Sinusitis FAQ » Rhinosinusitis

Treatment of Refractory Allergic Fungal Rhinosinusitis

admin — Mon, 18 Oct 2004 00:00:00 +0000

Question:

Itraconazole in the Treatment of Refractory Allergic Fungal Rhinosinusitis Date and Time: Sunday, Sep 19, 11:30 am to 11:38 am Location: Room Special Events Hall DMR Category: Rhinology Authors Amin R Javer, MD , Kwai Onn Chan, MD (Presenter) Abstract Objectives: The conventional management of Allergic Fungal Sinusitis (AFS) after surgery consists of systemic and topical steroids to immunomodulate the body

Anyone know what's in it?

admin — Mon, 29 Mar 2004 00:00:00 +0000

Question:

Scott wrote: >>According to http://www.sinofresh.com/content/clinicaloverview.aspx >>Clinical Overview >>What is SinoFresh? > . . . . > So does this mean we can just put some mouthwash (Scope which contains > Cetylpyridinium Chloride) in a spray bottle and have the same affect?

Scope Mouthwash contains alcohol. You don’t want to put alcohol or any other astringent ingredient up your nose, believe me. — Steven L.

Response:

- Hide quoted text — Show quoted text -NorthShore…@yahoo.com (Mareda) wrote in message … > entcons…@aol.comnospam (ENTconsult) wrote in message … > > I have been to the web site but couldn’t find any reference as to what is in > > sino fresh. Anyonw know? > > Murray Grossan, M.D. > > http://www.ent-consult.com > Active Ingredients: > Cetylpyridinium chloride 0.5% > Inactive Ingredients: > Benzalkonium chloride, dibasic sodium phosphate, eucalyptus oil, > monobasic sodium phosphate, peppermint oil, polysorbate 80, propylene > glycol, purified water, sodium chloride, sorbitol solution, spearmint > oil and wintergreen oil.

Cetylpyridinium chloride 0.05% Sorry for the correction, Bill

Response:

entcons…@aol.comnospam (ENTconsult) wrote in message … > I have been to the web site but couldn’t find any reference as to what is in > sino fresh. Anyonw know? > Murray Grossan, M.D. > http://www.ent-consult.com

Active Ingredients: Cetylpyridinium chloride 0.5% Inactive Ingredients: Benzalkonium chloride, dibasic sodium phosphate, eucalyptus oil, monobasic sodium phosphate, peppermint oil, polysorbate 80, propylene glycol, purified water, sodium chloride, sorbitol solution, spearmint oil and wintergreen oil.

Response:

