicine comes in as opposed to science. Because often what people tend to use to try to prove or disprove infection are tools that are now our understanding of what those tools can do shows that they’re not very perfect or good.

So for example, people have suggested culturing sinuses to decide if there’s a bacterial infection or a viral infection or whether it’s just inflammatory. And for a long time, that was pretty standard that if people came in with sinusitis, we’d just swab them and see what it was and make sure we knew what antibiotics to give them.

But now that we have much better, more accurate tools of looking at the bacteria that are in our sinuses, we know that culturing and swabbing the nose and growing that culture on a Petri dish is not very exact at all. In fact, when we compare cultures to actual PCR analysis, which is kind of the best way of looking at the microbiome in the sinuses. We know that cultures do not show what the most prevalent bacteria is in the sinuses. They do not show what the most pathogenic bacteria is in that particular sinusitis. And they really don’t show us overall the entire picture.

We have hundreds of bacteria and viruses and fungus particles in our sinus microbiome at baseline in a healthy sinus, we have these and they aren’t necessarily bad for us. It’s really only when we have an alteration in the diversity, when there’s some that overgrow or are underrepresented and we have decreased diversity of species, that’s what we can say is, okay, that matches an abnormal type of microbiome. And that’s what we see in people with chronic sinusitis.

But to try to answer your question more succinctly, that just shows that, you know, culturing sinuses is just not really a great way of distinguishing whether people have infection or inflammation. And that’s why a careful history is really often the best way. Now, having said all that, I will say in particular patient populations where we know they’ve already been treated with a whole host of antibiotics, they’re not responding to the antibiotics. And we want to know if someone has grown a resistance to particular antibiotics, then culturing can be quite helpful because then we can test whether they are sensitive or resistant to particular antibiotics.

So cystic fibrosis patients, for example, who have been on antibiotics since almost birth for all of their different complicated infections, those are people that we culture quite frequently and we do actually get good results and can tailor our treatment for them. But it’s not something that I honestly do for all of my patients with sinusitis.

Joe

28:55-29:48

Now, Dr. Patel, you’ve just said something that I think is really provocative, and I’m not sure everyone who’s been listening picked up on it. You basically said there is a microbiome in the nasal sinuses, and there are hundreds, not dozens, not scores, hundreds of creepy crawlies in there. And some of them are probably healthy, sort of just like our digestive tracts where we have, well, probably trillions.

So we have all kinds of different kinds of bacteria and viruses and fungi. And I think a lot of times people think, well, just give me a Z-Pak doctor and that’ll knock out my sinus infection. But if it’s a fungus that’s growing out of control, antibiotics aren’t going to do a thing.

Dr. Zara Patel

29:49-31:48

Yeah. So what I would say to that is that’s correct. We have this microbiome. I think the understanding of the microbiome has been, a lot of people talk about the microbiome in an incorrect or inaccurate way. So yes, we have all these things to discuss.

So for example, a lot of people come to me and say, oh, someone told me I might have fungal overgrowth or a fungal infection in my sinuses and that’s what’s causing this problem. We have disproven that so many times that fungus is the cause of any sort of acute or chronic sinus issue other than in immunocompromised patients. Immunocompromised or immunosuppressed patients are the only people that actually have to be concerned about a fungal infection.

And in those patients, it can become very dangerous. It invasive type of fungal infection that can lead to death. But people with a functioning immune system, and this isn’t just people who think their immune system is like a little weak or something, this is people who are actually completely suppressed that that happens to. People with a normal immune system will not get fungal infections in their sinuses.

Our immune system is very clear about not having that occur. We can get reactivity to fungal spores, And that is quite commonly what happens. We can get allergic fungal sinusitis where we’re all breathing in fungal spores every single day and people can react to that like a foreign body reaction, an allergic reaction, and that causes swelling of the lining.

But I will say that there are a lot of alternative practitioners out there giving away, you know, having people do fungal tests and making a lot of money off of antifungal treatments that are completely not based in scientific fact. So I want to make that totally clear.

Terry

31:49-32:09

Tell us about the different types of sinusitis that you have encountered. Acute sinusitis, you mentioned already, we hear that there’s recurrent sinusitis, chronic sinusitis. Why would someone go from acute sinusitis to chronic sinusitis? What are the factors?

