Talk:Sinusitis

Effect of water

Water is a good expectorant, as it thins mucus. This effect of water on mucus is also relevant to articles such as sinusitis and nasal mucus (logically, and based on personal experience). However I can't find suitable sources (only this commerical link). --Singkong2005 04:51, 20 April 2006 (UTC)

Nasal flush section

I haven't deleted it, but is this article really the place for this piece of first-person free-form medical advice? You wouldn't find it a "real" encyclopedia.

Added: I'm deleting it. It's covered under the Nasal irrigation article, which is linked in the "Treatment" section.

Doctors for three family memebers (father, father in-law, and cousin) independently recommended this "nasal flush" treatment for their cronic sinusitis All three were cured, where antibiotics and steroids had failed. In addition, the flush helps alleviate my allergy symptoms.

Nasal irrigation (or flush) should be covered on the main topic page under treatment. It is non-invasive, simple, safe, generally effective, and should be tried before more intensive treatments are considered. Placing a standard treatment in a "linked" article is a disservice to wiki readers.

That section wasn't even trying to be encylopedic. Wikipedia is not your personal medical advice column. Cheapestcostavoider 16:11, 24 June 2006 (UTC)

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'''STEAM, PRANAYAM AND GARGLES''' I have experimented with cabbage steam and breathing exercises and regular gargling with lukewarm salt water(mild)...hope you find this helpful, plus this is not gonna harm anyone in anyway.Contact hemant_devi@rediffmail.com

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Dietary considerations

As the first point of contact the environment has with the immune system, the respiratory track can become hyper-reactive if there is an underlying weakness in the immune system. In Chinese medicine, under-performing kidneys (the source of che - energy) can be an explanation for the root cause of auto-immune dysfunctions such as sinusitis and asthma. Why under-performing? A weakness, perhaps genetic, environmental, or social (e.g. stress) further complicated by dietary elements that depress the kidney function (sugar, alcohol and cold drinks/food). Improving kidney function through dietary changes and acupuncture can resolve sinusitis as well as numerous seemingly unrelated problems.

This is just an experiential commentary, someone with training in traditional chinese medicine should really elaborate and include in the main article as a treatment.

— Preceding unsigned comment added by 203.149.69.210 (talk • contribs) 07:29, 30 October 2006

Sinus Headache vs. Migrane

This section seems to be opinion-based and makes unsupported (not to mention unclear) claims. "Headache is rarely a symptom of sinusitis and a 'sinus headache' is often a misdiagnosis of a migraine." -- does this mean that sinusitis rarely causes pain? That needs some citation to back it up. If it means that "headache" is not the appropriate term for the pain caused by sinusitis, then the distinction between the two needs to defined clearly.

Similarly "Recent studies indicate that approximately 90% of 'sinus headaches' are migraine headache" is a surprising statement that lacks citations (not to mention an explanation as to the methodology for arriving at such a conclusion). - Leonard of Vince 01:25, 6 December 2006 (UTC)

I provided two references. There are many others. E4043 00:50, 12 December 2006 (UTC)

Okay. I've edited "approximately 90%" to "the majority", consistent with the article cited.

I still have concerns about "Headache is rarely a symptom of sinusitis." If this means "sinusitus does not cause pain" then a citation is needed for this statement. If it does not mean that, then it needs to be re-written. - Leonard of Vince 21:54, 14 December 2006 (UTC)

Biofilms

Biofilms are fascinating, but I am really not sure current long discussion in article is appropriate.

• The description seems overly lengthy compared to rest of discussion on the types of sinusitis.
• Is much of the explaination as to what biofilms are off-topic (i.e. should be under Biofilm to which there is a wikilink) ?
• Is discussion of biofilms one line of research whose relevance to clinical practice (investigation and treatment) in humans (vs researching on mice) has yet to be established ? The individual studies are cited, but the overall discussion of biofilm's role and implications for management is not cited and seems to breach WP:NOR#Synthesis of published material serving to advance a position. David Ruben ^Talk 03:25, 23 December 2006 (UTC)

All Cited Results Were from Human Samples

I detect a straw man.

