ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

TODD ACKERMAN: I’m Todd Ackerman. I’m a former medical reporter and currently an editor at Houston Methodist.

ZACH: And Todd, do you have allergy and sinus trouble?

TODD: It seems like we’ve been through this before on a previous episode.

ZACH: A little bit, yeah.

TODD: Yeah. I certainly have sinus issues, which date back to when I was five years old. They’re kind of mysterious and baffling. I’ve been working on them for nearly 40 years.

ZACH: And you still haven’t solved them?

TODD: We’re getting closer. I feel the best I’ve felt in -- ever.

ZACH: Okay, great.

TODD: I feel the best I’ve felt ever. Allergies has not been an issue for me, but I will say that every doctor I’ve seen, that’s one of the first things they suspect, and we do some testing, or even a course of allergy treatments before they rule it out.

ZACH: So, we have sinus infections, and we have allergies, and there’s a difference between the two of them, and this is what we’re talking about today.

TODD: Right. Do you have either?

ZACH: I know I have sinuses.

[Laughter]

TODD: I hope so.

[Laughter]

ZACH: Everybody has sinuses, yes. No, like you, I feel like I’m, kinda, in between some things right now as far as like, “Hey, I got this issue, what is it?” And I’m also on a similar journey, we’ll talk about it over the course of the conversation that you have with our expert today. But a couple things resonated with me about certain things they mentioned like, “Oh, that might be what I have right now.” Because sometimes if I’ll like -- I’ll get congested sometimes if after a certain thing, I’m like, “Is this a seasonal thing? Is it a food thing?” So that’s, kinda, my most -- biggest struggle with these things.

TODD: You know, they say, like, especially living in Houston, most everybody has some sort of sinus problem.

ZACH: Mm-hmm.

TODD: You’re just in recent years, kind of, feeling like you’re joining the group?

ZACH: Yeah, because I feel like in the past, like, I would get, maybe, sinusitis every now and then. Every now and then, I don’t know, every couple years or something. Like, I would get sick around the same time of year, so I figured it was something like that. But as far as like, you know, going outside and then feeling, like, congestion or like I said, like, eating or drinking certain things and feeling congested, I feel like that’s a more recent development for me.

TODD: Okay. Well, you should consider yourself lucky that you’re only just getting there.

ZACH:  Hmm.

TODD:  You know, I did a little research on this and diagnosed sinusitis affects roughly 12% of people in the U.S. annually. That’s about 30 million, and it’s currently the fifth most common condition treated with antibiotics.

ZACH: Yeah.

TODD: Seasonal allergies are even more prevalent. They affect more than one in four adults, one in five children, that’s about eighty-one million people. So, this certainly affects a lot of people.

ZACH: Mm-hmm, no, I’m part of that 12% then for the sinusitis. I don’t -- not annually, though. Like I said, it’s, kinda, more sporadically, yeah.

TODD: I think talking to people, that number doesn’t really surprise me just ‘cause people -- seems like most people have some sort of sinus...

ZACH: Yeah.

TODD: ...problem that I talk to. But that’s a lot of people.

ZACH: And I think the struggle is people don’t know is it a sinus infection? Or is it allergies? And that’s what we talked to our expert about today.

TODD: Yes. We talked to Dr. Mas Takashima who’s a sinus specialist at Houston Methodist and he’ll break that down for us.

[Sound effect plays to signal beginning of interview]

TODD: Well, hello Dr. Takashima. How are you?

DR. MAS TAKASHIMA: I’m doing great, how are you doing?

TODD: Good. Welcome to the podcast, our second podcast on sinuses.

DR. TAKASHIMA: Yes.

TODD: First time we talked a lot about allergies, this time we’re gonna talk about allergies versus infections.

DR. TAKASHIMA: Yes.

TODD: Are those two things the things that you probably most commonly treat? Is that the reason that people come to a sinus specialist?