Dr. Zara Patel

32:10-33:55

Yeah, we actually are learning more and more about that because that’s something that happens quite often. People go their entire lives with no sinus problem at all. And then suddenly they have one big, big flare, a big event of sinusitis. And then suddenly they just cannot resolve. They cannot go back to their normal baseline and they come in and wonder, you know, why have I developed this chronic problem? Why couldn’t I just take a course of antibiotics like that and get back to normal like I always did in the past?

What we are now learning through some really interesting research is that your basal stem cells, the cells that can differentiate into all the different types of cells in the lining of the sinuses, are actually impacted and affected in a long-term permanent sort of way by a big inflammatory event, whether it is an infectious event or an inflammatory just allergic type of event. And what happens is that those stem cells shift, they have memory. And instead of differentiating into all the normal types of cells they always have in the past, they instead start preferentially producing the inflammatory type of cells, things like goblet cells that produce more mucus, those cells that are able to respond to allergens or infectious pathogens much more readily.

And so that is one of the reasons why people can have this sudden shift from just having acute sinusitis and being able to resolve to more of a chronic pattern, which sometimes, you know, medical therapy can resolve and sometimes it cannot. Sometimes people need in the end to undergo surgery to help with that type of problem.

Joe

33:56-34:09

So let’s start talking about treatment. I want to go back to my friend who has what he has described as the humongous sinuses, even if that’s not really his problem.

Terry

34:09-34:15

But what he does have is frequent sinus infections or sinusitis. Right.

Joe

34:15-34:54

If he gets a cold, if he comes down with some other kind of infection, it often attacks his sinuses. And his number one go-to treatment is what he calls inhalation. So, you know, I think when he was a kid, his mother would have a pot of water on the stove and she would put some Vick’s vapor rub in there and he put a towel over his head and he would inhale the vapors. And he says it works. Maybe not every time and maybe not perfectly, but it is that steam inhalation that he seems to think is beneficial. Any truth to that?

Dr. Zara Patel

34:56-36:42

Yeah. So, you know, we can start with why does he have these frequent sinus infections, right? And that goes to the underlying anatomy and the likely environmental reactivity or predisposition to swell if you get a virus or are exposed to an allergen. So there is some underlying anatomy that some people have, anatomic variants, that make your drainage pathways a little more crowded. And so you have less room for the mucosal surface to swell before it completely shuts off that drainage pathway.

And so whether it’s an anatomic factor or more likely to swell, people who end up getting these sinus problems, when they do that inhalation or have that heated steam that they’re breathing in, what that does is it’s really just kind of loosening up any of that mucus that’s kind of getting stuck or plugged in those tiny little drainage pathways. And that can in turn allow for more drainage of the mucus behind it. And so certainly doing things like, you know, just standing in the shower for a long time and allowing that to hit your face or doing that steam inhalation, that can be helpful.

But probably the most helpful thing that people can do is just rinsing their nose with salt water because that can really get in there and not only loosen up mucus, but through the mechanism of osmosis, when you put salt inside the water, it can draw out that excessive boggy moisture that’s in the tissues and naturally decongest the lining. And that also allows that mucus to come out. So that’s another way that you can really nicely open up the sinus pathways in some cases.

Joe

36:43-36:54

Now, Dr. Patel, that sounds suspiciously like a neti pot, which goes back quite a long time in the Ayurvedic tradition.

Dr. Zara Patel

36:55-37:49

That’s right. That’s exactly right. Neti pot has been used for hundreds, if not thousands of years. And the only difference now is kind of what we recommend around using boiled water or distilled water to make sure that people are using water that’s safe for their nose and sinuses.

Because there have been some case reports out there of people getting bad amoebic infections from rinsing their nose. But those are all honestly related to people either rinsing with things like shallow well water where that stuff can grow or rinsing with water that’s gone through a filter that hasn’t been changed for 20 years or things like that. So really, if you boil the water that comes out of the tap or if you use distilled water, that’s really safe and effective. And yes, you’re right. It has many, many years of proof of principle that it can help people.

