If you suffer from sinus issues but are reluctant to go to the doctor, we encourage you to listen to this week's audio blog. We spoke to Dr. Joorabchi about the most common sinus disorders, how they're diagnosed, and some incredible new treatment options to find relief.
Shelby Stockton (00:01):
Welcome to the South Florida ENT Audio Blog. I'm Shelby Stockton. Today, I spoke with otolaryngologist, Dr. Sina Joorabchi, about sinus disorders. He told me about the most common sinus issues that he deals with in his office and how he goes about diagnosing them. We discussed treatment options and some cool new technology that makes treatment easier, less painful, and quick. If you've been dealing with sinus issues, take a listen.
Shelby Stockton (00:25):
Dr. Joorabchi, thank you so much for spending some time with me today.
Dr. Sina Joorabchi (00:29):
It's my pleasure, Shelby. Thanks for having me.
Shelby Stockton (00:31):
Of course. I have a few questions for you. I'd like to know what are the most common sinus disorders that you see in your office?
Dr. Sina Joorabchi (00:40):
The most common sinus disorders that I see? Well, I live in South Florida. And so if you look at a map of the incidence of allergy, we're in the deep red, as far as the amount of allergy, we see. So allergic rhinitis is definitely at the top of the list, and that's just a fancy word for an inflammation of your sinus linings. And so what happens is your nose breathes in these allergens, and then it just starts to react. It starts to react to, one, try to cleanse out whatever's there. And two, it reacts as a foreign matter. So by this reaction, it can cause a couple different symptoms. The classic allergy symptoms, the stuffy nose, the runny nose, the sinus pressure.
Dr. Sina Joorabchi (01:22):
And it can even go further than that. It can go into your ears. You can get ear clogging, you can get throat irritation. A lot of the kids get that classic, throat scratchy noise that they make. I can't even reproduce that. I don't even ... I try to do it with my patients and I can't do that. But that is definitely one of the most common things we see, is allergic rhinitis. Followed after that is just traditional sinusitis and probably in the more chronic form. Chronic form, meaning something lasting more than three months. Where, the best way to think about it, it's like arthritis. You have your good days and bad, but generally, it's pretty mild. It's a mild to moderate affliction.
Dr. Sina Joorabchi (02:01):
And then after that, ear wax, ear issues, ear clogging issues, ear plugging issues are probably the third thing that ... it's like pseudo sinus. Because things that affect the nose can affect the ears. So those are the classic sinus stuff that we see in the office day-to-day.
Shelby Stockton (02:24):
So how are sinus disorders diagnosed?
Dr. Sina Joorabchi (02:28):
So we're all taught, it's all about history, right? So someone can come in and they can look great, but their story is awful. They're saying that they're symptomatic. When they go home and they lie flat in bed, they can't breathe. Or they go to school and all the mold that's in the environment makes them react. And they come to your temperature controlled, well ventilated, no perfume office, and they look great. So if you look at them, they may look great, but that's not going to help you. So it's really understanding the story. It's understanding how frequent are they getting this issue? How bad is it affecting their quality of life? What have they tried? And what conservative things have they tried to help.
Dr. Sina Joorabchi (03:11):
And sometimes if they've tried conservative allergy medicines and they're successful, it's kind of like a tip off. Well, okay. You tried something that's allergic and it worked, you probably have allergies. So having that longer story helps me diagnose if they have allergies. Also, if there's a seasonal component. If it starts to kick in March or April, if it's something where they go up north and they're fine, they come back down to Florida and they're symptomatic again, if's a geographic or location specific component. But definitely having the history is very important.
Dr. Sina Joorabchi (03:45):
When we look at an exam, it's almost like the easy tip off. Hopefully we get to see some swollen, clear runny nose, inflamed tissues. And when you do see that, that's a second layer of evidence. You have the evidence of history, you have evidence of physical exam. And so what we look for, again, on an allergic patient, sometimes they'll have just that, what we call allergic salute. They'll have a crease on the upper aspect of their nose. Sometimes, especially in kids, they have something called Dennies lines, where there's creases in the lower eyelids. Actually, people love hearing this. Long eyelashes can be associated with having allergies, or a predisposition for allergies. Because the thought is that you've evolved evolutionarily to bat away the allergens from the eyes. So yeah, a lot of people find that interesting to learn about that.