I would point out that none, repeat 'NONE of the cites in the biofilm section refer to experiments on mice'.

For example, one of the titles who someone (maybe you?) removed was

'Bacterial biofilms on the sinus mucosa of human subjects with chronic rhinosinusitis.'

The work was preformed at Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California 92134-2200, USA.

All the cites report on the results of observations on tissue removed from 'human' patients during sinus surgery.

It would seem that someone is advancing a position to exclude valid findings creditable sources about the actual nature of sinusitis in 'humans'.

(By the way, since rodents express high levels of vitiman C in their epi cells they are immune to the sort of crud that humans get, so they are poor experimental subjects for this sort of work.)

— Preceding unsigned comment added by Truehawk (talk • contribs) 02:03, 24 December 2006

Sorry, indeed I need offer an appology for false allusion to non-human studies (that was in a separate topic I was editing around the same time and I clearly mixed up my notes over this point). However the length of discussion of biofilms is out of proportion to discussion of acute sinusitis or current generally accepted understanding of chronic sinusitis (remember wikipedia does not report the scientific point of view - see WP:SPOV), and much of it would seem better in the article biofilm, with this article linking to that page.

• Ref 2 PMID 16826045 concludes "The presence of biofilms on the mucosa of patients with CRS offers a possible cause of antimicrobial therapy failure and could change the approach to treatment. However, the presence of biofilms on healthy control samples implies that biofilms may simply be colonizers. The precise role that biofilms play in CRS still remains to be determined. Further studies with larger sample sizes are needed." which is far less definite than it being used to verify the article's sentance of "the cultures were negative though the bacteria were present" used to imply that seeking negative cultures has been a misguided approach to understanding the true nature of chronic sinusitis (the removed opinionated text being "The governing paradigm within the oralangyeal community is that if it cultures are negative and treatment with antibiotics fails, then the condition is autoimmune, or paradoxically an immune deficient condition. Only a well-documented test that puts biofilm detection within the abilities of the clinician will allow patients with biofilm sinusitis to be diagnosed as having an infection rather than an allergy, and receive more effective treatment.")
• Ref 5 PMID 17074796 refers to a case of "an indwelling nephrostomy tube", clearly a point about biofilms but not as they apply to sinusitis. ^Talk 02:05, 24 December 2006 (UTC)

David:

Thank you so much for your help!

I will clarify if I may.

1. The sentance "the cultures were negative though the bacteria were present" is simpally a restatement of the sentance in the cite.

"The intraoperative cultures of the planktonic bacteria present in the sinuses did not correlate with the biofilms identified." [1] How would you interpert that sentance? If the cultures had been positive for the same bacteria found in the biofilm, then the culture results WOULD have been correlated.

2. The presence of biofilms in 2 out of 10 healthy controls indicates that some people have biofilms that

A. Do not express high levels of tissue disolving enzymes, (bacteria very wildly in their expression of these enzymes from strain to strain), or

B. that the biofilm is not yet big enough to cause noticeable disease. You well know that staph a. is often cultured from asymptomic healthy patients. That does not mean that staph A. does not cause disease. Nor does the presence of possibly non-agressive biofilms in healthy patients mean that other species varients found in biofilms in CS patients are not sufficent to cause all the sinusitis symptoms observed.

It is possible to culture the biofilm with the proper flow rig, and it is possilble to assay the films for the production of protein disolving emzymes. It should be possible to divise a EP test to differentate bacterial mucus from the product of human goblet cells. This work just has not been done yet, and needs to be funded. It needs to be done.

3.The artical that mentions the indwelling cathater illustrates that the piliated bacteria in biofilms can trade plasmids containing resistance factors like kids trade pokemon cards, and thus readily confer resistance to the whole biofilm. It reasons that biofilms in sinus patients would share this property with those recovered from indwelling cathaers from human patients. Are you proposeing that bacteria in biofilms in the sinuses would abstain from the plasmid swapping (bacterial sex) shown to be carried out by the same species in biofilms found elsewhere in the body?

Would it be a mischaracterization to state your position thus: "biofilms are irrevelant until proven otherwise"?