Terry

37:51-38:18

You are listening to Dr. Zara Patel, professor and director of endoscopic skull base surgery. Dr. Patel is director of the Stanford Initiative to Cure Smell and Taste Loss. She’s also director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship in the Department of Otolaryngology, head and neck surgery at Stanford University School of Medicine.

Joe

38:19-38:26

After the break, we’ll hear more about how neti pots can be helpful and how to find the right one.

Terry

38:27-38:30

When do you move on to some other treatment beyond irrigation?

Joe

38:31-38:35

What place do nasal sprays and topical steroids have?

Terry

38:35-38:43

We’ll find out about ingredients that are not good for your nose, so you can avoid nasal sprays that contain them.

Joe

38:43-38:50

Dr. Patel will also describe how people make the decision to have surgery for chronic sinusitis.

Terry

39:05-39:09

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

39:17-39:20

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

39:21-39:39

And I’m Terry Graedon.

Joe

39:40-39:50

We’re talking about sinusitis today and some strategies to prevent or treat this common disorder. Are there medications that can make matters worse?

Terry

39:51-39:59

When is surgery appropriate for sinusitis? What factors should doctors and patients consider when contemplating that approach?

Joe

40:00-40:05

What’s the best after-surgery care to prevent problems from coming back?

Terry

40:05-40:35

Today’s guest is Dr. Zara Patel. She’s a professor in the Department of Otolaryngology, Head and Neck Surgery at Stanford School of Medicine. Dr. Patel is also Director of Endoscopic Skull Base Surgery and Director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship. Dr. Patel is director of the Stanford Initiative to Cure Smell and Taste Loss.

Joe

40:36-40:59

Dr. Patel, we’ve been talking about the neti pot, and I wish you could describe that because some of our listeners may never have seen or heard about a neti pot. I describe it as Aladdin’s lamp, but that’s not a very good description. And are there any brands that you sometimes recommend that might be especially helpful.

Dr. Zara Patel

41:00-43:27

Yeah, I think that’s actually a great description. It is a sort of small squat type of pot that has that sort of elongated spout coming off of it. And it can be ceramic. It can be made of plastic. It comes in all sort of shapes and sizes, honestly.

But what that is, is a high volume, low pressure type of irrigation. Now we’ve studied a lot of different irrigation mechanisms. There’s no particular brand that I would recommend. But what I would say is the type of irrigation device that I recommend for my patients is actually not a low pressure, high volume, but a high pressure, high volume. It’s actually just a simple squeeze bottle.

And you use it in the exact same way that you would use a neti pot. You’d put your head over the sink, turn it a bit to the side and a little head hanging forward. And then you’re just sort of slowly and gently squeezing the salt water through. And your active squeezing, that active sort of control over the flow of water is why the high pressure, high volume is a little bit more effective than low pressure, high volume at getting in and out of the sinus drainage pathways. So that simple squeeze bottle is the one that I recommend most.

And a lot of patients will ask me, well, what about these motorized irrigators that they see advertised on TV? Can I use that? That seems a little more simple. I can just put it up to my nose and have it do the job for me. And what I sort of caution about is that any motorized device, that motor you’re not actually able to get to to really sterilize. And that can sometimes harbor bacteria or viruses or fungus that you then are jetting back into your nose and sinuses.

And so, you know, if people insist on using those, I say, okay, maybe try using a really dilute bleach solution like 10% to rinse through that motor once a week. But then you really have to put a ton of water through that device to make sure you’re not putting bleach in your nose. So that becomes a little more cumbersome. And I think just the simple squeeze bottle and washing it with hot water and soap completely sterilizes the entire device in between uses. I think that’s a little bit more straightforward and is really helpful.

Terry

43:28-43:49

We have seen such a squeeze bottle under the brand name NeilMed. Is that the sort of thing you have in mind?

Dr. Zara Patel

43:34-43:35

That’s exactly right.

Terry

43:36-43:49

Okay. Now, obviously, we want to start with irrigation, but what if that’s not quite enough? When do you move on to some other treatment and how do you know?

Dr. Zara Patel

43:50-45:28

Yeah. So, you know, I would say people who have persistent symptoms, whether it’s nasal congestion or obstruction or facial pressure or that smell issue or drainage, if those things are not completely resolved by rinsing, then you probably need something more.