Dr. Sina Joorabchi (04:35):
So there's tip offs you can look at. In a kid, they can be ... people that have long standing nasal congestion, they have what's called adenoid faces. And the best way to think about it's almost like the face of Howard Stern, where it's like the flat mid-face, the retrusive chin, that long appearance, open mouth appearance. It's the adenoid face. Also, kids that have high arched palettes because they've been doing a lot of mouth breathing, that's a tip off that they've had allergies for a long time.
Dr. Sina Joorabchi (05:06):
So you have your history, you have your physical, and then you try to confirm it with the testing. So allergy testing is the ultimate way to diagnose what you're allergic to and what you're afflicted by. And it's important you have the first two ahead of it. Because if you just allergy test the whole United States, 50% of people will test positive, and 50% of people who are positive may not be symptomatic. But it's more the first two that you're doing, and then the allergy test is the direction to find out what you need to treat, how you need to target that approach. That's allergy, in a nutshell.
Dr. Sina Joorabchi (05:44):
With sinusitis, it's kind of the same thing. It's, what's your story? In the last year, have you been a person that's getting stuffy, runny nose? Are you getting sinus attacks? And again, I love the analogy of arthritis. You have your good days and bad. And also think of it like if you have knee arthritis, unless you do a total body workout, where are you going to feel that pain first after your workout? You're going to feel it in the knee. So people that have chronic sinus, they have general inflammation in their sinus. So any body inflammation, whether it's a cold, whether it's coronavirus, whether it's an allergen, they're going to feel it in the focus where they already have inflammation. So kind of teasing that out of their story can be helpful.
Dr. Sina Joorabchi (06:27):
Seeing what they've tried. And how many times they tried antibiotics, how many times they tried different nasal sprays. Then we look at the exam. Is the exam showing signs of nasal polyps? Are the tissues swollen, not healthy looking? Is there a lot of clear mucus running from the nose? Obviously the symptoms, too. We haven't talked about the symptoms of sinusitis. Which is stuffy nose, headache, loss of smell, runny nose. But coming back to the exam portion, there's definitely tip offs from there that can help you with the diagnosis.
Dr. Sina Joorabchi (07:01):
Then ultimately, it comes back to testing, then. The confirmatory test for sinusitis is a CT scan. It's an x-ray. When we look inside someone's nose, you can only see this far. You see just right here. When actually, the picture could be completely in a different area. So someone could look fantastic here, but look like a mess in their forehead and cheek sinuses. And the best way to assess that is to get a CT scan. So that's the approach of looking at between allergies and chronic sinus. But history is definitely one of the most important, probably underestimated tools, for diagnosing them.
Shelby Stockton (07:39):
That's so interesting. I'd never heard that long eyelash thing before. That's fascinating to me.
Dr. Sina Joorabchi (07:46):
Yeah. We got to get you more allergies, right?
Shelby Stockton (07:48):
I know, right. Forget Latisse. You can just get more allergies.
Dr. Sina Joorabchi (07:51):
Right, right.
Shelby Stockton (07:52):
So what are some treatment options for people that suffer from sinus disorders?
Dr. Sina Joorabchi (07:58):
So, from sinus disorders, the first thing we always try to push is, one, is there anything you can prevent? Is there something you're doing or exposing yourself to that is causing this? Is there a medicine you're taking? Is it the environment you're in? Do you have mold in your household? Are you controlling the mold that's causing inflammation in your sinus? So preventative things. If there's nothing in the history that comes out from the preventative side, then you look at medications, right? So it's a stair step progress, right? You start from prevention and education, to medications, and then ultimately to some sort of intervention.