DR. TAKASHIMA: You know, they are. And if you think about what allergies are, you know, allergies affect so many different areas of the head and neck. I mean, it can cause hoarseness, it can cause congestion, it can cause runny nose, it can cause eustachian tube problems, which is problems with your hearing, with fluid buildup behind your ear drums. But on top of that, you also have infections that we’re dealing with as well. And so, whenever we’re talking about rhinologic issues, issues that affect the nose, the sinuses, allergies, and sinus infections clearly take the cake.

TODD: And is that, like, a big question is which it is?

DR. TAKASHIMA: Yes. And sometimes it’s even very difficult for us as physicians to really tell because really bad exacerbations of allergies can sometimes mimic a sinus infection to the point where we need other tools such as endoscopies or even CT scanners to really figure out, “Is this really an exacerbation of allergies? Or is this more of a sinus infection?”

TODD: But what are the key distinguishers to the patient when it’s more simple cut and dried case?

DR. TAKASHIMA: Yeah. So, from a patient standpoint, patients typically know “Hey, certain seasons might affect them a little bit more,” or “Hey, they spent a lot more time outdoors and then they started developing symptoms.” So, if you can find a cause to effect those symptoms such as certain seasons, certain activities, then we start painting that picture. And so, it really is about trying to be a detective and doing good history, you know, then thinking about what the potential diagnoses are before we run into treatments. But, you know, from a patient perspective, if it seems like allergies such as nasal congestion, runny nose, postnasal drainage, cough, and associated with some irritation of the eyes without any fevers, without any significant facial pain, without any purulent drainage from their nose. Then more than likely, that’s allergies. But then again, from a sinus infection standpoint, patients can expect, you know, -- it’s allergy symptoms and then some, I like to say. You know? And so, you definitely will have those congestion, you still with have nasal drainage, possibly some coughing, postnasal drainage and hoarseness. But on top of that, patients will complain more about “Hey, every time I blow my nose, I’ll have a lot of yellow stuff coming out, green stuff coming out. And on top of that, I’m having more facial pressure, facial tenderness every time I lean over to tie my shoes, pick up something. I start noticing throbbing of my sinuses and sinuses behind my cheeks, up in my forehead.” And on top of that, if you get fevers, then that’s a -- that’s more a clear cut definition of “Hey, there’s probably something else going on than just allergies.”

TODD: And when does it become a little bit more unclear to doctors?

DR. TAKASHIMA:  Yeah, so during that phase where patients are having a really bad acute allergy attack, all the symptoms can really mimic a sinus infection, because if you think about the symptoms associated with allergies, you know, the nasal congestion, the fullness in the head, drainage. I mean, all of those, when it’s exacerbated significantly, if you have a really bad allergic attack, I mean, you’re feeling miserable. I mean, you also have that fatigue ‘cause you’re not breathing well out of your nose. And so, when they’re getting these really bad allergic attacks, sometimes it can be very difficult to differentiate the two.

TODD: Is blood also a distinguisher? If you get a little blood out into your discharge, is that a sign that your immune system is rushing to the site of an infection or not necessarily?

DR. TAKASHIMA: Yeah, yeah. So, you know, the bleeding, nasal bleeding that’s associated with any allergies or a sinus infection. It’s more due to the inflammation of the nasal mucosa and the tissues. And so, any time there is inflammation that the tissues all look very irritated. And so, it’s more prone to bleeding, so a casual bonk to the nose, a casual picking of the nose or whatnot can easily cause that bleeding because the nasal mucosa isn’t as healthy. So, healthy nasal mucosa typically tends to bleed a lot less, but irritated nasal mucosa, even just a casual touch of the mucosa can cause some bleeding, and so. You know, that just signifies the degree of inflammation. Usually, we see more bleeding with a sinus infection, but that’s not always the case, so we really don’t utilize that as a differentiator. But that being said, with a bad sinus infection, and the mucosa can be really inflamed to the point where bleeding can be an issue for the patients.

TODD: So, how do you know if the antibiotic course really killed all the infection? Particularly when it’s allergy season and you still have nasal symptoms that could be from allergies?

