Can Acid Reflux Cause Sinus Problems?
- Facial pain, sinus pressure, and post-nasal drip are symptoms that do not make a diagnosis of sinusitis; those symptoms are more often related to Supine Nocturnal Respiratory Reflux (SNoRR) affecting the sinuses… do you eat too late or snack before bed?
- At present, surgeons are performing a ton of uncalled for, unnecessary, and ineffective nose and sinus surgeries that are more likely to harm than help patients; respiratory reflux is not corrected by sinus surgery.
- Hopefully this post will provide you with enough information to help you understand your sinus problems and differentiate reflux symptoms from true sinus disease … and help you stay away from surgery.
Note: Respiratory Reflux (RR) and Laryngopharyngeal Reflux (LPR) are synonyms and the terms can be used interchangeably. Going forward, I prefer the term RR and so should you; it is easier to pronounce, more intuitive, more comprehensive, and implies that RR can affect any and all parts of the respiratory system, which it does.
Recently, I did a consultation with an otherwise healthy 55-year-old woman who told me that she had had sinusitis four times in the prior ten months, each treated with antibiotics and steroids. In addition, she was scheduled to undergo her third sinus surgery. Her symptoms were facial pressure, post-nasal drip, and a full feeling in her sinuses. I gasped. This clinical pattern made no sense. To keep a long story short, she had respiratory reflux, and did not meet any reasonable indications for surgery.
Reflux patients who had had multiple sinus surgeries were my angriest group of patients ― “I’ve has a septoplasty, turbinate reduction, and three sinus surgeries, all of which have did nothing except make me miserable. Then I found you, and I now know that it’s all reflux … please, please fix me” ― many such patients wanted to sue their sinus doctors for malpractice.
When It Comes to Nose and Sinus Surgery, Double Caveat Emptor
Alas, the go-to doctor for nose and sinus problems is the otolaryngologist (ear, nose, and throat, physician and surgeon); unfortunately, otolaryngologists have no formal training in respiratory reflux; it just isn’t in their curriculum. That said, respiratory reflux-caused sinus symptoms are extremely common, but otolaryngologists generally don’t recognize reflux as the underlying problem. To make matters worse, there is a reflux-testing apparatus on the market (Restech) for otolaryngologists, but I believe that this test is worthless, that is, the data are unreliable.
Most of the time, true sinusitis follows an upper respiratory infection or upper jaw dental procedure, and it is uncommon for both sides to be involved. This type of infective sinusitis is rarely a problem that reoccurs; it usually happens once in a lifetime. If you get this real sinusitis, you will have pain and even painful teeth on the affected side. Dental problems and dental surgery are a common cause of maxillary sinusitis, perhaps as common as sinusitis after infections … but again, usually just one sinus.
If respiratory reflux causes sinus symptoms such as nasal obstruction, post-nasal drip, a feeling of fullness in the sinuses, facial pain and pressure, those symptoms almost never meet the criteria for nasal septal straightening, turbinate reduction, balloon sinuoplasty, or in-the-operating-room sinus surgery,
The radiographic criteria for the accurate diagnosis of sinusitis depend on having a completely opaque sinus, that, is full of pus and no air. Having thick or swollen sinus lining, called mucoperiosteal thickening is not sinusitis. A friend who sells medical instruments told me that some radiologists assist the surgeon’s desire to perform surgery by calling mucoperiosteal thickening, “Consistent with chronic sinusitis.” Even worse, some ENT physicians have their own x-ray equipment, so they can interpret the images any way the choose.
Surgeons have an intrinsic conflict of interest. Let me explain. After I had been in practice two years, I made some calculations: I made about $100 per hour in the office and $1,000 per hour in the operating room. So, I thought to myself that surgeons (like me) have a great incentive to do surgery. So, I devised a strategy that would keep me honest and ethical. I would only make recommendations to my patients as though they were in my family … my son, my brother, my mother. It worked, in 45 years of practice, I never did a single surgery that wasn’t necessary and I never once was sued for malpractice.
If you are convinced that you might be an actual candidate for nose/sinus surgery, ALWAYS get a second opinion. And no, you should not see your doctor’s partner, or anyone else in his building. Your second opinion should be elsewhere; and ask the second opinion doctor if he knows if doctor #1 has a good reputation as a surgeon.
In summary, facial pressure, feeling of fullness in the sinuses, nasal congestion, and post-nasal drip are common symptoms of Respiratory Reflux. This post is a warning that too many ENT surgeons are doing too many unnecessary surgeries, including septoplasties (nasal septum surgery), turbinate reductions, balloon sinuplasties, as well as in-the-operating-room surgeries. Remember, second opinions are a must.
Think respiratory reflux and beware of the surgeon: the two main points of this post.