I decided to start running again but I can hardly breathe! What's the story?

Since Austin is one of the fittest cities in the country as well as one of the most prone to sinus and nasal problems, it is not surprising that they frequently conflict with one another. Whether you like to run, cycle, swim or any other aerobic exercise, sinus and nasal problems can definitely slow you down. You should be consistently breathing through the nose during aerobic exercise, and that's because the nose provides important humidification to the air entering the lungs. If you're not moving air through the nose, your compromising your performance. Limited nasal airflow can be the result of swelling in the nose, or structural abnormalities such as a deviated septum or nasal polyps. The first step is to identify the problem, and then apply the proper remedy. Sometimes, it's as simple as a daily nasal spray; other problems require surgery to provide lifelong improvement of the nasal breathing. If you are one of the people pulling down the average fitness level of Austin, you might be able to blame your nose. Christopher Thompson, MD

Recurring sinus issues after sinus surgery

Traditional sinus surgery uses special instruments to remove tissue in an effort to open sinus drainage pathways and resolve chronic sinusitis. The surgery is very effective at opening the maxillary and ethmoid sinuses. Many physicians do not treat the sphenoid sinus during initial sinus surgeries, and frontal sinuses are very difficult to effectively treat with traditional sinus surgery methods. The most common persistent symptom after traditional sinus surgery is headaches. Frontal headaches and retro-orbital headaches are typically related to untreated, or poorly treated frontal and sphenoid sinuses during traditional sinus surgery. Advances in sinus treatment have led to significant improvements in treating these sinuses. Balloon Sinuplasty is very effective at treating persistent narrowing in the sphenoid sinus and frontal sinuses. This will significantly decrease infections and pressure headaches in these sinuses. Even better, the revision balloon procedure is a simple clinic procedure that will require no packing. Recovery is easy with most patients returning to work the next day. Success rates are over 90%. Chronic sinusitis has a known 10% recurrence rate after traditional sinus surgery. Many of these patients will be good candidates for simple Balloon Sinuplasty revision. Evaluation by an otolaryngologist familiar with balloon technology is the first step to resolving your recurrent symptoms. Zachary Wassmuth, MD

Is my sinus infection immune to antibiotics?

Patients who get recurring sinus infections have real concerns about using so many antibiotics. They are not just concerned about the side effects and the cost but also the risk that these important medicines will no longer be effective. It's not actually the patient that becomes immune but the particular bacteria. Bacteria have sensitivity to some antibiotics and resistance to others. After repeated exposure to antibiotics the bacteria can actually learn to become resistant making the antibiotic ineffective. This is why it is important to follow some important steps when treating with antibiotics. Viral infections should not be treated with antibiotics. Your clinician can help you determine if the infection is bacterial. Treatment should be based on an accurate culture of the infection if possible. Nasal endoscopy can be used to accurately and painlessly obtain a sinus culture in the office setting by an ENT physician. Therapy should be long enough and strong enough to resolve the infection. Weak or short courses tend to create resistant bacteria. Confirmation that the infection has been resolved is also important. Frequently the patient will feel better but may still be carrying a low grade infection. Imaging or repeat culture can be done if there is doubt that the infection has resolved. Lastly, if the infections continue to recur quickly after treatment there must be an evaluation to see if there is an underlying chronic sinus infection with obstruction of the outflow tracts. Simple procedures such as balloon sinuplasty can resolve the obstruction and make the antibiotic therapy successful. Using these guidelines you can be assured that your antibiotic treatment will be effective and safe. Daniel Slaughter, MD