Charlotte Smarty Pants podcast with Dr. Cuite and Dr. Tebbit to discuss sinuses

CEENTA oculoplastic surgeon Dr. Catherine Cuite and otolaryngologist Dr. Christopher Tebbit stopped by Charlotte Smarty Pants to discuss sinus health on the Smarty Podcast. Click here to access the podcast episode, read the transcript below, and schedule your next appointment with Dr. Cuite at our SouthPark location or Dr. Tebbit in Belmont today!

Transcript of The Interview

Caroll Watson: Welcome to the Smarty Podcast series from Charlotte Smarty Pants, where we focus on all things parenting. We talk about everything from education, health, travel, beauty, fashion and more. Join in on the discussion at charlottesmartypants.com. The Smarty Podcast series is produced by Charlotte Star Room, Charlotte’s premier boutique, music development, and corporate video production studio, and the best parties in the QC. For pop star music, video parties and professional voice lessons in a studio and also amazing content creation, check them out at charlottestarroom.com.

Jennifer Plym: Hi everyone, this is Jen Plym with Charlotte Smarty Pants. Thanks for listening. Being joining us today from our Smarty Health Corner: experts at Charlotte Eye Ear Nose and Throat Associates, also known as CEENTA, is Doctor Catherine Cuite, an ophthalmologist from the SouthPark Office and Doctor Christopher Tebbit, an ENT from the Belmont office.

Plym: So, thanks for coming and sharing your expertise today. So, we're going to dive into talking about sinuses. When people usually think about sinuses, it's almost always associated with things like infections, headaches and stuffy nose, and I wanted you all to go into detail about what the sinuses are and what are some common issues that we have with them.

Dr. Christopher Tebbit: Sure, so the sinuses are aerated parts of our skull in the front of our face that everybody has. We all have eight of them. There's four on each side, and you have a sinus under your cheek called the maxillary sinus one, next to your eye, sort of. Immediately they're called an ethmoid sinus and then one in the frontal area here and then kind of one in the middle of your head called the sphenoid sinus, and the sinus problems are very common here in North Carolina. I would like to tell patients we live in the belt buckle of the allergy belt here.

Plym: Right, right?

Dr. Tebbit: And common problems with sinuses are infections. Other problems are that the sinus and nose get locked in together, although they are different anatomically, but other problems with the nose and sizes include difficulty breathing through your nose.

Having an increased drainage going down the back of your throat or coming out the front of your nose and then more peripherally other problems including feeling stuffy in your ear, having headaches, and even occasionally if you have a bad sinus infection, you can have problems within the.

Plym: Yeah, I don't suffer from sinus infections, but one time I had one and actually two times with pregnancy. It was so painful, and I give so much credit to people when you hear of them having an infection. You're like giving a lot of sympathy. But why are healthy sinuses so important?

Dr. Tebbit: Well, I think it's good to be healthy, the best answer for that. But when your sinuses are unhealthy, it does cause a lot of symptoms which do decrease individuals' quality of life.

Plym: Yeah, so when you have a sinus situation, what are some of the symptoms of that and how do they get escalated to a sinus infection? Like, what are some treatments and what are some signs that you need to treat at home versus go see a specialist, sure.

Dr. Tebbit: So, let's start with what a sinus infection oftentimes is like when the sinus is are typically sterile cavities, and they when a bacteria or a virus gets hold and starts creating an infection, people start to feel pain in their sinus is they can feel pressure in the front of their face, they get drainage and oftentimes that drainage is thickened and discolored. It can be yellow or green, although sometimes it is still clear with an infection. They have a harder time breathing through their nose, they have nasal obstruction where that happens.

In addition, you can have more systemic symptoms, like you can have fevers and body aches associated with that as well. A great deal of sinus and nasal infections or viral infections, and most of the time our bodies are very efficient at taking care of those.

When those are going on, we oftentimes will treat with Tylenol or ibuprofen to help with the body aches and the fevers, and then doing some saline irrigations to help wash out some of the secretions from the nose can be helpful. And using over the counter medications like antihistamines and nasal steroid sprays can help decrease some of the inflammation while you're recovering from it.

Sometimes you'll have a bacterial infection, which it actually needs antibiotics, which is oftentimes a time that you'll come seek medical. They’re ways that you know you need an antibiotic, or if your symptoms are progressive and don't get better over, you know, three to five days. If you're having severe fevers or severe pain, or you're having more complicated symptoms.

Plym: I always had a hard time with the Neti pots, like what's your take on Neti pots? I feel like I've done it, and the water gets stuck, the saline gets stuck.

Dr. Tebbit: Tips on that, so it's all a big fan of Neti pots.

Plym: Right, I know they're great.

Dr. Tebbit: And I actually I should say, I'm a big fan of saline irrigation because it does not have to be a Neti pot.

Plym: Right?

Dr. Tebbit: So, what a Neti pot is for those who don't know, it literally looks like a genie bottle, and you fill it with saline and then you put it in one side of your nose and it's supposed to, the sailing goes in one side and comes out the other there. Other iterations of this, like the NeilMed Sinus Rinse, which is more of a squeeze bottle that you can squeeze to get it to go in one side or the other, and now there's a new one which is actually battery powered.

