Do you have sinus problems?
You’ve gone to your primary care doctor and you’ve been prescribed multiple courses of antibiotics which stopped working. You’ve gone to an ear nose, & throat surgeon and you’ve been prescribed more antibiotics, allergy meds, and decongestants which also stopped working. You’ve even had a CAT scan of your sinuses which came back normal. Your symptoms can be interpreted as chronic sinusitis, but why was the CAT scan normal?
Currently, recommendations for chronic sinusitis that antibiotics don’t help is to consider sinus surgery. But not all sinusitis is from an infection. It may be linked to obstructive sleep apnea (OSA) and reflux if you also have chronic daytime tiredness, you snore, you have morning headaches, you have reflux, and you have anxiety attacks.
There is an interesting phenomenon. Patients who continue to have sinusitis symptoms after sinus surgery have a high rate of having OSA. Most of these patients have had snoring and sleep problems prior to the development of their current sinus problems.
We know that there is a link between OSA and acid reflux, and acid reflux causes inflammation of the upper airway. This combination can make the sinus symptoms worse. OSA can aggravate reflux which, in turn, can aggravate sinusitis, and can increase OSA. Acidic stomach juices reflux into the throat which causes swelling and leads to more OSA. And if the patient has tonsils, these tonsils swell, leading to more OSA, leading to more reflux, leading to more sinusitis and the cycle continues!
What is refluxed from your stomach is acid around a PH of 2, bile, digestive enzymes which include pepsin, and bacteria. Pepsin has been found in the middle ear in patients with chronic ear infections. Pepsin has also been found in patients with chronic lung disease.
So, it makes sense that if you have unresolved symptoms of sinusitis, reflux, snoring, and excessive daytime tiredness, you should be tested for OSA. This is simple and can be done in a sleep lab or more conveniently with an at-home sleep test. And if you test positive for OSA and get treated for it with, for instance, an oral appliance fitted by a qualified dentist, the reflux and sinusitis symptoms may be eliminated.
Next week we will be talking about the relationship between OSA and sudden cardiac death.