Dr. Sina Joorabchi (08:33):
The best way to think about sinus, we're like plumbers, right? We're plumbers who just have fancy tools. And so what we're just trying to do is just unclog your drains. And so if the education piece doesn't work, I want to try to unclog the drain with the Draino, which is your nasal spray. And one of the biggest fails people do is that they expect to unclog a drain in a matter of two days of using a spray. If you've had one year of sinus, how can I fix you in two days with a medicine? So people have unrealistic expectations that way. So using that nasal spray consistently, if they can't get any sort of progress ... They don't need to be a hundred percent. But are you getting momentum? Are you getting better? Are you going in the right direction? And if they're using that spray and if they're successful, then that's a good first litmus test.
Dr. Sina Joorabchi (09:22):
And there's other things we look at, too. Obviously, if there's some form of active infection or if there's polyps, sometimes other oral medicines can be helpful to get that swelling down. But ultimately, the main goal is ... you have that kitchen sink and you have that drain. How do we get the kitchen sink to drain again? So whatever medicine we see that can close the gap and achieve that, that's what we're going to prescribe, and foundationally nasal sprays are a part of that.
Dr. Sina Joorabchi (09:47):
If that doesn't work, and we've given it a conservative try, then you're going to go to the Roto-Rooter. You got to get in there. You got to unclog the sinus. And the cool thing about sinusitis and the treatment of sinusitis is that it's had a huge, huge development in the last, I'd say 10 to 15 years where, this was primarily an operating room intervention, and it's now primarily becoming an in-office intervention. So there's a lot of fancy technology, a lot of fancy equipment that we're using that can get less invasive care, and care that doesn't require general anesthesia. And anytime you can remove the risk of general anesthesia, you're going to absolutely do it. And also be comfortable. It's not something that's like a traumatic experience, you'd never want to do it again. And actually the hope is that you don't do it again. But basically, it's working at the sinus level.
Dr. Sina Joorabchi (10:38):
So one of the classic, tried-and-true things that are talked about, you hear a lot of sinus surgeons talk about is the sinuplasty. It's a technology we stole from the cardiologists ... actually, no. It was a cardiologist that brought it over and applied it to the ear, nose, and throat field. And it's basically just dilating the drain. Giving you a bigger drain to reduce the odds of it clogging. So if you have a drain like this and you put a balloon in there and inflate it, a bigger drain will be less likely to clog. And then hopefully you're proactive there afterwards, and using the Draino, using the medicines, preventing the exposure of things that cause an inflammation, it'll be a one time intervention.
Dr. Sina Joorabchi (11:15):
So what's evolved is that getting into the drain usually requires some form of what's called image guidance. It's like a GPS. The GPS systems are amazingly accurate now, where we can go right to the area where you're narrowed, dilate the specific spot and get out. We can be minimally invasive and be effective. And so a lot of these technologies have done a fantastic job of doing that. Also, a lot of these technologies have gotten really good at making the airway breathe better, make people have stuffy noses go to unstuffy noses pretty easily. So there's a lot of different technologies that are out there to help bridge that gap. And that's the sequence of treating it.
Shelby Stockton (11:59):
Well, you've talked about a lot of new technology. Is there any other stuff coming around the bend that you're excited about?
Dr. Sina Joorabchi (12:07):
Yeah, absolutely. So people want to breathe, too. Stuffy nose is a problem, and people notice it most at night. When you lie flat, all that extra blood flow goes to the nose and it clogs you up. So let's say you have your septum right here, and you have your turbinates. Everyone has these things called turbinates that swell and decongest in the nose, right? So if you have your septum here and you have your turbinate, let's say it's not fully blocking, but almost there. When you lie flat at night, it just shuts a completely. So there's a lot of different interventions to try to shrink these guys down. And how can we do it in a painless, in a quick, and in a nice experienced fashion?
Dr. Sina Joorabchi (12:43):
So one of the coolest things ... actually I'm using quite a bit of now, something called the Vivaer. The Vivaer is basically just using this technology to evaporate inflammation of the sinuses without destroying, without cutting, without altering the outer surface. It's maintaining that outer aspect, which is really important for the nose, and just getting that excess swelling out of it. And what's cool about it is that not only can it be applied to the actual turbinate, it can be applied to the septum. And it can be applied to something called the nasal valve.
