Nasal and Sinus

Nasal & Sinus | Sinus Infection | Sinus Headaches | SLIT | Allergy Shots

Nasal & Sinus

Overview
Located in the Stone Oak area of San Antonio, TX, Everyone’s ENT & Sinus Center provides pediatric and adult treatment to those suffering from sinus discomfort.

There are four sinus cavities on each side of our head:

  • Maxillary
  • Ethmoid
  • Frontal
  • Sphenoid

The primary purpose of our sinuses is to produce mucous that is taken into the back of our throats with any dust, pollens, bacteria or viruses that have been filtered. When there is a disturbance to this process, sinus infections, sinus headaches, facial pain, nasal congestion and more occur.

Symptoms
The most common symptoms are listed below. We encourage you to make an appointment if you have 3 or more of these symptoms:

  • Sinus infections lasting longer than a few weeks or months
  • Discolored nasal drainage
  • Nasal congestion
  • Mouth breathing
  • Lack of energy/lethargic
  • Headaches
  • Inability to breathe through one or both sides of your nose
  • Facial pain
  • Sore upper teeth

Nasal and SinusEvaluation and Treatment
What will happen at my first visit?

  • A thorough and complete examination/history will be taken
  • Nasal Endoscopy (see video below)
  • Differential diagnosis of conditions
  • Compile a plan to address issues
  • Begin diagnostic testing & treatments

Developing a treatment plan requires the following steps:

  • Medical Questionnaire & History

A. We will discuss your present and past symptoms’ frequencies and severities

  • Nasal Endoscopy

A. A small telescope allows Dr. Gilliam to look for obstructions and abnormalities

B. Dr. Gilliam can see down your throat to your vocal chords (laryngopharyngeal reflux may be a cause of recurring sinusitis)

  • CT Scan

A. Looks within the sinus itself

B. Gives a look into the future of your sinuses

C. Dr. Gilliam can see the structure/anatomy of the sinuses along with possible mucosa or fungal issues.

  • Allergy Testing

​A. If you are already seeing an allergist, Dr. Gilliam will work with them and keep them well-informed of our plans. If you do not have an allergist, we will conduct testing and treatment to your problems

  • Medical Treatment

A. Once a diagnosis is made, a custom-tailored treatment plan will be recommended i.e. nasal irrigations, nasal steroids, decongestants, antihistamines, and antibiotics

B. We will try to cure inflammation with medications. However, if this is not possible, surgery may be necessary

A. Abnormal anatomy from birth, disease or trauma cannot be corrected with medicines. Therefore, surgery may need to be considered

B. Several Surgical Options:

i. Balloon Sinuplasty

ii. Endoscopic Sinus Surgery

iii. An Image Guidance machine may be used to get areas that have been changed with prior surgery, nasal polyps or anatomic abnormalities

iV. More aggressive surgical treatments

  • Continued Follow-Up

A. Re-examination can help detect inflammation, scarring, and polyp problems before you begin to show symptoms

B. We help provide you with a long term resource for your sinus problems

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Sinus Infection

Overview
Chronic and recurrent sinus infections can cause severe facial pressure, congestion and drainage, as well as headaches and exhaustion. The negative affects of this could be costly if required to miss school or work for multiple doctors’ appointments.

What are sinus infections?
Sinus infections are a result of bacteria growing in the sinuses. All of us have bacteria and fungus in our nose; however, the number of sinus infections we get determines the way our body filters and removes them. Allergies, irritants, a poor immune system and abnormal anatomy are all contributing factors to sinus infections. A combination of these things is what brings you to us. The occasional sinus infection is normal, but when you suffer throughout the year or get an infection consistently is when it is time to make an appointment.

Treatment
Medical management can consist of three weeks of antibiotics, nasal saline flushes, steroids, nasal steroids, and/or antihistamines used to treat sinus infections. Simply because you have a sinus disease does not mean you have allergies. Also, if you have allergies and are going through treatment and continue to show symptoms, you may have a sinus disease that needs to be taken care of. Dr. Gilliam will look at these factors to determine the full scope of your situation.

The sinuses are still present after surgery unlike many operations that remove a structure. Some diseases are very persistent and may require more than one surgery. For the majority, the need for additional surgery is due to lack of medical management after surgery. This is extremely vital to the success of treating sinusitis. Here at Everyone’s ENT & Sinus Center we are here to help before, during, and after surgery.

Anti-fungal treatments may be necessary and patients with polyps have overactive mucosa, which will need maintenance therapy to prevent recurrence.