DR. TAKASHIMA: If a patient initially starts getting better, and patients should start getting better after about 48-72 hours, and if a patient, although they started feeling better, they start feeling worse, then you can either give another course of antibiotics, or the other option is just to go see an otolaryngologist or an ENT doctor, and have them look inside the nose, see if there is any evidence of persistent purulence coming out of the sinuses, and if there is, the otolaryngologist can do a quick sampling of that secretion so they can get a quick culture of that secretions. And then we can identify exactly if there is a active organism there, what the organism is, as well as if the antibiotics that were prescribed to the patient is sufficient. Because there are some bacteria that can be resistant to certain antibiotics. And so, we need to make sure that we’re adequately treating the actual organism that’s causing the infection.

TODD: So, is what’s going on physiologically in the nasal passages different during the allergies as it is during an infection?

DR. TAKASHIMA: So, overall, you know, it is a very similar process because it is an inflammation of the nasal cavities. And so, with allergies, it’s more of an inflammation secondary to allergens that irritate the nose. While, from an infection standpoint, it’s actually the infection that’s causing the inflammation. And so, the responses are very similar in regards to you do get the nasal congestion, or the nasal inflammation, you do get more mucus production, you do get more rhinorrhea and postnasal drainage with both. And so, that process is very similar. The only differentiator is that, of course, the actual process with the allergic being more of an allergic process, there’s more histamine released that causes all that swelling, all of the symptoms.  First is an infection where it’s the infecting organism that’s actually causing that inflammation. So, really very similar. Of course, the treatments vary, depending on if it’s more allergic verses bacterial.

TODD: And is there any overlap in the treatments, sinuses versus allergy or are they pretty fundamentally different? I mean, if you don’t see a doctor when you have an infection, is anything you’re doing for your allergy regimen doing any good?

DR. TAKASHIMA: Yeah, and so, really the treatment is very similar in many ways. Like I mentioned before, it’s very consistent with dealing with the inflammation that’s going on inside your nose. And so, what can we do to decrease that inflammation inside the nose? What can we do to remove the irritants, be it the allergen or the infectious process? And so, a lot of that is treated through the use of nasal saline irrigations. And so, nasal saline irrigations for those that don’t know, it is really forcing nasal saline through your nose to, sort of, cleanse the nasal passageways and the sinuses. And so, what that does is that eliminates any allergic material that might get caught inside your nose such as pollens. It also will decrease the bacterial counts inside your nose too. And so, by doing that, you give the nasal mucosa a chance to heal, a chance to improve, a chance to decongest, chance to open up the sinuses a little bit because all that inflammation can block off the sinuses causing more problems. Whenever the sinuses are blocked off, then you can’t get circula -- air circulation inside the sinuses, you get stagnant mucus inside the sinuses, which are then more prone to getting infected. I like to picture this as more of like a running stream. When you have a running stream, it’s a lot safer to drink out of a running stream than drinking out of a stagnant pond. And so, similarly inside the nose, if the mucus is running, if it’s actually able to get out of your nose, the bacterial counts in that mucus in that mucus is a lot lower than stagnant mucus. And so -- so, there is that. And so -- You know, but the primary difference of course is for an infection, you should definitely treat it with an antibiotic. An antibiotic will shorten the course of the infection, it’ll make you feel better quicker, and it’ll also prevent any potential complications.

TODD: So, what are the most common causes of sinusitis, particularly allergies? Allergies causing sinusitis.

DR. TAKASHIMA: Any allergens can cause sinusitis, and the mechanism is the allergens get inside the nose, it causes an inflammatory process which blocks off the sinuses then causing a sinus infection. And so, we definitely see that very frequently. And so, whenever we see patients with allergies that’s causing a lot of sinus problems, we don’t just try to treat the sinus infection, we obviously need to treat the cause of the recurring sinus infections. And so, with that, we do treat the allergies via allergy nasal sprays, allergy oral medications, and allergy immunotherapy or allergy shots.