Dr. Sina Joorabchi (13:15):
So to take it a step further, the nasal valve, it's almost like the front door to the nose. If the front door to the nose is closing like 20 to 30%, it doesn't matter how straight you are on the inside. Your airflow is getting choke pointed 20, 30%. But if you're going on the inside and your nose is already swollen here and swollen here, then you're blocked. The Vivaer can hit all three areas. It can help the front door of the nose to stay open. It can reduce the swelling off the turbinate, and it can get ... I mean, get the swelling off the septum. And then get the swelling off the turbinate too. And it does it in a really comfortable fashion.
Dr. Sina Joorabchi (13:49):
It's a boring procedure. It takes five minutes. And it's actually fun, because it's a time I just start to get to know the patient. They're comfortable enough to start talking about their life. I'll ask them what they do, what their interests are. It's what I call talkesthesia, where I'm just getting them distracted, but also genuinely getting interested in what they're doing. And it's a very simple, very straightforward, but very effective thing. I've done this on my best friend, and I would absolutely do it to my wife if she needed it too.
Dr. Sina Joorabchi (14:17):
So it's a really cool piece of technology, and they've actually taken that similar technology and applied it to people that have runny noses. So that's a common thing, especially in the elderly people, their nose will run for no rhyme or reason. It's just an oversensitive nose. It's a nose that ... so we all have this nerve that controls the drip in the nose. It's called the posterior nasal nerve. It's like the thermostat of the nose. It helps sense when there's something in there. And it says, okay, nose. Start to clean that mucus, get that stuff clean, get it out there. But over time that can get oversensitive and it can do it for no rhyme or reason. So eating certain foods, certain temperatures, or certain emotions, it can start to drip.
Dr. Sina Joorabchi (14:56):
And so there's a lot of elderly people in Florida, and a lot of people actually above the age of 50 or 60, and it's a big problem for them. So we apply that same technology and do three treatments over the nerve that controls that drip. And after about a month, 50% improvement, people usually get. After about three months, it's about 100% improvement. So it's a fairly easy, fairly effective measure. And I'd say, it's definitely one thing I'm doing a lot of is the Vivaer in my practice, on top of traditional sinus intervention and allergy treatment.
Dr. Sina Joorabchi (15:30):
So that's some of the newer, latest and greatest stuff that we're doing to help people breathe better. And breathe better in an easy way, and have less sinus in an easy way.
Shelby Stockton (15:40):
That's awesome. One last thing before I let you go. What would you say to a patient who's just like, I just tough these things out. I don't really need to go to the doctor. Or maybe they're scared to go to the doctor. What would you say to those patients?
Dr. Sina Joorabchi (15:53):
So, one, I'm going to give you an answer you probably wouldn't expect. I want people that are motivated to get better. If you're not motivated, then you're not going to get a value if I take that problem away from you, number one. Number two, don't let fear be a deterrent for the care, because the care is so easy now. It's not painful. The recovery is fast. You're not going through a big hack and slash. It's not hard to have better sinuses now. You don't have to work that hard at it. So those people who are usually afraid, I would say, just don't be afraid of what we'd be doing, because it's fairly easy. I like to throw the dentist under the bus and say, we're far better than the dentist. I've been tortured by the dentist all my life.
Dr. Sina Joorabchi (16:37):
But ultimately, these are things you don't have to do. I call myself the happy doctor. I want to make you happy. I want to bring you quality of life. If you don't perceive it as a problem, then I'll point it out to you, but I won't push back too hard. If you're not ready for it, come back to me when you're motivated to get it done. Because the people that are motivated will, one, be appreciative. And also, put in the work to be successful there afterwards. And if they're successful, then when they're at a dinner party talking about how great they are, that next person's suffering, they'll inherently talk about the person they saw.
Dr. Sina Joorabchi (17:08):
So I think you've got to put good out, and eventually the good will come back. And so that's my answer to you on that ... Attend to the people that are motivated. But also try to reassure them that it's not a fearful thing to go through.
Shelby Stockton (17:21):
All right. That's great advice. Doctor, thank you so much for spending time with us today.
Dr. Sina Joorabchi (17:26):
My pleasure. My pleasure, it was good to chat with you, Shelby. Look forward to chatting with you again.