And that something more can be as simple as just optimizing your topical regimen. So adding some sprays to your rinses can be really effective for a lot of people, especially if it’s just allergy that you’re dealing with.

But if that’s not enough, and we can talk a little bit about the different types of sprays that can be helpful for people, but if sprays and rinses are not enough, then that’s when we start talking about medical therapy that you would take in pill form. So in the form of either antibiotics or steroids or a combination of that. And that sometimes is what people need to get rid of their sinusitis, whether it’s an acute episode or a chronic episode. And then even that sometimes for some patients is not enough.

And if someone has failed all of that, good optimized topical therapy, good, appropriate medical therapy, that’s when we start talking about sinus surgery. And that can really be the most definitive final step for people. And I guess I shouldn’t say final, but the most definitive next step for people. And then often we want them to continue with an optimized topical regimen to keep them at that good new baseline that surgery can get them to.

Terry

45:28-45:52

Now, you mentioned sprays and you said you’d tell us what kinds. I’m assuming that one of the types of sprays you might recommend would be, again, steroid. You mentioned that sometimes people need to take oral steroids, but I’m assuming that the topical steroids, which are so common, like Flonase, would be a first step rather than oral.

Dr. Zara Patel

45:53-46:58

Yeah. So I’ve made a whole YouTube video about nasal sprays and also a whole different YouTube video about rinses. So if people want really good detail, they can go find me on YouTube and, and re and listen to those videos.

But just in brief, the sprays that we tend to prescribe people can be nasal steroid sprays, like fluticasone or Flonase or Nasonex, Nasocort, those types of things, or antihistamine nasal sprays like Astapro or Astelin, Patanase, those types of things, or a particular type of spray that can just decrease the amount of mucus production in the nose, something called ipratropium or Atrovent nasal sprays. They all do slightly different things. And so we choose them for different types of diagnoses and different patients. And we can use them in combination also because they’re all doing different things. There are lots of nasal sprays out there that are sold over the counter that are actually really bad for your nose and should not be used on a regular basis.

Joe

46:59-47:06

I assume you’re referring to the decongestant sprays. Can you go into a little more detail on those, please?

Dr. Zara Patel

47:06-49:16

Sure. So that’s one form of the sprays that are bad for your nose. So decongestant sprays like Afrin or Sinex, there’s a lot of other brand names out there. What they’re doing is they’re constricting the blood vessels in the structures in your nose, most often the turbinate structures that tend to swell in response to things like allergens in the air.

That’s why they can give a really great immediate relief and decongestant because there’s a lot of blood flow to those structures. And so constricting the blood vessels will immediately shrink down the size of those structures.

The problem with that is that these vessels should be at a good resting tone. They should not be too constricted or too dilated all the time. They should be able to respond to whatever is going on in your environment to constrict or dilate in that response. If you continually apply a vasoconstrictor, the baseline resting tone becomes more and more and more dilated and needs that medication to constrict even back down to normal. And so what you get over time is what we call rebound congestion, you make yourself more and more congested.

You feel worse and worse and worse by using the spray. And then people get addicted to these sprays because then that’s the only thing that can make them feel even a little better and able to get airflow through.

So really the only time that I tell people to use a spray like that is if they’re having a very severe nosebleed, and that can help constricting the vessels, stopping the nosebleed in that moment. But really, these sprays should not be used other than that really specific instance.

Now, there’s also other types of sprays that are sold over the counter that have all kinds of different ingredients that are not great for your nose. They contain things like menthol that might desensitize your receptors for airflow. They contain other ingredients that haven’t been studied and may be detrimental. We know that zinc nasal sprays were sold for a long time and caused irreversible smell loss. So I would really be cautious about putting really anything in the nose that is not being prescribed by your doctor.

Joe

49:16-49:52

I do have one of my favorite nasal sprays. And these days, very few physicians recommend it. But it’s really been around a long time. And it was developed originally from a plant called Bishop’s weed. And the original inhaler was for asthma. It was called Intal. And now I think that’s unavailable, but you can still get nasal chrome, which contains the ingredient cromolyn sodium.

Dr. Zara Patel

49:53-49:53

Yeah.