- Hide quoted text — Show quoted text -> According to http://www.sinofresh.com/content/clinicaloverview.aspx > Clinical Overview > What is SinoFresh? > SinoFresh is a topical antiseptic nasal spray effective against the molds and > bacteria that are most commonly associated with "Rhinosinusitis." The need for > an effective topical antimicrobial in nasal and sinus disease is well > documented because, despite extended courses of systemic therapy, the spectrum > of persistent bacteria and fungi in the nose and sinus is extensive. It is the > persistent extra mucosal colonization that allows these organisms to function > as "living antigens," triggering lgG, lgE, and neutrophil medicated > inflammatory reactions. No other agent attacks the cause of the inflammatory > response except for the dilutional effect of saline irrigation. SinoFresh has > been shown to kill these organisms, essentially on contact. SinoFresh, 1-3 > sprays twice daily, is used as a daily antiseptic nasal hygiene regiment in > patients with chronic nasal and sinus symptoms and in patients who simply > desire a refreshing cleansing of the accessible nasal and sinus mucosa. > What is CPC? > The active ingredient in SinoFresh is a surface active cationic antiseptic, > Cetylpyridinium Chloride (CPC), with antimicrobial activity against bacteria, > fungi, and viruses. CPC has been used in oral rinse products for over fifty > years and it`s safety has been documented extensively. It has been formulated > into topical nasal spray, along with moisturizers and mint aromatics, to be > used as a nasal hygiene product. In Intranasal safety studies to date, and > national chain store distribution, there have been no significant adverse side > effects reported. SinoFresh can also be used in conjunction with other > traditional medications without adverse reactions. The total monthly dose of > CPC in SinoFresh is less than typical daily dose of an oral rinse product > containing CPC. Its surface active properties and proven safety profile in > mucosal applications makes it an ideal agent for intranasal topical use. The > intact SinoFresh product containing .05% CPC was tested in vitro against a > spectrum of bacteria and fungal organisms known to be present in rhinosinusitis > and was found to be both bactericidal and fungicidal, essentially on contact. > Swabs of the middle meatus taken before and after twice daily SinoFresh use has > show clearance of pathogens in as little as 4 days in initial studies. A > visible reduction in nasal mucosal swelling accompanied this antimicorbial > response. > Organisms Killed by SinoFresh in vitro:* > Bacteria > Haemophilus Influenzae > Moraxella Cattarrhalis > Streptotoccus Pyogenes > Staphlococcus Aureus > MRSA Species > Psudomonas Aeruginosa > Escherichia Coli > Fungal Species-inhaled molds > Candida Albicans > Aspergillus Niger > Cladosporium Herbarum > Alternaria Alternata > Pennicillium Finiculosum > Fusarium Solani > Strachyboytris Chartarum > Who My Benefit From SinoFresh Use? > Patients with Chronic non-allergic nasal and sinus symptoms > Mold-allergic and sensitive patients > Fetid breath or nasal odor > Snoring > Travelers > People in close contact with the public > Patients with Chronic recurrent rhinosinusitis unresponsive to systemic > therapy** > * USP Quantitative mini-kill time test – Nelson Laboratories, Salt Lake City > ** These patients may benefit from twice daily antiseptic cleansing of the > nose and sinuses. Not intended as a treatment or proven preventive therapy of > any medical condition.

So does this mean we can just put some mouthwash (Scope which contains Cetylpyridinium Chloride) in a spray bottle and have the same affect? Then we don’t have to worry about the BKC or BKZ ingredient that so many on this board seem to react badly to. A bottle of mouthwash sure is cheaper than a bottle of sinofresh. Probably get that minty-fresh feel afterwards also.

Response:

On 30 Mar 2004 04:51:53 GMT, entcons…@aol.comnospam (ENTconsult) wrote: >I have been to the web site but couldn’t find any reference as to what is in >sino fresh. Anyonw know? >Murray Grossan, M.D. >http://www.ent-consult.com

