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)

---

'''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

---

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.

1. The presence of biofilms in 2 out of 10 healthy controls indicates that some people have biofilms that 1. Do not express high levels of tissue disolving enzymes, (bacteria very wildly in their expression of these enzymes from strain to strain), or 2. 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.

1. 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.

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 ````