Joe

49:54-50:18

And it stabilizes those mast cells in the nose that release not just histamine, but lots of other inflammatory compounds. Do you ever recommend Nasalcrom? I know that a lot of doctors say, well, you have to use it two, three, four times a day. Nobody will ever do that. It’s not worth your time. But what’s your thought?

Dr. Zara Patel

50:19-50:56

Yeah, certainly that’s something that people still prescribe and still use. I think it’s good for a particular subset of patients. It’s not helpful for everyone. When we’ve done studies on it, you can see that there are very particular patients who respond really well.

The majority of patients don’t find a lot of benefit from it. So you really have to, again, it goes back to that careful history taking as to what is causing the patient’s symptoms. And that really allows us to decide which specific spray is going to help which specific person. And so yes, for some patients, that is a great option.

Terry

50:58-51:19

Now, Dr. Patel, a few minutes ago, we suggested that surgery might be a next step for people who have not responded adequately to some of these medical treatments. Tell us, if you would, please, what is the goal of surgery? How do you decide that it is time for surgery?

Joe

51:20-51:26

And what is it you do when you perform surgery on someone with chronic sinusitis?

Dr. Zara Patel

51:27-54:22

Yeah. So how we decide it’s time for surgery really, again, depends on how well patients have responded to any of those topical therapeutic regimens or medical therapy. And if they have not been able to resolve and we see not just based on their symptoms, but we see on a CT scan, that’s a really crucial component to have objective findings, either a CT scan or nasal endoscopy that we perform in the clinic. If we see on those types of images that patients do truly have sinusitis and that is the cause of the symptoms, because often people have these symptoms and not have sinusitis, which we can talk about in a moment. If that is proven, then surgery is the next step. And what surgery entails is what we call endoscopic sinus surgery.

So using that small, tiny, thin camera that we look into patients’ noses in our clinic. And a lot of different instruments that have been developed over time to be very specific to these tiny little nooks and crannies that are within the sinus spaces and drainage pathways. So that we are very delicately and meticulously opening the sinuses, removing these tiny little septations, removing inflammatory tissue and any mucus that’s trapped in there.

So that at the end of that surgery, you have one big confluent drainage pathway and aeration pathway for all of the sinuses on each side. And that can be really, really effective and helpful in just allowing patients to have their sinuses function again more normally. Now, what I will say is that for most patients with a chronic inflammatory process like this, they need to continue doing something like rinses and sprays to keep themselves at that good new baseline. And I often will see patients who have had six or seven sinus surgeries by other practitioners out in the community, and no one should have that many surgeries.

You should have one good, complete, thorough surgery by an expert sinus surgeon, and then have the education about what you need to stay on to remain well, and that should be it.

Now, the reason people fail sinus surgery include things like either they haven’t had a good surgery, they haven’t had the complete or thorough surgery, they’ve just had something like balloon sinuplasty, which is not surgery, and they needed something more than that, or they haven’t been educated on what their regimen should be after surgery. So there’s a lot of different reasons why people could fail. But if you go to an expert, someone who, you know, like me as a rhinologist or has done thousands of this type of surgery and treated a lot of patients like this, you should be able to get a really good result with just one good surgery.

Terry

54:22-54:30

And so what is it that you’re telling your patients, after surgery, you need to do this and you need to be very conscientious about it.

Dr. Zara Patel

54:30-55:47

Yeah. So again, that depends on the individual patient. So if a patient’s main problem leading up to the surgery was underlying anatomy changes or variants that were really, really crowding them, maybe they had a terrible septal deviation and that was leading to crowding of the sinus drainage pathway or really a lot of cells that were going into the drainage pathway of another sinus, things like that, then maybe they don’t need to continue doing long-term topical therapy. Maybe I’ll just have them doing rinses for a good six months to a year, and then they can just go about their life and be done with it.

But most patients are not just having anatomic issues. They’re having either a combination of underlying anatomy and inflammatory patterns, or it’s really just much more of a reactive inflammatory issue. Now, surgery can do a lot of great things, but nothing about surgery is going to change your underlying reactivity to your environment. And so that’s why remaining on rinses and sprays and us optimizing that, changing the type of sprays or adding medication even to the rinses can be what really keeps you at that good new baseline after surgery.

