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You keep getting sinus infections, so you keep getting antibiotics. What if the antibiotics are part of the problem? Franklyn R. Gergits is a board-certified otolaryngologist and fellowship-trained otolaryngic allergist with about 30 years in practice. This episode is based on his article “Recurrent sinus infections leave damage beyond your sinuses,” published on KevinMD. He explains why 2025 guidelines shifted from reaching for antibiotics to treating inflammation, and how repeated courses can wipe out your good bacteria, let resistant bugs and biofilms take hold, and leave you feeling reinfected when the real issue is inflammation. You will hear how this can progress to stubborn fungal infections, why he tests with a scope and lab analysis instead of guessing, and what he reaches for first, from high-volume sinus rinses to steroid sprays. He also shares what he wishes primary care physicians would do before writing the next prescription. Press play to learn how to tell a true infection from chronic inflammation, and what to reach for before the next antibiotic.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Franklyn R. Gergits. He’s an otolaryngologist, and today’s KevinMD article is “Recurrent sinus infections leave damage beyond your sinuses.” Franklyn, welcome to the show.

Franklyn R. Gergits: Thank you, Kevin. Thanks for having me.

Kevin Pho: All right, so let’s start by briefly sharing your story, and then we’ll jump right into your KevinMD article.

Franklyn R. Gergits: I’m an ear, nose, and throat specialist with a focus in otolaryngic allergy. I’ve been in practice for about 30 years now. Twenty of them have been in Pennsylvania, and then the last 10 in Scottsdale, Arizona. What I was able to do in Scottsdale was really just try to focus my practice on my passion, which is nose, sinus, allergy, and airway inflammation, and thus the birth of Sinus and Allergy Wellness Center.

Kevin Pho: All right. Excellent. So when it comes to allergy symptoms and things that you see in your clinic, what are some common presentations that you see that would require a specialist like yourself to address?

Franklyn R. Gergits: Sure. These are patients who have been suffering for a long time. They may have been on allergy medications in the past and not found relief. But sometimes this allergy inflammation is more than just a sniffle or a cold or a sneeze. It may actually progress to inflammatory conditions in the airway. I myself am an asthmatic. Other patients would have chronic sinusitis.

And then we know that the allergy system and the immune system can be triggered by everything that comes into the airway. So sometimes that causes more of a systemic allergic reaction, not just a sniffle or a sneeze.

Kevin Pho: All right. So your article talks specifically about recurrent sinus infections. Tell us why you decided to write this article in the first place, and then about the article itself, for those who didn’t get a chance to read it.

Franklyn R. Gergits: The article really stemmed from a patient I had who I thought of as just a person who was unfortunately suffering from so many chronic infections that she had been given antibiotics over and over and over again. At that time, it was also around the same time that the Academy of Otolaryngology came out with antibiotic prescribing recommendations, and instead of being antibiotic focused, now it’s inflammatory focused.

So with her history and what they showed us in that article, it really gave me that aha moment. What’s causing these patients, and since we’ve been over-prescribing them, I kind of put myself in the primary care role, thinking that they have about 18 minutes to take care of a patient in general when they first come in. And they have to focus on heart disease, diabetes, cancer risk, all the important stuff. And then at the very end, all of a sudden, “Oh, by the way, I have this sinus trouble.” It may be allergy, but the doctors just don’t have time to treat those patients, so a lot of times an antibiotic goes out unwillingly. Too many antibiotics are being prescribed nationally. So that’s really where the article came from.

Kevin Pho: Just give us a sense, for those who aren’t familiar with the guidelines you mentioned in your article, that it shifted in 2025. That’s of course relatively recently. So what were the guidelines before, and then the guidelines after when it comes to sinusitis?

Franklyn R. Gergits: Right. With antibiotics, in fact, still to this day, there are certain insurance companies where, before we are able to do a CAT scan or before we’re able to do a procedure, patients have to be on multiple weeks of antibiotics. And a lot of times these patients have been on them in the past. So prior to that, the insurance companies’ guidelines followed the academy’s recommendations, which was sometimes 10 to 14 days of antibiotics.

And then, knowingly, they found that this antibiotic problem and crisis is just going in the wrong direction. So really it was stop and pause and think about that antibiotic.