According to http://www.sinofresh.com/content/clinicaloverview.aspx Clinical Overview What is SinoFresh? SinoFresh is a topical antiseptic nasal spray effective against the molds and bacteria that are most commonly associated with "Rhinosinusitis." The need for an effective topical antimicrobial in nasal and sinus disease is well documented because, despite extended courses of systemic therapy, the spectrum of persistent bacteria and fungi in the nose and sinus is extensive. It is the persistent extra mucosal colonization that allows these organisms to function as "living antigens," triggering lgG, lgE, and neutrophil medicated inflammatory reactions. No other agent attacks the cause of the inflammatory response except for the dilutional effect of saline irrigation. SinoFresh has been shown to kill these organisms, essentially on contact. SinoFresh, 1-3 sprays twice daily, is used as a daily antiseptic nasal hygiene regiment in patients with chronic nasal and sinus symptoms and in patients who simply desire a refreshing cleansing of the accessible nasal and sinus mucosa. What is CPC? The active ingredient in SinoFresh is a surface active cationic antiseptic, Cetylpyridinium Chloride (CPC), with antimicrobial activity against bacteria, fungi, and viruses. CPC has been used in oral rinse products for over fifty years and it`s safety has been documented extensively. It has been formulated into topical nasal spray, along with moisturizers and mint aromatics, to be used as a nasal hygiene product. In Intranasal safety studies to date, and national chain store distribution, there have been no significant adverse side effects reported. SinoFresh can also be used in conjunction with other traditional medications without adverse reactions. The total monthly dose of CPC in SinoFresh is less than typical daily dose of an oral rinse product containing CPC. Its surface active properties and proven safety profile in mucosal applications makes it an ideal agent for intranasal topical use. The intact SinoFresh product containing .05% CPC was tested in vitro against a spectrum of bacteria and fungal organisms known to be present in rhinosinusitis and was found to be both bactericidal and fungicidal, essentially on contact. Swabs of the middle meatus taken before and after twice daily SinoFresh use has show clearance of pathogens in as little as 4 days in initial studies. A visible reduction in nasal mucosal swelling accompanied this antimicorbial response. Organisms Killed by SinoFresh in vitro:* Bacteria Haemophilus Influenzae Moraxella Cattarrhalis Streptotoccus Pyogenes Staphlococcus Aureus MRSA Species Psudomonas Aeruginosa Escherichia Coli Fungal Species-inhaled molds Candida Albicans Aspergillus Niger Cladosporium Herbarum Alternaria Alternata Pennicillium Finiculosum Fusarium Solani Strachyboytris Chartarum Who My Benefit From SinoFresh Use? Patients with Chronic non-allergic nasal and sinus symptoms Mold-allergic and sensitive patients Fetid breath or nasal odor Snoring Travelers People in close contact with the public Patients with Chronic recurrent rhinosinusitis unresponsive to systemic therapy** * USP Quantitative mini-kill time test – Nelson Laboratories, Salt Lake City ** These patients may benefit from twice daily antiseptic cleansing of the nose and sinuses. Not intended as a treatment or proven preventive therapy of any medical condition.

Response:

I have been to the web site but couldn’t find any reference as to what is in sino fresh. Anyonw know? Murray Grossan, M.D. http://www.ent-consult.com

Response:

A doctor told me..

admin — Thu, 04 Jan 2001 00:00:00 +0000

Question:

re the hypertonic solution: A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Adam P. Arch Fam Med, 7(1):39-43 1998 Jan-Feb Hypertonic saline does not improve nasal symptoms or illness duration in patients with the common cold or rhinosinusitis. Thirty two percent of users noted burning and wouldn’t use the product again. Murray Grossan, M.D. http://www.ent-consult.com

Response:

Therefore, tell them how much salt to use. the best instruction on making your own salline are here at the FAQ. You should make your own solution because most of the products contain preservatives and antifungal agents which can irritate. For example these are some of the ingredients: Benzalkonium chloride Thimersal MonoBasic Sodium Phosphate DiBasic Sodium Phosphate Phenylcarbinol Benzyl Alcohol Edetate Disodium Providone Disodium ETA Iodine Sodium Silicoaluminate Thimersal is recommended by the American Academy of Pediatrics to be withdwarn, otherwise can get mercury poisoning. Benzalkonium is known to burn MonoBasic Sodium Phosphate DiBasic Sodium Phosphate must be used at room temperature to avoid chemical percipitation into chemical compounds whose toxicity is not proven ( unfortunately this is in the VERY small print The flip side is that when you use Breathe.ease you have to change the solution every week because there are no preservatives. Likewise when you make your own saline. Isotonic saline is made one teaspoon of salt – kosher or pickling – to pint of water with 1/4 teaspoon of baking soda or soda bicarbonate. At FAQ are instructions to make your own Breathe. ease. too. Murray Grossan, M.D. http://www.ent-consult.com

Response:

In article , Betty wrote: > Don’t know what hypertonic etc. is, but a thoughtful person sent me an > e-mail telling me I had too much salt in it,

Hypo=less than Iso=the same as Hyper=more than A hypertonic salt solution is one that has more salts per unit of fluid than your normal body fluids. An isotonic solution has the same salt concentration as your body fluids, and a hypotonic solution has less. Larry