TODD: But the most common allergens are pollen, mold…

DR. TAKASHIMA: Yes, exactly. Pollens, mold, pet dander is also very common, and dust mites. Especially if you’re in Houston, dust mites is very prevalent. You can’t get rid of dust mites; they thrive in this type of humid environment. And more so than not, most of my patients are allergic to dust mites.

TODD: And how about more unusual things? Like, do food allergies affect your sinuses?

DR. TAKASHIMA: Food allergies commonly affect the G.I. system, it rarely affects the sinuses. So, it’s not very common that we see a sinus exacerbation due to food allergies. There is a subset of patients however that these patients might be highly allergic to yeast or mold, and so, as you can imagine, if you then consume a lot of products that contain yeast or mold and, you know, we might say, “Hey, well we don’t need that kind of stuff.” But think about it, right? Any bread that’s risen, dried nuts have a lot of yeast on it, beer, wine. I mean, there’s a lot of really good stuff that we eat that’s high in yeast. And so, that might be a trigger for the nose. And so, some of my patients might say hey they -- you know, every time they drink a beer, they get really congested. And so, that would be some semblance of a food allergy affecting the nose.

TODD: How about secondhand tobacco smoke?

DR. TAKASHIMA: So, secondhand tobacco smoke along with any occupational chemicals, any pollutants, you know, they all sort of are within that same category of irritants inside the nose that can cause a sinus exacerbation or an allergic attack. But that being said, you know, it’s hard to identify what those chemicals are. In Houston, the pollution -- I mean, there’s a lot of different things that constitute pollution. And so, it’s hard to test for everything in the air to see what you’re allergic to and so forth. But that being said, you know, allergy testing is very helpful, but I always tell my patients that just because your allergy test was negative, that does not necessarily mean that you’re not allergic to anything. It’s just that you’re not allergic to whatever they tested you for. And so, you have to make sure that you still keep that in the differential, especially if you are having exacerbations of allergies and/or sinus infections.

TODD: So, how long is too long to have mysterious nasal symptoms? What’s the first step for dealing with them?

DR. TAKASHIMA: Yeah. You know, I think the first step is to have a routine evaluation by your primary care doctor, make sure that they are on board, because a lot of things that affect the nose and sinus can be taken care of by a primary care doctor. Allergies definitely can, as well as sinus infections. It’s those sinus infections that persist. And so, patients who have recurring sinus infections one after another, they have prolonged periods of sinus infections. So, I like to define, you know, prolonged periods as really greater than ten days. If after ten days, things aren’t improving, then that is somewhat of a concern, especially after treatment with antibiotics and/or nasal regimens. And so, if you have issues that aren’t getting better, if you start noticing any kind of complications due to sinus infections such as irritation of the eyes, swelling of the skin, severe headaches. You know, those kinds of things. Then that needs to be evaluated as well.

TODD: And as far as infections go, people usually get viruses, and those are sometimes followed by an opportunistic bacterial infection.

DR. TAKASHIMA: Yes. And so, currently, we actually have a study going on here within the department utilizing AI and combing through databases to identify predictive models to define exactly, you know, who gets sinus infections, why are they getting sinus infections? You know, if you remove certain elements from their lives such as smoking, does that improve their sinus health? And the nice thing about AI is that it can comb through all these huge databases of patient information that we have to produce these predictive models. So, one database query that we were recently involved with involved looking at viral infections and how frequently patients get sinus infections after a viral infection. And it’s very interesting in that, if you look at all that data, it shows that if you have a viral infection, the following year after that viral infection, you are at a 2.5 times greater risk of developing a sinus infection…

TODD: Bacterial.

DR. TAKASHIMA: A bacterial sinus infection in that subsequent year. So, we found that really interesting because right now, there’s a lot of discussions about climate change, pollution causing sinus infections, but it doesn’t come anywhere close to that 2.5 value that we’re seeing with the viral infections. So, viral infections definitely will predispose you.

TODD: And not during the course of the viral infection. It could be much later. Why is that?