Surgery for Sinus Infections

  • Balloon Sinuplasty
  • In office procedure under local anesthesia
  • Endoscopic Sinus SurgeryOutpatient basis under general anesthesia1-2 hours Recovery of 1-2 hoursNo incisions, swelling, or bruising to the external face

What To Expect During Sinus Surgery Recovery

  • Sleep elevated for the first 203 nights to help with drainage and swelling
  • Begin to flush debris out of nose the day after
  • No school/work for 1 week
  • Follow Up visit 1 week after surgery
  • No heavy lifting, exercise/physical activity for 2 weeks
  • Second follow up visit 2 weeks after surgery
  • No flying for 3 weeks
  • Complete healing can take up to a month

–A pain medication will be prescribed after surgery, but many patients do well with simply Tylenol after the first couple days.–Patients with diabetes or patients who smoke may have a longer recovery time

What to Expect After Surgery/Recovery

  1. Approximately 80% of patients feel better and experience fewer or less severe infections after surgery.
  2. Sinus surgery has proven to be beneficial for 95% of patients with sinus infections
  3. Minor bleeding is common after sinus surgery. Excessive bleeding and re-operation are rare. Only 1-2% of patients experience severe complications that may include meningitis, tearing problems, double vision or blindness.

Learn more about Sinus Surgery at one of the following links:

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Sinus Headaches

Overview
Sinus headaches are very annoying. In their mildest forms, they respond to over-the-counter decongestants. In their more severe forms, they require aggressive treatment with prescription medications. Headaches can be frustrating to treat because they can be difficult to distinguish from migraines or other forms of headaches.  The severity of the headache does not always correlate to the severity of the underlying sinus disease.  There are alot of patients with severe sinus disease with minimal headaches, while others experience headaches with simple weather/barometric changes.

Treatment
When medically treating sinus headaches, I am treating the swelling and congestion in the sinuses that is often the cause of the headaches. Treatment may include nasal saline flushes, nasal steroid sprays, decongestants, and/or antihistamines. Many people find these medications adequate to control their occasional sinus headache. Since the list of causes for headaches is so long, allergy testing (and allergy shots if indicated) or a CT scan of the sinuses could be beneficial to determine if there are anatomical reasons for your headaches.

Surgery for Sinus Headaches
Balloon Sinuplasty has made a large difference for patients with sinus headaches.  Previously, we had to weigh the risks of surgery vs. the possible benefits of surgery.  With Balloon Sinuplasty, the treatment options for patients have greatly improved. 

There are several different types of sinus surgery, and after a complete evaluation, we will create a surgical plan tailored to meet your individual needs.

What to Expect During Recovery
You will need to be off work/school for one week.  Two weeks free of heavy lifting, exercise/physical activity, and no flying for 3 weeks post surgery.  Sleeping elevated for the first 2-3 nights helps with drainage and swelling.  The day after surgery, the patient will start flushing to get all the debris from surgery out of the nose.  Many patients have described recovery to feel like a bad head cold with facial pressure, congestion and possible headaches.  A pain medication will be prescribed after surgery, but many patients do well with just Tylenol after the first couple of days.

We will schedule a follow up visit at one week after surgery, and then again at two weeks post surgery.  Even though you may be "feeling" better a week after surgery, complete healing can take up to a month. Patients with diabetes or patients who smoke may experience a longer recovery time.

What to Expect After Surgery/Recovery
When sinus surgery is performed because of an infection, approximately 80% of patients feel better and experience fewer or less severe infections. Sinus surgery has proven to be beneficial for up to 95% of patients with sinus infections.

Patients having sinus surgery for other reasons, such as severe headaches or the removal of polyps.  The success rate varies, but research still shows the majority of patients benefit from having sinus surgery.

Minor bleeding is common after sinus surgery. Excessive bleeding that requires hospitalization and re-operation are rare. While severe complications are very rare (1-2%), they may include meningitis, tearing problems, double vision and blindness.

Learn more about Sinus Surgery at one of the following links:

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SLIT Sub-Lingual-Immuno-Therapy

Overview
Allergies affect millions of patients. Medicines do not cure the problem, and it is not always possible to avoid the cause (such as grass pollen). Desensitization (immunotherapy) is currently the only way of “teaching” the immune system to tolerate allergic triggers. 

How The Treatment Works
Our immune system responds to substances in our environment that we eat, drink or inhale. By giving small but increasing amounts of those allergens at regular intervals, tolerance increases. On re-exposure to the allergens, symptoms may be milder or not occur at all.

How can this be done? 
Immunotherapy has been given by injection for more than 60 years and many studies prove that it is effective. A number of studies published have shown that sublingual immunotherapy (SLIT), where drops of the allergen extract are retained under the tongue for a few minutes, then swallowed, can also be effective. This form of treatment has a longer history of use in Europe than in the United States, where it is used more commonly than injected immunotherapy. 

Who should have immunotherapy?
Immunotherapy is indicated in people when:

  • Allergy is severe
  • The cause is hard to avoid
  • Reducing exposure to allergenic triggers is only partially effective
  • Medication does not work
  • Medications cause side-effects, or a person would prefer to avoid medication.