Response:

Don’t know what hypertonic etc. is, but a thoughtful person sent me an e-mail telling me I had too much salt in it, which I gathered anyhow when I woke up this morning dripping blood. He also told me how much to use. If you are a doctor, maybe you can learn from this. If you tell a patient to use saline solution, the patient may just be smart enough to make his/her own with salt and water rather than spending lots of bucks at the store. Therefore, tell them how much salt to use. Betty S ENTconsult wrote in message

news:20010104205612.14047.00001383@ng-mi1.aol.com… – Hide quoted text — Show quoted text -> sounds like you are using a hypertonic solution. These do smart and may > adversely affect the cilia. Try to make your solution isotonic. Also > hypertonic is especially painful if your membranes are irritated. > Murray Grossan, M.D. > http://www.ent-consult.com

Response:

to use a saline solution spray three times a day. So I put a lot of salt in warm water in a nasal spray bottle. Boy does that stuff smart! Is this normal? Betty S

Response:

You are not supposed to "use a lot of salt". You should mix 1/2 tsp. to a pint of water. Some add to that 1/4 tsp. of sodium bicarbonate. This is a normal saline solution. If you mix it stronger it irritates. The normal solution is the same concentration as in your body. It neither absorbs as with plain water nor irritates as with a too strong solution.

Response:

sounds like you are using a hypertonic solution. These do smart and may adversely affect the cilia. Try to make your solution isotonic. Also hypertonic is especially painful if your membranes are irritated. Murray Grossan, M.D. http://www.ent-consult.com

Response:

FESS

admin — Fri, 17 Oct 1997 00:00:00 +0000

Question:

is there a web site where I could learn more about theFESS surgery? — Peace, Tish ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dreaming permits each and every one of us to be quietly and safely insane every night of our lives.-Charles Fisher

Response:

You can try: http://www.dakotacom.net/%7Efinch/se.htm http://www.sinuses.com/faq.htm#surgery Regards, Michael M. – Hide quoted text — Show quoted text -tweety wrote: > is there a web site where I could learn more about theFESS surgery? > — > Peace, > Tish > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Dreaming permits each and every one of us to be > quietly and safely insane every night of our lives.-Charles Fisher

Response:

On 30 Oct 2003 01:43:24 -0800, turbina…@hotmail.com (turbinates) wrote: – Hide quoted text — Show quoted text ->from http://www.arabmedmag.com/issue-30-06-2003/orl/main01.htm >…. >In conclusion, FESS is not the panacea for all sinus disorders, and >its role has been overemphasized. In allergy-associated chronic >rhinosinusitis, FESS actually aggravates allergic symptoms. We found >FESS to be more troublesome than beneficial because of the incidence >of persistent or even increased postnasal drip. This was probably the >result of the increase in mucosal surface area that became available >for allergen exposure plus the drying effect of the increased volume >of air as a result of overzealous turbinate resection and total >ethmoidectomy. >FENS, on the other hand, provides a safe and efficient method of >relieving obstruction in the nasal passage and osteomeatal complex. At >the same time, it protects the sinuses from allergen exposure, >ventilating them during an allergen-free expiratory phase. It is not >merely a viable alternative in the management of allergy-associated >chronic rhinosinusitis, it is a superior alternative. >…

Interesting article for a different point of view on sinus surgery. (There are quite a few points of view…)