DR. TAKASHIMA: Yes. Exactly. It’s definitely much later. We don’t absolutely know why that is. Is it because the natural biome of the sinuses are affected? And so, we have less natural defenses to fight off sinus infections possibly. You know, the other thing is, a lot of times, whenever we get a viral infection, a lot of times, patients take antibiotics or are given steroids during that course, and that can really also not only kill all the bad bacteria, but also all the good bacteria in your sinuses too. The bad bacteria can then populate inside your sinuses where typically the good bacteria, sorta, crowds them out and prevents that from happening.

TODD: And so, if you have a virus, it’s not only bad to get an antibiotic treatment for it, it’s bad to get allergy treatment for it?

DR. TAKASHIMA: Well, so, mainly antibiotics and steroids is what we think is the main culprit there. And the fact is, you know, unfortunately sometimes if you have a viral infection, sometimes if you have a bad allergic attack, it mimics a sinus infection. And so, unless you have all the fancy tools that we have such as these nasal endoscopes or an in-office CT scanner like we have, it can be very difficult to differentiate the two. And so unfortunately, I do think that a lot of patients do get antibiotics and steroids when they absolutely don’t necessarily need that.

[ Music plays signaling brief pause in the interview]

ZACH: Dr. Takashima mentioned the difficulty, even among doctors, distinguishing sinus infections from allergies. Probably no better evidence of that exists than a study published earlier this year. The study involves 219 people thought to have sinus allergies. Each underwent nasal endoscopy and testing to gauge the severity and type of their sinus or nasal symptoms. The study did find a majority of test participants, 91%, did have some form of environmental allergy. However, the study also found that almost half, 45%, also tested positive for chronic rhinisitis, an inflammation of the sinuses often caused by infection and treated with antibiotics. Researchers noted that they had had patients who had been treated with allergy shots for ten, twenty, or even more years without relief of their symptoms. After it was discovered they had chronic rhinisitis, they had relief within a few months once they were put on the appropriate treatment.

[Music plays]

TODD: More with Dr. Takashima after the break.

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[Sound effect plays to signal resumption of interview]

TODD: Do you ever get opportunistic fungal infections of the sinuses after -- during or after a viral infection?

DR. TAKASHIMA: So, there’s two types of fungal infections patients get. One is called allergic fungal sinusitis, and what that is is that is secondary to an allergy, to mold. And unfortunately, living here in Houston where it’s so humid and there’s mold spores around us all over the place, as you can imagine if you’re highly allergic to molds, then that can be a problem. But, interestingly, it’s more of an allergy to mold than a fungal infection in those patients. And so, if you clear that mold from the sinuses with sinus surgery, you just flush out all that mold out of the sinuses. And get these patients on a good allergy regimen, typically, that’s the course -- that’s the treatment course of allergic fungal sinusitis. The other type of fungal disease that we see in the sinuses occur in the immunocompromised patient. This is called invasive fungal sinusitis, and this is where, due to the patient’s low immune system, let’s say a patient is a severe diabetic, let’s say a patient is post-transplant and on immunosuppressive medications, then the body cannot fight these opportunistic fungal infections. And that is actually a very serious infection that’s very difficult to treat as well, which required typically multiple sinus surgeries to remove dead tissue, which the fungus actually cause to thrive in.

TODD: So, it sounds like you don’t want a fungal infection there, huh?

DR. TAKASHIMA: Yeah. Fungal infections are not anything to be toyed with, that’s for sure. And to tell you the truth, you know, we are much more scared of fungal infections than we are of bacterial infections.

TODD: We? Doctors.

DR. TAKASHIMA: Doctors.

TODD: You don’t see fungal infections that often.

DR. TAKASHIMA: Here in Houston, we see that allergic fungal sinusitis quite frequently. When I used to practice in Colorado where it was extremely dry, we hardly ever saw allergic fungal disease. But in the southern states, definitely with the high humidity levels, we see it all the time.

TODD: Are there clear indications to the patients if it’s a viral, versus bacterial, versus fungal?