Plym: Oh wow.

Dr. Tebbit: To get the saline to go through, but all the purpose of putting saline in your nose is to wash out any allergens that may be causing inflammation in your nose. It helps decrease the bacterial or viral load that's in your nose. It thins out the secretions in your nose, which just helps your nose work better. I tell patients commonly that using a Neti pot or using saline irrigation is not a medication. It's more like it's hygiene. It's just like brushing your teeth. It's something you do to kind of help keep your nose clean and help it function properly.

Plym: Do you do that regularly, not just when you feel like it?

Dr. Tebbit: I think it depends on the patient. If you're somebody who has very few sinus infections and otherwise doesn't have any sino-nasal complaints, of course you don't necessarily need to use a Neti pot to keep your nose comfortable, but people who have but people who have allergies.

It's very helpful for them or people who get recurrent sinus infections.

Plym: Yeah, yeah.

Dr. Tebbit: It can be helpful and even patients who are more complicated sinus patients who have had sinus surgery before will put medications inside the Neti pot solution so you're actually topically administering that as well.

Plym: OK, that's interesting. Well, let's discuss problems with sinus inflammation and sinus infection. It's like I know, sometimes you just feel it. You oftentimes just feel it in your eyes and that's such a strange feeling.

Dr. Catherine Cuite: Yeah, yeah, yeah, it's you're absolutely right, I think because the sinus is wrapped around the bony space that holds the eyes.

Plym: It's not, It doesn't seem as common. Maybe it is.

Dr. Cuite: So, the walls of the eye socket all have sinuses on them, and so when the sinus is inflamed or infected, as Doctor Tebbit said, patients can feel it in the eyes, so they can certainly drop in with eye pain or eye pressure eyelid swelling. It's not that they're wrong.Those things actually do happen with sinus infection, but it takes a good exam from a good eye doc to recognize that the problem is actually one of bad neighbors and not of the eye itself in its origin.

Plym: Right, so it's good to work in tandem together. So what are some treatment options? So say you're taking antibiotics, it's not working. At what point does it become where you need surgery? Is that like when you're delaying too long, you haven't treated it.

Plym: You waited too long to get started. Because that almost happened to me. I'd never had a sinus infection before I was pregnant with my twins. Didn't address it, delivered then afterwards. I was a hot mess and almost needed surgery and I was like. I've never had a sinus infection before, so, was that on me? I didn't have this, I didn't need this. A last resort effort worked, but I did not need surgery. But I was close. Everything was clogged.

Dr. Tebbit: Well, I'm glad you didn't need surgery. We do sinus surgery for a couple of reasons. When patients are having a lot of in sinus infections, what's the purpose of sinus surgery is really to open the plumbing of the nose.

Plym: Right?

Dr. Tebbit: You're not actually fixing the problem by doing surgery the same way you might be if you're removing a tumor or something, but what you're doing is you're opening up the sinus is so they don't get clogged, and the drainage pathways are patent, and that also allows you to administer medications better and reduce inflammation.

Plym: Right?

Dr. Tebbit: That way the reasons we do sinus surgery when patients get a lot of infections. And they're just their sinus is are blocked off and are not open enough. So by getting by getting obstructed, they're predisposed to getting infections. Some patients also have what are called nasal polyps. Polyps are growths within the nose that really happen from just chronic inflammation.

Most typically, allergy inflammation in the nose, but when that happens, the polyps will block the sinus drainage pathways as well and we have to go in and remove those polyps in order to reestablish normal sinus drainage and reduce the number of infections. How we kind of get there if you're having one or two, the average American gets one - it's one to two sinus infections a year.

It's very common that does not mean that you need sinus surgery, but if you're getting three to five infections a year or more, and we treat those appropriately with medications and get a CT scan and notice that even with appropriate medications, you still are exhibiting sinus disease, that's a patient who may benefit from sinus surgery.

Plym: What about deviated septum? Like you know, it's kind of goes hand in hand, how does that? How do you get diagnosed with deviated septum?

Dr. Tebbit: Sure, so the septum is, it's partly bone and partly cartilage, and it's what divides the left and the right nostril within the nose, and most people are at least a little bit crooked.

Plym: Yeah, yeah.

Dr. Tebbit: Here they are. Nobody's 100% straight, but it becomes a problem when it inhibits your ability to breathe through your nose. So most patients when they are dealing with a deviated septum that's clinically significant. We'll come in and say I just can't breathe through either my right or left side, or sometimes both.

Plym: Yeah, does it cause drainage?

Dr. Tebbit: That can happen, but it does not necessarily cause drainage. It mostly causes nasal obstruction. But when you're obstructed, that will inhibit your ability to get sinonasal medications like saline and nasal steroid sprays like Flonase and that can inhibit your ability to treat the drainage that's subsequent to that.