Fine, but there is a catch 22 here. I would LOVE to see a well designed epidimoligical study of a thousand patients characterizing their biofilms, and the enzymes that they produce. (pretty much regardless of the specific species), but as long as the information about biofilms in CS patients remains largely unknown, then the work that would conclusively prove the revelance of biofilms has little chance of recieveing the level of funding that would allow it to proceed rapidly to produce the absolute proof of relevance that you desire. It involves people actually 1. running across the information, and 2. getting funding for the study.

It should also be noted that despite looking for it for years, objective data is thin throughout the field. For instance if you know of studies that assess the outcomes of sinus surgery and allergy shots by CT or MRI before and after treatment, I would appreciate if you would post the link here. When trying to assess outcomes I found one draft of an a committee report on assessment of sinus surgery that changed the criteria for success from something like "a 50% or better resolution of symptoms", to defining success as "symptoms get no worse", and a widely quoted report showing the effectiveness of allergy shots is based on entirely on the self-reports of patients who completed a certain number of weeks of allergy shots. (Not exactly your double blind placebo controlled trial.)

All statements are true for a given value of truth and words are slippery things if you don't know precisely how they are being defined. — Preceding unsigned comment added by 74.226.209.27 (talk • contribs) 08:59, 14 January 2007 (UTC)

Re consensus in the medical community, it was not so long ago that there were medical books describing the sinuses as "sterile", and containing statements such as "99% of bacteria can not be cultured, however the medically important bacteria can be cultured." or words to that effect. Given individuals of integrety and good will, the quality of the consenus opinion is of the same quality as the information on which it is based. Which brings up an series of related questions. Is medicine an evidence based, scientific dicipline, or a democratic debating society? Does it function for the good of the patients, or the good of the medical community? Does the medical community, occupying a position of public trust, and being considerably funded from the public til, have a responsibility to agressively presue research that might elucidate a cause and result in a cure of this notoriously difficult and presistant disease? Don't patients deserve treatment based on a consensus of those informed with the best information? Because the corrolation between biofilms and sinusitis is strong in the work done so far, and yet information is so realatively unknown, I believe it would be irresponsible to remove this section, which hopefully will attract additional attention and funding to this area of research. Truehawk Dec 25, 2006

This critism of "our" (ie modern medical peractice) understanding may or may not be correct - but wikipedia is not the place to carry out that argument or change of opinions - it is just an encyclopedia that mirrors current knowledge (even if that is incorrect). David Ruben ^Talk 13:40, 27 April 2007 (UTC)

Sinusitis Edits

David It is painfully obvious that you did not read the artical.

"The Penn research team demonstrated the disruptive action of SMase in frog oocytes (egg cells) engineered to place CFTR in their membrane. These oocytes are an experimental tool that allows the researchers to assess the flow of ions across the membrane by measuring electrical current. The researchers found that direct exposure of the CFTR-containing oocytes to SMase of Staphylococcus aureus and Bacillus anthracis bacteria shuts off the electrical current passing through not only the normal, but also the CF-causing mutant CFTR.

The next step for the research team is to develop specific inhibitors against the bacterial SMase and test the idea in an animal model."

1.The meat of the sentance about staph reads that Staph is capable of interfering with ion flow in the absense of any genetic abnormality of the host. This effect is not site dependent, in fact it is not even species dependent in that one of the studies I cited refered to work done on the effect of staph Smase on ion transport in frog eggs engineered to express CFTR. The bug does not care where the cell it situated. Staph A has all the viralance factors in inventory to interfer with normal epithiel mucus flow, in the lungs, in the sinuses whatever, and this by the way explains why only 50% of the people with Cystic Fibrosis have any anomolies in the TMCF gene, but that in NO way diminishes the applicability to sinusitis.

2. It is IRRESPONSIBLE to ignore the limitations of the current "gold standard" tissue stain and bacterial culture techniques to the point that those limitations have been FORGOTTEN. It knocks the old 'either this or that, not this, so that" chain of logic into a cocked hat because it is not either this or that by a long shot. The false negatives for cultures where the bacteria are present but have formed Voltron and settled down to a biofilm are very high, because unless that currate happens to scrape right on top of it they will not be picked up.