Joe

55:48-56:13

Dr. Patel, what can we do to keep our sinuses healthy so that we can avoid surgery, so that we can avoid infections or sinusitis or all of the things that we’ve been talking about today? Are there any steps that people can take in a kind of preventive methodology to keep that part of our anatomy healthy?

Dr. Zara Patel

56:14-58:05

Sure. I think that just rinsing with salt water is a great idea for anyone that kind of feels predisposed to allergy or reactivity. Anyone who feels like, oh, I have a toddler at home and they come home and just bring illnesses back to me all the time so I keep getting sick.

Just rinsing your nose on a regular basis can be really effective at sort of helping the underlying immune mechanism in your nose of just clearing away these inflammatory factors and pathogens before they’re able to really embed and enter into cells and cause that infectious inflammatory reaction. So just doing that.

And then of course, just all the other things about staying healthy in general. I think that when people have overall physical health, mental health, emotional health. We’ve seen that patients can respond much better to our treatments for chronic sinusitis. There’s so much more research that can be done in exploring these connections and pathways. A lot of people ask, should I eat something in particular or should I not eat something in particular

And really there hasn’t been any evidence showing that food changes sinusitis predisposition at all. But I will have patients sometimes coming in and saying, oh, well, I cut this out of my diet and I feel like my sinuses are less reactive than before. And in the end, we have a lot more research to do into the causes of inflammation, not just in the sinuses, but throughout our body. And so the more that we learn about that through science and good clinical trials, the more we’ll be able to really educate people about what those underlying factors may be.

Terry

58:05-58:29

Dr. Patel, you suggested that imaging, CT scan, or nasal endoscopy is critical before considering sinus surgery because you want to make sure it really is sinusitis and not, that would respond to surgery and not something else. So I’m wondering if you can tell us what that something else might be.

Dr. Zara Patel

58:29-01:00:20

Yeah, there’s actually so many different things that can masquerade as sinusitis. The most common missed diagnosis in patients that have been told all their lives by their primary care doctors or urgent care doctors that they have sinusitis is migraine. So people often think of migraine in a very classic form. They have aura, they have these terrible debilitating headaches, they have to lay down in a dark room, but that’s not always the way that migraine presents.

There is something called atypical migraine and even a subset called atypical facial migraine. And so people can have pain and pressure in their facial region for a lot of different reasons. There’s a lot of primary headache syndromes that can masquerade as sinusitis. So migraine is one. There’s also tension headache, cluster headache, hemicrania continua.

There’s all these different headache syndromes that people can think are really sinusitis. There’s temporomandibular joint dysfunction, so that when you have either inflammation or some misalignment of the joint, all of the muscles of our facial skeleton and our scalp and our jaw and our neck attach to that joint.

And so if there’s any tension there, you might have this radiating pain and pressure right across your cheek, right across your forehead. And of course, people are going to think that’s their sinuses, but a CT scan is what allows us to differentiate that. So when people are having a lot of pain and pressure, we get a CT and it’s totally clear in there, we then know, okay, this is not your sinuses.

And then we can point them down the correct pathway of investigation. So really getting that imaging and understanding what’s going on in there is crucial.

Joe

01:00:21-01:01:18

Dr. Patel, we live in North Carolina and like a lot of states in the southeast, in the summer, it gets hot and humid. And what that often means is that in the crawl spaces of people’s homes, where sometimes they have air conditioning ducts, the hot, humid air comes in through the vents. It hits the cold air in the ducts.

And of course, it turns into precipitation. And now in that area, the basement or the crawl space, there’s a lot of moisture and heat, and that leads to mold and mildew. And I’m just wondering how mold and mildew may affect some people, either in a sense of allergic reaction or ultimately leading to allergy and then sinus problems?

Dr. Zara Patel

01:01:19-01:04:45

Yeah, it’s a great question. And it goes back to what I had touched on earlier that, you know, definitely a lot of people react to fungal spores in their environment in an allergic manner. So we see a lot of allergy, especially in the Southeast region of the United States, but definitely everywhere, especially with climate change, you know, more and more places are becoming warmer than they were before. And as winters are less cold and we see less complete killing off of all of these different sort of allergens, we are seeing more and more allergy throughout the US. So people can have allergy, which is separate actually from chronic sinusitis.

