Dr. Grossan's Ear, Nose and Throat Consultant Pages

      AIDS Ear, Nose, and Throat Questions

AIDS and Sinusitis

AIDS patients develop major sinus disease that may be fatal. With sinusitis, the original toxic effect of the virus is aggravated by a secondary bacterial infection.

A single major characteristic of aids sinusitis is that the mucus of the nose and sinuses thickens so that the normal defense of the nose, which is movement of the microscopic hairs or cilia, can no longer function in order to move the film of mucus and bacteria out of the area.

Picture a row boat; the oars paddle the water and the boat glides nicely over the water. This is what the cilia normally do; the cilia (oars) move a blanket of liquid so that bacteria are moved along and won't have time to enter the body. Now, instead of water, picture egg yolk or molasses. Now the oars (the cilia) can't move the boat and the boat stagnates. Similarly, with the thick phlegm the cilia can't move the bacteria out of the area. Not only do non-moving bacteria multiply, but the thick mucous can actually plug the sinus openings. This creates a vacuum which is ideal for infection.

Any method that can thin the phlegm is helpful. All of the following should be done: drink hot tea, use saline or enhanced nasal moisturizer drops 4X per day, and proteolytic enzyme lozenges dissolved in the mouth between the cheek and the gums. An enhanced nasal moisturizer is one that follows a Locke-Ringer's formulation, which has been shown to aid cilia better than regular saline, and avoids the problems of additives that many other drops have. A good proteolytic enzyme formula is a bromelain/papain preparation that has calibrated enzyme activity - other enzyme preparations sold as supplements have enzyme activity so low they do no good. Various iodide preparations may help. In one study taking guaifenesin helped thin the phlegm. Use of pulsatile irrigation works because the pressure is delivered at a correct level and the pulsation frequency acts to break up the bonds of the thick mucous and thereby thin the mucus so the cilia can do their job of defense. Also, irrigation removes much bacteria from the area and the saline is good for the nose and sinuses.

An important advantage of an appropriate pulsatile irrigation device is that the pressure is set at 5 psi. Simply sniffing salt water may raise the pressure too high and push bacteria deep into the sinus or into the ear. Thus the pulsation allows a low pressure to do the same work that would require a high pressure without the pulsation.

Another problem seen in aids - sinusitis is that the thick phlegm induces a natural tendency to try to clear the nose by snorting or blowing too hard. This can then spread the bacteria into the other sinus area and into the ear. For this reason I recommend the irrigator early at the onset of symptoms.

For my patients, I encourage these steps to prevent thick mucous from accumulating:

In the office we perform local suction, or needle irrigation in order to remove mucous plugs. At surgery the sinus cavities are drained and opened to encourage drainage.

The pulsatile irrigator device has been especially useful because the physician can add various antibiotics to the saline solution for local treatment and may be able to avoid systemic treatment.

AIDS and Bronchitis

The mechanism of aids in bronchitis is similar to that of aids in sinusitis. There are thick plugs which prevent the bronchial cilia from beating at a normal rate. This allows bacteria to remain stagnant when the good white cells are missing. Early treatment is the same as in sinusitis, lots of liquids, guaifenesin, papaya enzyme. Some doctors prescribe bronchial dilators and of course the correct antibiotic or combinations.

Some bronchial patients benefit by performing pulsatile irrigation twice a day. The exact mechanism for this helping is not known. Whether it is because the bacterial load is reduced by clearing the sinus, or some connection so that when the nasal cilia are stimulated it also stimulates the bronchial cilia, or some other means is still being studied. It makes sense to do this because in regular asthmatic or bronchial cough this nasal sinus irrigation helps these problems.

As in cystic fibrosis any measure that will help the chest to drain is useful including lying so that the hips are elevated and the shoulders are down, deep breathing, percussion to the chest, steam inhalation with the tongue out. A flutter device is used in cystic fibrosis which delivers a vibration to the lower chest. This vibration movement helps break up the thick mucus so it can drain in a normal manner. Although not designed for aids bronchitis it should be of value. Some practitioners teach their patients to make a sound like a low pitched "ooommmm" which seems to help.

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Last Update 2001 January 21
Murray Grossan M.D.