Ellen:

Try the University of Michigan Sinus Center
Here is their web site.
Their lab is better than most and they recognize the bacterial nature
of the disease.
And some microbiologists that I truely respect have gone to teach
there.
I don't know if that guarentees anything, but I think the odds are
better there.
Read what is below. I think the chances are good that there you won't
get the same glazed eyeballs and shruged sholdiers.

Their FAQ are well worth a read, as they are reasonable logical
comprehensive and mscope true, not some mumbojumbo.

Universtiy of Michigan Health Center
Michigan Sinus Center
FAQ
What is sinusitis?
Sinusitis is defined as inflammation of the sinuses. The sinuses are
chambers that communicate with the nasal cavity through tiny openings
(See "What are sinuses?"). They become inflamed due to a variety of
causes but typical sinusitis is due to a bacterial infection. Often
the problem in the sinuses occurs in association with a condition that
affects the nasal cavity, such as allergies, a viral infection, or
irritation. Because the nasal cavity and the sinuses typically react
in conjunction with one another, some experts have suggested that the
term "sinusitis" be replaced with "rhinosinusitis" (rhino = nose) to
emphasize this association.

Sinusitis is a common condition that affects millions of people across
the world. It has been estimated that as many as 35 million Americans
suffer from this disease at that it accounts for at least $2.4 billion
in direct medical costs alone. This figure does not take into account
the economic impact of lost productivity, work days lost for illness,
and time lost for doctor's office visits.

What causes sinusitis?
As mentioned earlier, sinusitis typically occurs in association with
conditions that affect the nasal cavity, such as allergies,
irritations to the nose, or a viral infection (like a common cold).
All of these conditions cause the lining of the nose (the "mucosa") to
swell. This swelling, often called "edema," further constricts the
already narrow openings through which mucus leaves the sinus. Air
circulation into and out of the sinuses is also impaired. With further
inflammation, the movement of mucus out of the sinuses by the
microscopic hairs called cilia slows and the secretions become
stagnant. These conditions favor growth of bacteria and an infection
sets in. Once the bacterial infection begins, it causes more
inflammation and swelling and leading to increased mucus production.
More swelling only worsens the mucus transport and air exchange,
favoring more bacterial growth and the cycle continues.

Symptoms of sinusitis can be quite variable, both in whether or not
they are present and how severe they are. They can mimic many other
conditions, including the common cold, allergies, migraines and other
types of headaches, and jaw problems. Patients with sinusitis
typically have at least one of the following symptoms:

discolored nasal discharge - often yellow or green
facial fullness, heaviness, or congestion
facial pain or pressure
decrease or loss of the sense of smell (the sense of taste may also be
affected)
decrease in the ability to breathe through the nose
Other symptoms that patients may have in association with the ones
above are:
fever - often low grade and variable
fatigue or malaise (flu-like symptoms)
pain in the upper teeth
pressure or fullness in the ears
chronic cough
bad breath
Clearly, these symptoms are not specific and could be from a number of
conditions. It is for this reason that sinusitis can be difficult to
diagnose. Fortunately, recent diagnostic advances have improved our
ability to accurately identify patients with sinusitis so that they
can be appropriately treated.

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How is sinusitis diagnosed?
Because the symptoms of sinusitis can mimic other diseases, a careful
history of the problem is important. While facial pain and discolored
nasal discharge or mucus is most often associated with sinusitis,
other more subtle symptoms like cough, malaise, or fatigue should also
be sought out. Questions about each specific symptom, including its
duration and severity, and about the success or failure of past
interventions can help to shed light on the nature of the problem. In
order to be thorough and complete, we use a questionnaire to gather
information about a patient's symptoms. The patient's responses then
form a basis for a more thorough discussion of the history of the
illness.

An equally thorough physical examination then compliments the history
of the illness. Because symptoms within the nose and sinuses can be
associated with findings within the ears, throat, and neck, a complete
otolaryngological (ENT) examination is warranted.

Often a more thorough examination of the nose, called a "diagnostic
nasal endoscopy" is performed. This procedure involves passing a fiber-
optic telescope, or "endoscope," into the nose and examining the
interior of the nasal cavity. In this manner, the condition of the
mucosal lining surrounding the sinus openings can be examined. Nasal
endoscopy has greatly advanced the diagnosis and treatment of
sinusitis. By providing superb illumination and magnification, it
gives physicians the ability to closely examine conditions deep within
the nose. It allows precise identification and targeting of problem
areas and gives physicians an increased ability to monitor a patient's
response to therapy.