Often we see allergic rhinitis and chronic sinusitis in the same patient, but we’ve actually done a lot of studies trying to show causation and we have not been able to identify that. And so it’s just that both of those things can happen in the same person, but not always in the same person all the time.

So you can have allergy from fungus and you can go to an allergist, get tested and potentially get desensitized through allergy shots or drops. That’s a great way of trying to deal with that type of thing. And again, rinses, sprays that deal with that. Those are great ways of treating allergic rhinitis. And then you can also get an entity that we call allergic fungal sinusitis.

And remember, this is not a fungal infection. You do not treat this with antifungal medication or therapy. You do treat this with, again, allergy desensitization and often surgery. Because what happens with allergic fungal sinusitis is, and this is also the sort of mechanism by which people can develop what’s called a ball or mysotoma in their sinuses. The lining of your sinuses recognize these fungal spores as either a foreign body and they produce a bunch of mucus and wall it off. That’s what causes a fungal ball. Or they can recognize it and they react to it in an allergic manner.

And that causes this huge inflammatory reaction in some patients where there’s a huge number of polyps that are produced. And you also develop all this mucus, this inflammatory mucus that walls off around all of these fungal spores in there. And some patients get so bad of allergic fungal sinusitis that the bone within the sinuses actually starts getting eroded from this chronic constant pressure of all of these polyps growing within their sinuses.

And before I came to Stanford, I actually worked at Emory University in Atlanta, Georgia for four years right after training. And I saw a lot of allergic fungal sinusitis in the Southeast. And sometimes patients will come in and you can actually see that their eyes have been pushed apart. The nasal bridge has been flattened because of all of this pressure coming from the inside of their sinuses and almost trying to break through a road through the bone. And we get erosion of the bone that separates the sinuses from the above.

And so these are patients that really need surgery to clear out all of the polyp and inflammatory mucus and then stay on a really strict regimen of anti-inflammatory rinses to keep them from regrowing that type of polyp formation.

Joe

01:04:45-01:04:58

Of course, I would argue that if you are in an environment where there are a lot of fungal spores, Maybe you should do something about that crawl space.

Terry

01:04:59-01:04:59

Like move.

Joe

01:04:59-01:05:19

Well, either move or have it dried out and sealed up and make sure that you’re not hosting a lot of mold, mildew, fungal, and bacterial stuff that should not be in your home and in your duct work.

Dr. Zara Patel

01:05:19-01:05:35

Yeah. So I would say I tell a lot of patients, you know, they’ll ask me, oh, should I get this remediated? And certainly if you have the ability to do that, yes, definitely try to get that fixed. Unfortunately, there’s a lot of people that live in environments that they don’t have complete control over.

Joe

01:05:35-01:05:35

Right.

Dr. Zara Patel

01:05:35-01:05:56

So a lot of renters, right? They ask their landlord to take care of things, and they’ve been asking them for years, and it just doesn’t get taken care of. And so, you know, certainly if you have control over your own living environment and you have the funds available to take care of something like that, then yes, you should try. But unfortunately, that’s not the reality for a lot of people.

Terry

01:05:56-01:05:58

Right. And it is pricey.

Dr. Zara Patel

01:05:58-01:05:58

Yeah.

Joe

01:05:59-01:06:19

The idea that sinusitis and rheumatic diseases can go together, can you help us understand that a little bit better? There apparently is some research suggesting that people who have chronic sinusitis may also have rheumatic disease.

Dr. Zara Patel

01:06:21-01:08:17

Yeah. So the study that you’re referencing showed that patients with chronic sinusitis may develop rheumatoid arthritis or other autoimmune type of diseases later on, like five to 10 years later. And what I want to be clear about is that the study does not show causation.

When you read media publications about it, often it’ll say, oh, chronic sinusitis is a risk factor for developing rheumatoid arthritis. That’s not actually what the study shows. What it shows is that there is an association. So when you look back and look back to see, oh, these patients with rheumatoid arthritis, what did they have before in their health record? Well, some had chronic sinusitis. And an association, it’s one of the most important things actually in scientific research and literature is to make that distinction.