DR. TAKASHIMA: Viral infections typically tend to be less severe. It’s more of a milder form of sinusitis that they get. You know, they still get the nasal congestion, they still get the drainage. And that’s really about it. They may get occasional facial pressure and pain, yeah, and so forth, but that’s about all that’s involved with a viral sinusitis.

TODD: Viral discharge tend to be less colored than bacterial?

DR. TAKASHIMA: Absolutely. Yes. It typically is more clear. And it’s usually the bacterial infections that cause the purulence.

TODD: Viral infections tend to resolve on their own and antivirals aren’t really that effective.

DR. TAKASHIMA: Antivirals typically don’t play a role in viral sinusitis. By the time you get viral sinusitis and you’re significantly symptomatic from that, usually the timeframe has already passed in regards to the efficacy of some of these antiviral medications because these antiviral medications, you really have to start taking almost immediately at the first sign of symptoms. And it usually takes a little time for all the symptoms to evolve into a viral sinusitis.

TODD: Bacterial infections doesn’t resolve on their own as much?

DR. TAKASHIMA: Not as much. I mean, with time, eventually a good immune system will be able to cure that, but it can take a significant period of time. But along with that, it can also cause a lot of symptoms during that time. Take for example, you know, if you have a lot of puss going down the back of your throat, you know, there’s a higher risk of you developing pneumonia, especially while you’re sleeping and some of that puss gets down into your lungs. Also, because of the location of where the sinuses are right between the eyes and right underneath the brain. We, I wouldn’t say commonly, but we definitely see complications associated with extension of the sinus infection into the eyes, into the brain, which can obviously cause very serious problems there too. And so, I mean, just to improve quality of life, shorten the time that you’re infected, as well as avoiding, kinda, complications, I definitely think that if you’re diagnosed or if you have signs and symptoms of an acute sinus infection, that it be treated appropriately with antibiotics.

TODD: How about long Covid? Is that played into this equation much? Does that complicate determining whether the issue is infection or allergy?

DR. TAKASHIMA: Right. So, long Covid, it is a very interesting phenomenon because its symptoms associated after a Covid infection that we really can’t attribute it to any other diagnoses or disease process. There’s certain side effects of long Covid that we as rhinologists see very commonly, and that can be rhinorrhea, so runny nose, cough, as well as the loss of smell. You know, how do we really differentiate and, you know, is this allergy? Is this long covid. It really is by history. And so, the patient has been doing well, you know, all of a sudden after Covid, it’s not like their allergies should really spike up or anything like that. And so, a lot of that is with history. Obviously, there are some quantitative tests that we can do in regards to smell loss with smell tests and so forth. And right now, we actually are leading in multi-institutional trial, looking at certain medications to improve the anosmia or the smell loss that’s associated with long Covid, and we’re getting some fantastic results so stay tuned with that.

TODD: Well, that’s all I have. Is there anything you’d want to add about -- just for the average person out there not sure what they have? How they should be thinking about it.

DR. TAKASHIMA: Yeah. You know, I think it really is about decreasing inflammation inside the nose, decreasing any kind of bacteria inside the nose or any allergens inside the nose and so you'd be surprised at how just a nasal saline irrigation, or a saline rinse will make a difference in regards to decreasing allergic irritants. And irritants secondary to pollution, irritants secondary to bacteria from the nose, and so, you know. If you’re concerned and you want to start something, that’s probably the first place I would start.

TODD: Very good. Alright, well thank you for taking time to talk about this, very informative.

DR. TAKASHIMA: Great. Thank you so much.

[Sound effect signaling end of interview]

 

ZACH: So, Todd, do you feel like you have a better understanding now of the differences between allergies and sinus infection?

TODD: Well, to be honest with you, I’ve seen so many sinus doctors in my life that I always felt like I had pretty good hand on it. I guess the question is do you feel like you have one? You probably came into this a little colder than me.

ZACH: Yeah. I mean, him talking about antibiotics and how the roles -- that played -- I thought it was interesting he talked about sometimes it's a viral infection first, it becomes a bacterial infection. I thought that was pretty interesting.