Despite the great advances brought about by nasal endoscopy, this
procedure can only give information about the openings of the sinuses.
Unless a patient has had previous sinus surgery, the examiner cannot
see the interior of the sinuses. Even in patients who have had sinus
surgery, scarring can obscure the view into the previously opened
sinuses. For this reason, another tool is used to visualize the sinus
interior: computerized tomography, also known as a CT scan.
(Previously the procedure was also referred to as a CAT scan, for
computerized axial tomography). The CT scan provides information about
swelling within the sinuses and also provides a road map of sinus
anatomy should surgery be necessary.

CT scanning can be a powerful tool in diagnosing sinusitis but must be
performed under the right conditions. In patients with "chronic
sinusitis," the procedure should be performed when the patient is at
his/her best. Patients should have received appropriate medical
therapy and the scan should be performed no sooner than four weeks
after the last flare-up. Otherwise, residual acute (short-term)
inflammation will show up on the CT scan and give a false impression
about the severity of the disease. If a patient undergoes a scan
during an acute flare of sinusitis - or even during an episode of the
common cold - the scan may show inflammation that will completely
resolve. Such inflammation does not necessitate long-term medications
and especially does not require surgery. In contrast, patients with
"recurrent acute sinusitis," a less common variation of sinus
problems, sometimes have CT scanning performed during the acute
exacerbation in order to demonstrate that sinusitis is truly occurring
and which sinuses are affected.

"Recurrent acute sinusitis" is much less common than "chronic
sinusitis" but the difference shows the importance of a thorough
evaluation. All components of each patient's assessment - history,
general otolaryngological examination, nasal endoscopy, and CT
scanning - must be considered before embarking upon a course of
treatment. Trying to use just one without the others can lead to
errors in diagnosis and delays in instituting the correct therapy.

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How is sinusitis treated?
The goal in treating sinusitis is to re-open the narrow communication
between the sinuses and the nasal cavity (See "What are sinuses?").
This in turn promotes movement of mucus out of the sinus and re-
establishes normal oxygen levels within the sinuses. In chronic
sinusitis, the principal way to accomplish this goal remains
medications. In some patients, medical therapy fails to provide relief
of their symptoms. These patients may be considered for surgery (See
"What is Endoscopic Sinus Surgery?").

Often the treatment of chronic sinusitis involves combining a number
of medications. Each class of drugs is summarized below.

STEROID NASAL SPRAYS
This class of medications works to diminish the nasal lining's
inflammatory response, resulting in less swelling and better mucus
transport. These sprays form the first in the treatment of a number of
inflammatory conditions within the nose (See "What about other sinus
conditions?"). They are typically sprayed into both sides of the nose
and work directly on the lining they come into contact with. Their
onset of action is relatively slow and patients may not feel their
effect for days or weeks. For this reason, often patients give up on
this method of treatment too soon.

Steroid nasal sprays are generally well tolerated. Side effects from
these medications include irritation within the nose and nasal
bleeding. This bleeding can be avoided by pointing the spray bottle
away from the nasal septum (the bone and cartilage that runs down the
middle of the nasal cavity). Because the sprays are minimally absorbed
throughout the rest of the body, side effects seen with taking steroid
pills (see below) are extremely rare.

ANTIBIOTICS
The vast majority of cases of chronic sinusitis are due to bacteria.
For this reason, antibiotics are another mainstay of treatment. Most
patients who see a specialist regarding their sinuses have previously
been on many courses of numerous antibiotics. In many cases, these
courses are for only seven to ten days, usually insufficient to stamp
out the bacteria in a chronic infection. Most experts now believe that
antibiotics for chronic sinus infections should be maintained for a
minimum of three to four weeks. Ideally, the antibiotic should be
chosen based on the results of a culture, where a sample of the
bacteria is sent to the laboratory for identification and other
testing. Because the openings of the sinuses cannot be seen without an
endoscope (See "How is sinusitis diagnosed?"), blind sampling of the
nasal cavity using conventional equipment is nearly useless.
Nevertheless, endoscopically directed cultures have proven quite
useful and specific.