Kevin Pho: And what are some of the harms that can come from that? Obviously, we talk about antibiotic resistance and things like that, but from your lens as an otolaryngologist, why was that harmful? Why did they make that shift?

Franklyn R. Gergits: Exactly. So the problem is that the patients we’re seeing now are coming in and they may have been on multiple therapies. They come into our office, and we may see the CT scan, and the CT scan may look like it’s inflamed chronic sinusitis, but some of these patients have lots of symptoms that make us think of sinusitis, yet the CT scan doesn’t show that.

And that made me think. Going back, the problem is that a lot of these bacteria that have normally been the good bacteria, our host bacteria, are getting wiped out from these antibiotics, and now what happens is the resistant bacteria fall into place, the biofilms start to happen, they’re present, and they’re sending chronic inflammatory measures to the mucosa. The mucosa responds, and the patients think that they’re reinfected.

Kevin Pho: So when these patients come to you, they’ve been on multiple courses of antibiotics, yet their symptoms still persist. What are some of the recourses? How would you treat these patients on recurrent antibiotic regimens?

Franklyn R. Gergits: Absolutely. Great question. It’s really to know first. Instead of guessing, let’s know. So what I’ll do is I’ll try to do an endoscopic examination, and if I see this patient who has had this problem, I’m going to grab a specimen from where the sinus cavities drain. So I’m going to use the endoscope to really guide my location. That specimen goes off to a company that does PCR testing, next generation evaluation of the mucosa, or the mucus. So they’re able to find out what we’re treating. Now that I know what’s going on, I can use evidence-based medical therapy to treat that patient.

And for me as a sinus doctor, sometimes we’ll actually get patients doing the sinus rinse just to kind of get rid of some of that mucus inside there. Hopefully we’re going to start to break up some of those biofilms. We can add xylitol to that rinse. But now we also can use the antibiotic that may be the best antibiotic based on that evidence. Now we know what we’re treating, and if we add that, the rinse goes through the nose and the sinus cavities, and it treats the bacteria, and it goes in the sink. We’re not swallowing it, so we’re saving our gut microbiome from more bacterial assault from these antibiotics.

Kevin Pho: So it sounds like rather than something broad-spectrum, by getting a sample and doing that PCR testing, you could do a more targeted antibiotic therapy, right? And obviously that can lead down the road to fewer complications from these antibiotics. You mentioned that the guidelines also shifted from antimicrobial therapy to an anti-inflammatory approach. So what exactly does that look like? What does that mean?

Franklyn R. Gergits: Exactly. It really is the high-volume sinus rinses that we try to get patients on. And oftentimes once we get patients using it, that might be the regular neti pot, but it could be the Navage system that actually washes and suctions the mucus out, or it could also be a high-rinse-volume bottle like NeilMed, which is what I use.

And then we also have the patients follow that up with a steroid nasal spray, something like Flonase, for example, or any other over-the-counter steroid medical therapy. If they can do that on a regular basis, most patients start to feel better. Then we can also, if the patients are still suffering, do the deep dive. We’ll try to find out, is it allergy induced? Is it silent reflux or LPR induced? Could it be the exposure of the air? Maybe they’re just not drinking enough water, or maybe there’s another immune deficiency that we may be able to identify.

Kevin Pho: So when it comes to those sinus rinses, and I certainly use those squeeze bottles myself, does it matter which one you use? Does it have to be a fancy system like the one that you mentioned? Neti pot, squeeze bottles, do they all work very similarly when it comes to outcomes?

Franklyn R. Gergits: That’s a great question too, because for me personally, I’m like you and I have a deviated septum, so for me to try to use the neti pot, I think I’m waterboarding myself sometimes when I’m trying to use that. But if I can get that sinus rinse bottle, NeilMed or any of the other nasal rinses, you can find them over the counter at the grocery stores. Just as long as it’s distilled water or boiled water, that way we’re not going to introduce any amoebas or any other foreign material inside the lining of the sinus cavities.

And then it’s just a good squeeze of the rinse bottle. I tilt my head down. It goes through easily, even with my deviated septum, so I get good delivery on both sides, and I really feel well afterwards. And then I do that morning and night. I kind of time it right with brushing my teeth, and it works great.