By the way, in 1981 a researcher for the CDC named Couch who worked in Epidimology published a study linking flu, and staph to chronic respitory infections. He published and then retired and nothing was done with the data. If more attention had been given to it we might have a staph vaccine by now.

AND In addition to the links I posted you really need to go here, to that wild and crazy Center for Biofilm Engineering website funded by that hotbed of specioius activity the US National Science Foundation.

http://www.biofilmsonline.com/cgi-bin/biofilmsonline/ed_misconception.html

A Biofilm Primer

HTML Printable Version PDF Printable Version

A misconception A science based largely on an artifact. Over one hundred years ago, Robert Koch made one of the most important conceptual and technological breakthroughs in the history of microbiology. He developed the methods to create a solid nutrient media in order to grow and isolate pure cultures of microorganisms.

The importance of this discovery to advances in medical, agricultural and industrial microbiology would be hard to overestimate. The dividends these techniques returned have positively affected the lives of nearly everyone on the planet. The training of generations of microbiologists has been based, to a significant degree, on the investigation of the properties of pure cultures and the elucidation of the properties of these organisms one at a time. As productive as this strategy has been, it tends to perpetuate a misconception. In fact, pure cultures are virtually absent in nature.

This suggests that most of what we know about microorganisms has been learned under laboratory conditions that are not representative of how microorganisms are found in nature. Microorganisms, like other organisms, exist in assemblages or communities where a variety of interactions exist. Mutualism, commensalism, antagonism, and saprophytism are but a few of the more common interactions known to exist among microorganisms and multicellular organisms.

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You really need to go over there and take a read. —The preceding unsigned comment was added by Truehawk (talk • contribs) 08:18, 27 April 2007 (UTC).

I did read the links given, and to accuse me otherwise is a breach of WP:Assume good faith. Indeed I thought they made interesting reading. The problem is of making the jump from a generalised point from general research to a role in a specific condition - whilst this may be the case (as in, it may be clinically relevant), to actual add into the article that this is the case is precluded under the WP:No original research guideline (whether or not it is true). In order to add into the article, one would need to cite from a reliable source a third party so states that the general research points apply in sinusitis.

Secondly the idea of biofilms, is as you correctly point out, is not generally considered by current microbiologists. This would make the idea that biofilms have an important role in sinusitis therefore a minority opinion. WP:NPOV guidelines of course require mentioning of non-trivial minority points of view, but not equal space in the article. Wikipedia does not follow Scientific point of view, nor is it a place to argue to correct current generally-held misunderstandings. So even if the current accepted majority view is totally wrong on something, in an encyclopaedia, that viewpoint is still the majority point and should have the greatest coverage in an article - wikipedia follows and mirrors the real world, it does not lead research and changes. Of course if and when the majority accept an updated view point, and one can cite reliable sources to verify that this is so, then the wikipedia article would need to be edited to reflect the change in knowledge.

I don't therefore disagree with you that biofilms may have a more improtant role than until now appreciated, but it is not the majority view point, and the wikipedia policies and guidelines place limits on what & how information should be included in articles. To continually reinsert the contentious points as "truth" without refereneces to confirm the majority acceptance of the information would therefore seem POV pushing. The links might be better in the article biofilm as they are clearly directly relevant (without the jump in applicability). Can other editors please add your thoughts too....David Ruben ^Talk 13:40, 27 April 2007 (UTC)

I read through this article after David Ruben posted a request for input on WikiProject Clinical medicine. I must say, I agree with David that some of the material added in the "Biofilm" and "diagnosis" sections is not appropriate for the article. While of possible interest to a specialist, I think those passages violate WP:NOR - specifically WP:SYN as well as WP:NPOV#Undue weight. There are likely many hypotheses about the etiology of sinusitis, but the author of those passages has devoted several paragraphs to a few particular hypotheses, which are not discussed in full by any of his sources. His hypotheses, rather, are novel syntheses of several primary sources which require specialist knowlege to interpret, and do not seem to be part of the mainstream medical consensus on sinusitis. Some obviously POV statements are made (e.g. UPenn researchers "solved the mystery"). Also, some of the papers he refers to (e.g. the 2002 Mayo Clinic study on CFTR) are not properly referenced, and not all of the reference links work. I would reccomend removing these sections to the talk page for further discussion & improvement, and possible deletion from the article or placement in a more appropriate article (e.g. Biofilm). -Rustavo^{Talk/Contribs} 22:20, 27 April 2007 (UTC)