Antibiotics have a number of side effects, many of which are specific
to each different type of drug. Nevertheless, some are common
including rash and diarrhea. If these occur, the drug should be
discontinued and the symptoms immediately reported to your physician.
While most reactions are mild, some can be serious and may require
additional medical attention.

ANTIHISTAMINES
Antihistamines combat the allergic response within the nose. Many
patients with chronic sinusitis have symptoms of allergies including
itchy nose or eyes, sneezing, watery eyes, and nasal congestion.
Patients with chronic allergies may not experience the typical itching
and sneezing symptoms, but may have chronic congestion, runny nose,
and fatigue. The allergic response to an irritant (commonly dust
mites, pet fur, or pollen) results in inflammation within the nose,
precipitating or worsening the sinus condition. Blocking this response
can improve sinus function and reduce symptoms of sinusitis.

One problem with many older antihistamines is the fact that they can
cause sedation as well as drying and thickening of nasal secretions.
Many new antihistamines have little or no sedative side effects and
don't cause problems with secretions. Some are also combined with a
decongestant to further reduce swelling within the nose and sinuses.
While most antihistamines come in the form of pills taken once or
twice a day, others can be sprayed into the nose or come as eye drops
to control specific symptoms.

DECONGESTANTS
Decongestants act specifically to decrease swelling within the nose.
They work directly on the blood vessels within the nose that control
the thickness of the lining. They may also affect blood vessels
throughout the body and should be used with caution (if at all) in
individuals with certain disorders, particularly difficult to control
hypertension or high blood pressure. Most decongestants are available
"over the counter" and they are often combined with antihistamines.
They can cause jitteriness or difficulty sleeping for some patients
and should not be used in men with prostate problems.

Decongestant nasal sprays merit a special word of caution. They are
particularly useful in diminishing swelling within the nose for a
short period of time. If used for more than three days in a row, they
can lead to a "rebound effect" and actually worsen nasal swelling.
Often patients will then increase the dosage or the frequency with
which they use the sprays in order to diminish the rebound swelling.
This leads to a vicious cycle of decongestion followed by rebound
swelling, a condition known as "rhinitis medicamentosa" (See "What
about other sinus conditions?").

MUCOLYTICS
These drugs, also known as expectorants, are common ingredients in
cough syrups to loosen and thin mucus. Because mucus often becomes
thick and stagnant in chronic sinusitis, many physicians believe these
medications may be helpful in this condition as well. The mucolytics
are usually well tolerated with almost no side effects. In higher
doses they can cause nausea and, because these drugs act to thin
mucus, they can increase fertility in women.

NASAL SALINE SPRAY
Like mucolytics, nasal saline (salt water) has been theorized to
improve mucus transport. While there are no good studies to support
this claim, saline sprays are relatively innocuous and inexpensive.
They appear to be helpful in some patients, especially those with
dryness or crusting as a major symptom. Other sprays, which have
various herbal additives, have given some patients relief as well.

IRRIGATIONS
Some physicians advocate rinsing the nose with saline or other
solutions. The fluid can be delivered using a rubber bulb or with an
attachment to a Water Pik machine. Irrigations can assist in removing
thick or dried mucus. Antibiotics are sometimes added to the solution
to decrease infection as well. If irrigations are used within the
nose, great care should be taken to keep all items as clean as
possible. This will prevent introducing new bacteria from the
irrigation system into the nose, which can perpetuate an infection.

ORAL STEROIDS
In severe cases of chronic sinusitis, oral steroids (steroid pills
taken by mouth) may be used. These drugs augment the action of the
nasal steroid sprays in decreasing the inflammatory response within
the nose and sinuses. While they are quite effective, because these
drugs are taken in pill form the medication spreads throughout the
body and may have significant side effects. These include
osteoporosis, liver abnormalities, cataracts, glaucoma, weight gain,
emotional changes, and joint problems. With the exception of emotional
changes and weight gain, most of the side effects are rarely seen
unless the drug is used for a prolonged period of time. Oral steroids
are often given to patients with nasal polyps (See "Other Conditions
Affecting the Nose and Sinuses") or asthma in preparation for surgery.
They may be continued for a few weeks following the procedure to
diminish the inflammatory response during healing.
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And if all else has pretty much failed..
I hear that Dresden is listed in the book in Chicago.

E.