So yes, it totally makes sense that someone who has developed an inflammatory condition is likely to develop other inflammatory conditions, whether that has to do with their specific environment or their specific genetic underlying predisposing factors, or most likely a combination of both. Yes, it makes sense that people who develop one inflammatory disease are more likely to develop other inflammatory diseases.

Now, what may also be true is that when you develop an inflammatory disease and that kicks your immune system into kind of this overdrive of dealing with chronic inflammation on a regular basis, especially if it goes untreated or unchecked, could that potentially lead to a predisposition of developing others? Maybe. That’s the part that we don’t know. It hasn’t been studied or proven, but could potentially be true and I think is a really interesting line of research for some people to focus on.

Joe

01:08:18-01:08:59

Dr. Patel, you deal with hundreds, if not thousands, of patients with sinusitis over the years. And I fear that friends and family of people who are suffering from sinusitis are not as sympathetic as they need to be. You know, when someone has sinusitis, they don’t look different. They don’t, you know, they don’t have a crutch. They don’t clutch their chest. They just look normal and yet they’re miserable.

Can you help us better understand what’s going on for someone with sinusitis and perhaps have a little more sympathy for them?

Dr. Zara Patel

01:09:00-01:10:50

Yeah. Well, I think that what I had mentioned before that the sort of health utility or cost of having chronic sinusitis is right up there with someone that has heart failure, right? That’s a really big deal, the amount that their quality of life is impacted by this underlying disease process.

And it can be those really apparent things like drainage and loss of smell taste and pressure or headache. But also we’ve shown that people maybe are not really feeling like they can process as well as they normally would when they have this chronic sinus issue going on. They feel like they’re not at their best. They can’t perform well at work. They can’t connect well with their family and friends. They’re sort of always suffering and feel like they can’t go outside because as soon as they go outside, they’re going to react to something more.

Sometimes people will avoid social events because people are worried they have some infectious or contractible disease process because they’re constantly blowing their nose or coughing because of the post-nasal drainage. So it really is highly impactful on patients’ quality of life.

And I just encourage all patients who are suffering from sinus issues to really see a highly specialized, well-trained ENT doctor because you don’t have to suffer like that. And I will say a lot of my patients who I’ve done sinus surgery for will often say, gosh, I just cannot believe I waited this long to feel this good. I can’t believe I just let myself suffer for that many years when I could have been feeling like this. So that’s my final sort of word of advice.

Terry

01:10:50-01:10:55

Dr. Zara Patel, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Zara Patel

01:10:56-01:10:58

My pleasure. Thank you for having me.

Terry

01:10:59-01:11:54

Dr. Zara Patel, thank you so much for talking with us on The People’s Pharmacy this week.

Dr. Zara Patel

1:11:04-1:11:08

It’s been a pleasure being here. Thank you so much for having me.

Terry

1:11:08-01:11:53

You’ve been listening to Dr. Zara Patel. Dr. Patel is professor and director of Endoscopic Skull Base Surgery. She’s also director of the Neurorhinology Advanced Sinus and Skull Base Surgery Fellowship in the Department of Otolaryngology Head and Neck Surgery at Stanford School of Medicine. Dr. Patel is director of the Stanford Initiative to Cure Smell and Taste Loss. We spoke with her about loss of the sense of smell and how it can be treated back in March. You can find that interview as show number 1422 on our website, peoplespharmacy.com.

Joe

01:11:54-01:12:03

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Liederman composed our theme music.

Terry

01:12:03-01:12:11

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

01:12:11-01:12:35

Today’s show is number 1,448. You can find it online at peoplespharmacy.com. The show notes now include a written transcript of this conversation. At peoplespharmacy.com, you can also share your comments about today’s show. You can also reach us through email, radio, at peoplespharmacy.com.

Terry

01:12:36-01:13:10

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In the podcast this week, you’ll learn what we can do to help keep our sinuses healthy and prevent problems.

What else might be masquerading as sinusitis? What role do mold and mildew in warm, humid crawl spaces play? You may be surprised to learn that rheumatic disease may also go hand-in-hand with sinusitis.

Joe

01:13:10-01:13:30

At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. And we’d be grateful if you’d write a review for the podcast. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:13:30-01:14:05

And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:14:05-01:14:15

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:14:16-01:14:20

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:14:21-01:14:34

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.