Response:

from http://www.arabmedmag.com/issue-30-06-2003/orl/main01.htm …. In conclusion, FESS is not the panacea for all sinus disorders, and its role has been overemphasized. In allergy-associated chronic rhinosinusitis, FESS actually aggravates allergic symptoms. We found FESS to be more troublesome than beneficial because of the incidence of persistent or even increased postnasal drip. This was probably the result of the increase in mucosal surface area that became available for allergen exposure plus the drying effect of the increased volume of air as a result of overzealous turbinate resection and total ethmoidectomy. FENS, on the other hand, provides a safe and efficient method of relieving obstruction in the nasal passage and osteomeatal complex. At the same time, it protects the sinuses from allergen exposure, ventilating them during an allergen-free expiratory phase. It is not merely a viable alternative in the management of allergy-associated chronic rhinosinusitis, it is a superior alternative. … Better use the netti pot and have along hot shower everyday…I am sure there are also pitfalls in FENS. We are paying them a hefty sum for the experiments that are performed on our bodies. – Hide quoted text — Show quoted text -Don Brady wrote in message … > On Sat, 18 Oct 2003 23:21:02 GMT, "JM" wrote: > >If you are greatly improved, I’d not do the surgery. I’ve had it, and I > >prefer how I felt before. I do not like the sense of air in my nostril > >without the turbinates. It’s loud and the air doesn’t get cooled when it > >comes in. A cold day is hard. The surgery healed with scarring, so in some > >ways the draining is worse now. > To prevent scarring, there need to be follow-ups rights after surgery and then > every week for a month or so for debridement. > If the turbinates are reduced, the reduction should not be excessive and the > mucus should be preserved.. > Unfortunately, people can not necessily expect perfect technique unless they > pick their surgeon only after a careful search…. > >IF you can improve without it, that is saying a LOT.

Response:

On Sat, 18 Oct 2003 23:21:02 GMT, "JM" wrote: >If you are greatly improved, I’d not do the surgery. I’ve had it, and I >prefer how I felt before. I do not like the sense of air in my nostril >without the turbinates. It’s loud and the air doesn’t get cooled when it >comes in. A cold day is hard. The surgery healed with scarring, so in some >ways the draining is worse now.

To prevent scarring, there need to be follow-ups rights after surgery and then every week for a month or so for debridement. If the turbinates are reduced, the reduction should not be excessive and the mucus should be preserved.. Unfortunately, people can not necessily expect perfect technique unless they pick their surgeon only after a careful search…. – Hide quoted text — Show quoted text ->IF you can improve without it, that is saying a LOT.

Response:

If you are greatly improved, I’d not do the surgery. I’ve had it, and I prefer how I felt before. I do not like the sense of air in my nostril without the turbinates. It’s loud and the air doesn’t get cooled when it comes in. A cold day is hard. The surgery healed with scarring, so in some ways the draining is worse now. IF you can improve without it, that is saying a LOT. "Don Brady" wrote in message

news:tib0pv80lvqu04qc13rmrdif1feifnai1p@4ax.com… – Hide quoted text — Show quoted text -> On Fri, 17 Oct 2003 16:43:14 +0100, "Tattyat" wrote: > >Hi there. I’ve suffered from recurrent sinus infections for many years now. > >However after some kinesiology/homeopathy treatment about 18months ago I’ve > >only had 2/3 full blown infections (by full blown I mean streaming green goo > >and feeling awful!). I also douche regularly although not with a water pik > >as I don’t seem to be able to get one in the UK. > >I have been seeing an ENT who specialises in sinuses and sinus surgery. My > >CT scans continue to show congestion, I am slowly loosing my sense of smell > >& I have an almost constant headache with feelings of pressure in my > >sinuses, with a cough and a messy chesty cough especially in the morning. > >However due to not having constant infections and not being on antibiotics I > >consider myself to be greatly ‘improved’ to 2 years ago. The last time I saw > >the ENT an endoscope was used in the office and I was told my sinuses are > >infected and dripping pus! despite the fact I consider myself to be in one > >of my, for me, ‘good’ periods. > >Now to the point. My ENT has recommended FESS to clear the congestion and > >improve air flow into the sinuses, as the area they drain through in the > >nose is very closed up. My worry is that I might end up worse after the > >surgery and whether I should just leave well alone at the moment. > >Any comments / experiences that might help me?? > Whetehr to have FESS is important but equally important is who to have do the > surgery. > It is partly an art not completely a science yet. > I would get at least 2 second opinoions from experts *you* find (not your > doctor). Try a Universirt medcial center. > Mayo is conservative about surgery so they would be good to include…

Response:

If your conditions have IMPROVED compared to two years ago, you should stay away from the surgery option and let your body continue with the repair and compensatory processes. There are just too many unknown with invasive surgery, bad surgeons will make terible mistakes and a even good surgeon can also make very lousy mistakes (from disagnose to the operating table) sometimes. I have learnt this fact after a failed surgery.