You can develop a deviated septum from trauma. So if you take a hit to the nose, that may break the septum and that may do it, and some people it's just it's an acquired anomaly that happens, and there's a very nice surgery that is, you know, very low risk, low pain and very effective.

Plym: I asked about the deviated septum. My college student is convinced she has one. And I gave her all the information to have her schedule her an appointment with CEENTA. She has not done that yet, but you know, it’s there. Is there any negativity of waiting too long to get that surgery done? Or is it something that it's just a matter of the patient tolerance point?

Dr. Tebbit: Yeah, I would say you know if your only isolated nasal problem is nasal obstruction due to a deviated septum. It's certainly not a medical emergency, the same way we might think of other things like cancer and whatnot, but it's a quality of life issue, and it's one that it can really improve somebody's quality of life and it can improve their overall sinonasal health.

Dr. Cuite: So just to dovetail with what Doctor Tebbit’s saying, in my practice I'm an oculoplastic surgeon and so patients come to me for tearing and when the tear drain is blocked.

Plym: Right?

Dr. Cuite: Usually if the patient’s infected and is not responding and the tear drain is anatomically blocked, that patient is usually being tied up as a pre-op patient and I do always have the same conversation that my colleagues are having in the ENT department. You know how do you breathe at night? Do you have to blow your nose every day?

Plym: Right, yeah, this affects her.

Dr. Cuite: Yeah, even though I'm an ophthalmologist, I'm fishing for those ENT type questions. And if the patient says, well, I can't breathe when I lay on the left side, or I've never been able to breathe out of the left side.

Plym: As you're talking about it, I feel like.

Dr. Cuite: Those patients know not all my patients get imaging before endoscopic tear drain opening.

Plym: I have this.

Dr. Cuite: I do that surgery through the nose, but if my patient is kind of making my ears perk up by giving me this. You know subtle history of nasal complaints. I will get imaging, and then that nasal drainage surgery is often done in combination with a specialist like Doctor Tebbit who straightens out the septum, and then I can perform the nasal drainage surgery more successfully.

Dr. Cuite: And that's just another example of how this dovetail. These two specialties work, and it always makes me smile when I see these patients post-op. Because I say, you know, “So how are you doing? Is there any infection in that ear drain?” And they invariably to a person or like, “Oh yeah, the tear drains fine. But boy, can I breathe better,” you know.

Plym: Right?

Dr. Cuite: So those patients I think they walk around with nasal with, you know, a nasal septal bend or a septal deviation. They're not totally aware of it. They kind of put up with it, and it only comes to light, right?

Plym: Right, you kind of learn the code.

Dr. Cuite: They cope, and it only comes to light when there's a problem.

Plym: You know you train.

Dr. Cuite: That that triggers it, but that's another example of how you know, kind of eye and ENT can walk together and in a way that I think most patients probably aren't aware of.

Plym: Yeah, it's so great that we have this at CEENTA. I mean what a great, great place that has so many different specialists that can work in tandem, like it's so wonderful.

Dr. Cuite: Oh yeah, it's it's fantastic.

Plym: Do you have anything else that you want to talk about with regard to I and Auntie together? Like closing remarks.

Dr. Tebbit: Like I surely say, I'm always very grateful to have the excellent ophthalmologists that we have with our practice.

Dr. Tebbit: Because it's a lot of times patients will assume that there is a problem somewhere in their face in their nose when they're having some ocular issues and it's very easy to just say, “You know what? Actually, your nose looks OK, but I can take you to the front desk.”

Plym: Right?

Dr. Tebbit: “We'll be happy to make an appointment right here. The same day with one of our ophthalmology colleagues.”

Dr. Cuite: Right? And from my standpoint, when a sinus infection does start to cause trouble in the socket, which in medical terms we call the OR. Orbit, that case is urgent and right.

Plym: Right, we waited too long.

Dr. Cuite: I'm lucky enough to be new at the center, but in the 20 years practicing before I joined this group, that meant getting on the phone, finding an ENT doc somewhere in town who was willing to collaborate with me.

Plym: Right, right?

Dr. Cuite: Sharing medical records with them. And now I just walk upstairs and patients.

Plym: And see them.

Dr. Cuite: Yeah, I mean we can take care of those patients immediately, so it's - that's a boon for the Charlotte area, for sure.

Plym: Yeah, it's like a one stop shop. So great.

Plym: Well, thank you all for joining us today and sharing all of your expertise that we're so grateful for that Smarties, our partners at CEENTA offer comprehensive adult and pediatric eye and ENT care in nearly twenty locations in the Carolinas. If you'd like to make an appointment, you can call 704-295-3000 or visit CEENTA.com/appointments and you can find us daily on charlottesmartypants.com and on Facebook and Instagram at Charlotte Smarty Pants.

Watson: Thanks so much for listening to our Smarty podcast. You can always join in on the conversation at Charlotte Smarty pants com. The Smarty Podcast series is produced by Charlotte Star Room, Charlotte's premier boutique, music development, and corporate video production studio. Check them out at charlottestarroom.com.

 


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