Why chose sublingual (SLIT) instead of injected immunotherapy?
The potential advantages of sublingual treatment are those of no injections, fewer regular doctor visits, no waiting periods after the injections, and a more natural way to intake the allergen. The main disadvantage of this form of treatment is cost; currently SLIT is not covered by insurance. If you have a high deductible your out of pocket expense may be the same or less than with shots. Some people also dislike the taste. On the other hand, this needs to be balanced with time, cost, and convenience of drops over shots. 

How long does it take?
Improvement does not occur immediately. You are training your immune system which takes time. Any immunotherapy is a 3-5 year commitment.  Your first allergy season after starting immunotherapy may only be slightly less than normal, but with each season you will notice the benefits.  Your symptoms are better controlled, and less medication is needed.

Can you still use medicines as well?
Yes. You can still use your usual allergy medicines. Symptoms will still need to be controlled with medications as your immunity is improved.

Common methods for taking the allergen extracts include:

  • Take in the morning on an empty stomach.
  • Keep them under the tongue for at least 2 minutes, then swallow.
  • Do NOT eat anything for 15 minutes.
  • Avoid crunchy cereals, as these may cut the tongue and increase the likelihood of mouth irritation from the extracts.
  • If you forget to take them in the morning, take them before bedtime instead.

Risks and side-effects of SLIT:

  • Salty or unpleasant taste - to make it more acceptable, children can suck on a sweet at the same time.
  • Irritation or itching inside the mouth - this can be controlled by temporarily reducing the dose or taking an antihistamine beforehand.
  • Upset stomach- allowing the drops to absorb in your mouth prior to swallowing decreases this risk.

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Patient Information on Immunotherapy (Allergy Shots)

From Expert San Antonio & Stone Oak ENT Doctors
Allergy shots (Immunotherapy injections) are administered to allergic patients who have symptoms that affect their quality of life. As an experienced San Antonio allergy doctor, Dr. Gilliam knows that some allergic patients may not need allergy shots for treatment of their symptoms. If however, medications and/or environmental changes are not sufficient to minimize symptoms, allergy shots may then be the most effective option available. In persons who require multiple medications to control their symptoms, allergy shots may actually be a cost saving option when considering the pharmacy "co-pays" and the out-of-pocket expense of "over-the-counter" drugs such as "Claritin" and "Allegra."

About Allergy Shots
Immunotherapy is usually very effective for the treatment of nasal allergies and approximately 95% of patients will improve on shots. Immunotherapy "turns off" the allergic reaction to pollens, molds, dust mites, and animal dander over time. This is accomplished by the frequent administration of the material to which the patient is allergic. During the "build-up" phase of immunotherapy (the initial 6 to 12 months on the allergy injections), there is a gradual decrease in sensitivity to allergens. Unfortunately, up to 50% of patients with true "Allergies" (Allergic Rhinitis) also suffer from "Non-Allergic" rhinitis. Allergy shots do not treat the symptoms of "Non-Allergic" Rhinitis caused by sensitivity to environmental irritants. Nasal symptoms triggered by weather changes, tobacco smoke, perfumes, strong odors, exercise, diesel fumes, spicy food, dust, dirt and other irritants, may require medical treatment while on allergy shots. Immunotherapy is the only real treatment for the underlying cause of allergies. Antihistamines and other medications try to stop the reaction after it has already started. Immunotherapy (allergy shots or allergy drops) try to prevent the reaction from ever starting.

Getting Allergy Shots
Immunotherapy shots are usually administered in the upper arm. During the "build-up" phase, these shots are given once a week using a schedule of progressive dosage increases until the "maintenance" dose is reached. Once you are on the maintenance dose, the time between injections can be increased, attempting to make the shot administration once or twice per month. Maintaining your shots at the proper time interval is very important, however, missing shots for a short vacation or because of some other problem is usually acceptable. Missing shots may require temporary dosage reductions. Allergy shots are generally continued for a period of three to five years; after which your doctor may consider discontinuing the allergy shots for an observation period. Symptom control along with repeat testing, helps determine when immunotherapy can be discontinued.

Side Effects Of Allergy Shots
Immunotherapy injections may be associated with various types of side effects. Side effects are usually more common in the most severely allergic patients and in those with asthma. The most common side effect is swelling or inflammation at the injection site. These "local" reactions almost always improve over time. Allergy shots may occasionally be associated with more serious generalized "systemic" reaction(s).

Symptoms or signs of these reactions may consist of hives, body tissue swelling distant from the injection site, increasing asthma symptoms, abdominal pain, diarrhea, dizziness and even loss of consciousness. Life-threatening reactions are extremely rare. However, it is very important to carry your Epipen at all times if receiving immunotherapy (allergy shots or drops). It is also vital to follow all doctor/ clinic instructions and let them know of any and all reactions. Our office is prepared to treat any serious reaction that our patients from San Antonio or Stone Oak may develop, but if the allergic symptoms do not respond quickly to our treatment, it may be necessary to transport you to the nearest Emergency room for further monitoring.

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