Response:

- Hide quoted text — Show quoted text -On Fri, 17 Oct 2003 16:43:14 +0100, "Tattyat" wrote: >Hi there. I’ve suffered from recurrent sinus infections for many years now. >However after some kinesiology/homeopathy treatment about 18months ago I’ve >only had 2/3 full blown infections (by full blown I mean streaming green goo >and feeling awful!). I also douche regularly although not with a water pik >as I don’t seem to be able to get one in the UK. >I have been seeing an ENT who specialises in sinuses and sinus surgery. My >CT scans continue to show congestion, I am slowly loosing my sense of smell >& I have an almost constant headache with feelings of pressure in my >sinuses, with a cough and a messy chesty cough especially in the morning. >However due to not having constant infections and not being on antibiotics I >consider myself to be greatly ‘improved’ to 2 years ago. The last time I saw >the ENT an endoscope was used in the office and I was told my sinuses are >infected and dripping pus! despite the fact I consider myself to be in one >of my, for me, ‘good’ periods. >Now to the point. My ENT has recommended FESS to clear the congestion and >improve air flow into the sinuses, as the area they drain through in the >nose is very closed up. My worry is that I might end up worse after the >surgery and whether I should just leave well alone at the moment. >Any comments / experiences that might help me??

Whetehr to have FESS is important but equally important is who to have do the surgery. It is partly an art not completely a science yet. I would get at least 2 second opinoions from experts *you* find (not your doctor). Try a Universirt medcial center. Mayo is conservative about surgery so they would be good to include…

Response:

Hi there. I’ve suffered from recurrent sinus infections for many years now. However after some kinesiology/homeopathy treatment about 18months ago I’ve only had 2/3 full blown infections (by full blown I mean streaming green goo and feeling awful!). I also douche regularly although not with a water pik as I don’t seem to be able to get one in the UK. I have been seeing an ENT who specialises in sinuses and sinus surgery. My CT scans continue to show congestion, I am slowly loosing my sense of smell & I have an almost constant headache with feelings of pressure in my sinuses, with a cough and a messy chesty cough especially in the morning. However due to not having constant infections and not being on antibiotics I consider myself to be greatly ‘improved’ to 2 years ago. The last time I saw the ENT an endoscope was used in the office and I was told my sinuses are infected and dripping pus! despite the fact I consider myself to be in one of my, for me, ‘good’ periods. Now to the point. My ENT has recommended FESS to clear the congestion and improve air flow into the sinuses, as the area they drain through in the nose is very closed up. My worry is that I might end up worse after the surgery and whether I should just leave well alone at the moment. Any comments / experiences that might help me?? Many thanks

Response:

What is FESS? I’ve never had surgery. Is this an outpatient procedure?? Thanks.

Response:

FESS: Functional Endoscopic Sinus Surgery, generally this is done as a 23 hr Outpatient surgery which means you’ll have one night in the hospital. Surgery one day and then usually the next day the ENT takes out the nasal packing and you go home late that afternoon after the bleeding has tapered off. You’ll be given saline drops to put in your nose and a bulb syringe to suction secretions. My 2 yr old just had it done last week and everything went fine. Good luck Ursula Holleman – Hide quoted text — Show quoted text -David A. O’Neill wrote: > What is FESS? I’ve never had surgery. Is this an outpatient > procedure?? > Thanks.