Kevin Pho: So in terms of the complications from these antimicrobial therapies, you’re seeing fungal co-infections in these patients who’ve been through multiple courses, right? Tell us how that presents, and what kind of trouble patients could get into when it reaches that point.

Franklyn R. Gergits: Exactly. The problem with fungus is that once it’s present, they’re not treated as easily as the antibiotics treat these resistant bacteria. So sometimes if a fungal infection is present and we’re doing the medical therapy based on the genetic evidence and the guidance, sometimes for some of those patients, if the fungus doesn’t leave, it can form what’s called a mycetoma.

And the mucus that’s inside those sinus cavities can become almost like peanut butter in those sinus cavities. So it won’t suction out easily. Those are the patients we wouldn’t be able to do the conservative in-office balloon procedure on. We may actually have to make that opening wider and use special suction techniques to get inside there. Sometimes we even need to do a second antrotomy if it’s in the maxillary sinus, for example. So we’ve got the irrigation going in and the suction coming out, and we can really use the techniques, bigger bore suctions, to really wash those clean. And a lot of times we’ll see that once we find it on a CAT scan, then we know we have a higher suspicion, and then we go back. These patients have been on lots of antibiotics.

Kevin Pho: So as you know, I do primary care internal medicine. What would you like primary care physicians to know from our conversation today, and what do you wish primary care physicians would do more of after seeing some of the patients referred to you?

Franklyn R. Gergits: Right. The first thing I would ask them is to pause, OK? Just give me two seconds. Before you write that antibiotic, think to yourself, do you know what you’re treating, right? And if you’re sure that it’s a bacterial infection, then right away, no doubt, just go. We’re not saying don’t write antibiotics, but if you don’t know, then consider a second opinion. Send the patients off to an ear, nose, and throat specialist or an allergy specialist who does nasal endoscopies, who can look inside, get a specimen, and make sure that they send it off to a company that does this PCR and next generation evaluation, because then we’re using the best technology to get that information into our hands.

Kevin Pho: And what’s the role of sinus imaging, if any?

Franklyn R. Gergits: When the patients are really suffering and maybe the symptoms are getting worse than we would expect as time goes by, or the patient who is really presenting in a mess situation, meaning facial pressure, their drainage is excessive, those are the patients where we may be able to do an evaluation to see, could there be polyps that are obstructing the inside of the lining of the nose? The patients who have worsening of their trouble with breathing or who lose their sense of smell, those are the patients where we’re thinking more about the lining in the sinus cavities and that there could be other reasons for the severity of their sinus problems.

Kevin Pho: Now, you mentioned topical steroids like Flonase or Nasacort. Any role for anything systemic? Prednisone, for instance?

Franklyn R. Gergits: Yes, sometimes we can even add budesonide to the sinus rinse as well. The medication comes from compounding pharmacies sometimes, where we get that therapy to the patient. So we’re using these stronger steroids, but sometimes in patients, if they’ve got inflammation inside the lungs, their asthma’s really kicking and they’re having these sinus issues, we might still prescribe a short course of steroids, but we have to make sure that it’s in the right patients. Obviously patients with diabetes, we’re not going to prescribe them big doses of steroids.

But we’ve used steroids. Sinus doctors and airway specialists use lots of steroids, and I always try to go with the least aggressive. Let’s try the over-the-counter first, maybe the sinus budesonide rinse second, and then maybe jump into the systemic.

Kevin Pho: We’re talking to Franklyn R. Gergits. He’s an otolaryngologist. Today’s KevinMD article is “Recurrent sinus infections leave damage beyond your sinuses.” Franklyn, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Franklyn R. Gergits: First is just the thought to know, don’t guess, OK? So if you have a patient in the practice and you’re losing time with your patient and you just need to think about what the patient is going to need for that therapy, don’t just prescribe an antibiotic indiscriminately without any knowledge. If you have a question, then the ear, nose, and throat doctors and the allergy specialists will be able to lend a hand and give you that information.

Kevin Pho: Franklyn, thank you so much for your perspective and insight, and thanks again for coming on the show.

Franklyn R. Gergits: Thank you, Kevin. Appreciate it.