While some of the biofilm ideas being discussed here are interesting, there are a couple of problems. I'm seeing a lot of primary sources (studies) being cited, and then conclusions being drawn which the authors themselves don't even come close to making. Wikipedia is not the place to propound original or unsourced theories of disease, nor to synthesize primary sources to advance a claim not made by the authors. It would be best to try to locate reliable secondary sources (e.g. review articles, medical textbooks, etc) discussing the importance of biofilms in sinusitis.

The other issue is one of undue weight. I'd wager you could look through the entire entry on "sinusitis" in an Infectious Disease textbook and not come upon the word "biofilm" (I tried it in Cohen & Powderly just now). Wikipedia is supposed to reflect the current state of knowledge, not get out in front of it. If medical/ID textbooks don't mention biofilm, then we probably either shouldn't mention it either, or should mention it very briefly. MastCell ^Talk 22:36, 27 April 2007 (UTC)

There are some 21 articals indexed under biofilm sinusitis in Pubmed.gov. There are several review articals in that body of work. I gave links and citations for each statement. The fact that you deleted the link and then post a "citation needed" icon is "interesting" to say the least. Is this indictiative of the quality and mindset of med students?

Since the majority of commentators seem to agree that the biofilm section needed a trim, I took a crack at it - I tried to capture the essence of the author's point without going beyond the evidence presented to support it. -Rustavo^{Talk/Contribs} 22:27, 29 April 2007 (UTC)

A New Hope

I remember reading a report that stated that fungi had a difficult time attaching to epitheal cells unless heavily piliated e coli or K. pneumoniae were present. [[2]] For years I have followed with a great deal of interest the progress of e.coli vaccines, only to be disappointed that the no vaccine has been lisenced and widely offered. Diarrheal diseases caused by e coli and shingilla represent a major threat to infants in the less developed countries. It would be interesting to see if these vaccines also would also protect against attachment of biofilms in the sinuses and elsewhere such as against uropathic e coli kidney infections. If it works, together there might be enough business to actually get the vaccine on the market.— Preceding unsigned comment added by 74.226.209.27 (talk • contribs) 08:59, 14 January 2007 (UTC)

Such a vaccine would be great (although it's hard enough to get people to vaccinate their kids with the vaccines we already do have). However, Wikipedia is not a crystal ball, so I don't think this that such speculation has any direct relevance to the sinusitis article at present. MastCell ^Talk 22:05, 27 April 2007 (UTC)

Expectorants to help with sinusitis.

I have suffered from sinus problems for most of my life, and have had many sinus infections. In fact, I currently have one. I have learned, however, that treating with antibiotics causes a host of other problems and I would rather deal with the sinus infection than the side effects from the antibiotics. As a result, I have discovered and researched a few home remedies. In addition to those mentioned in the article, I have found that honey works as a wonderful natural expectorant. The post-nasal drip and coughing I usually experience with a sinus infection are greatly relieved by drinking lots of hot tea with about 2 teaspoons of honey added to each mug. It makes my coughs more productive than tea alone and loosens up mucus. I start my day with 3 mugs of this mixture and promptly begin coughing up the stuff that is congesting my chest. The cough and congestion subside. I usually repeat this 3 times a day. I have also found that avoiding foods and drinks that cause mucus to form is helpful. For myself, dairy products like milk seem to be the biggest culprits. This combination works much better for me than over the counter expectorant medications which seem to do little to no good. Also a saline nasal spray or neti pot help greatly with nasal congestion. Owlgirlie 20:01, 30 April 2007 (UTC)

Glad you have found measures to help you, as for the article - see WP:MEDRS for details on appropriate reliable sources to cite from in order to verify (vs personal experience which only counts as original research) :-) David Ruben ^Talk 22:21, 30 April 2007 (UTC)