TODD: Well, I thought the really fascinating thing was that study that -- AI study that combed through all the many cases and found that if you had a viral infection, you are 2.5 times more likely to have a bacterial infection in the same year.

ZACH: Yeah.

TODD: I’ve always understood it that you get those opportunistic bacterial infections as you have a viral infection, not so much six months later or something like that.

ZACH: I feel like I’m one of those people. I feel like -- ‘cause it’s -- If I get sick, it’s usually one of these things, and I’m probably one of those -- one of the percentage of people that that happens to. And another thing about that is, you know, when he mentioned, like, certain things you like, you know, eat or drink and how people get stopped up after, that is totally me, a hundred percent. So, I need to go to a ENT for this.

TODD: That was pretty rare he said though. It’s interesting you’re --

ZACH: I’m rare, Todd. I’m a rare guy.

TODD: Yeah, yeah. That’s the nice way to put it. You’re rare.

[Laughter]

ZACH: No, but I mean, I haven’t quite figured out exactly what it is yet.  Like, he was talking about, like, keeping track of everything, very important. I should probably do some sort of, like, food journal to figure this out because I know sometimes, not like every time I eat something it happens, but sometimes, very much so.

TODD: So, with this you’re having more of an issue than I had originally thought…

ZACH: Well, yeah.

TODD: If you’re actually contemplating a food journal.

ZACH: I am.

TODD: Wow. Well, that’s good.

ZACH: I hope it takes me shorter than you to solve all my allergy problems but…

[Laughing]

TODD: Well, are yours allergy or sinusitis?

ZACH: That’s -- we’re gonna find out.

TODD: Yeah. Have you tried the saline --

ZACH: You know, I have. I have tried the nasal spray…

TODD: Yeah.

ZACH: No effect, really.

TODD: Really?

ZACH: Yeah. I do go to the doctor occasionally despite what you might think on this podcast. And I have been recommended the nasal spray, and didn’t really -- Didn’t really do much for me.

TODD: Nasal spray or the salt irrigations?

ZACH: Yes, yes.

TODD: I liked his analog of the benefit of that as being like -- because it opens your sinuses, allows you more oxygen there, that’s like the difference between a stagnant pond and a running stream, you know? You want the latter. And salt irrigations can help you do that.

ZACH: Yeah, that was a great analogy.

TODD: Yeah. For me, I just find that’s good maintenance. If there’s a day I feel a little congested that frees it up some. So, you haven't -- you didn’t find that?

ZACH: No. For whatever reason, it didn’t really help me that much, if at all. And so, I just need to look into deeper -- Like, I don’t wanna have, like, surgery. I mean there’s -- I know people have options about that, right? Sinus surgery and all that.

TODD: There are a number of surgeries for those issues.

ZACH: Yeah. So, not ideal but sometimes you gotta do it. Now, I’m not like, over here, like, “Oh, I got this terrible problem, I gotta solve it.” It’s a inconvenience. I hate having to, like, blow my nose a lot after I eat, and I feel like I have to do that a lot of times…

TODD: Yes.

ZACH:  And it’s, you know. It’s not fun for anybody, especially people who are with me, right?

TODD: In the movies, if they wanna depict you in a negative fashion stereotypically, they have you blowing your nose a lot.

ZACH: Yeah.

TODD: So. No one wants that.

ZACH: Nobody wants that guy around. Well, there you go. So, important information, as you guys talked about, you know, you live in Houston, you probably have something going on, and hopefully this information was helpful to you.

TODD: Yes, absolutely. I've heard it said that if you didn't have a sinus problem before you got to Houston, you will once you get here. So, be sure and see your primary care doctor or find a sinus specialist if your problems won’t go away.

ZACH: Absolutely. Good advice. Well, that's gonna do it for this episode of On Health with Houston Methodist. We drop episodes Tuesday mornings so be sure to share, like, and subscribe wherever you get your podcasts. And until next time, stay tuned and stay healthy.