General ENT

Sinusitis


Sinusitis, also called rhinosinusitis, affects about 1 in 8 adults annually.  Sinusitis can also affect children.  Usually, viruses or bacteria infect the nose and sinuses and cause swelling, blocking the channels that drain the sinuses into the nose.  The sinuses are the hollow spaces in the bones around the nose, and typically stay healthy when mucus drains freely into the nose.  When inflammation is present, mucus and pus fill up the nose and sinus cavities and cause the symptoms of sinusitis.

Acute sinusitis is diagnosed when there has been 10 or more days of abnormal nasal drainage, a stuffy or congested nose, and pain or pressure in the face, head, or upper teeth.  Viruses and bacteria are the most common causes of acute sinusitis.  When bacterial sinusitis is present, antibiotics may help patients get better faster.  Over-the-counter treatments like saline irrigations, nasal steroid sprays, decongestants, mucus thinning agents, and anti-inflammatory medications can all help treat the symptoms of an acute sinus infection.

Recurrent acute sinusitis is frequent bouts of sinus infections (4 or more in 1 year) that resolve with medications, but recur soon after finishing treatment.  This can result in the frequent use of oral antibiotics.  Sometimes, bacteria can become resistant to certain commonly used antibiotics.  Frequently, a patient’s anatomy causes narrow sinus drainage pathways that make them more prone to developing acute sinusitis.

Chronic sinusitis lasts for greater than 12 weeks, and is typically caused by prolonged inflammation rather than infection.  Sometimes allergies, nasal polyps, asthma, and problems with the body’s immune system can make chronic sinusitis worse.  Treatments for chronic sinusitis include antibiotics for 3 weeks (often selected based on results from cultures), oral and nasal steroids, and allergy medications or immunotherapy.  When these treatments fail, surgery can be necessary.

How will my ENT physician evaluate sinusitis?

Oftentimes, office nasal endoscopy is performed to evaluate patients with sinusitis that does not improve with medications.  After applying some numbing and decongestant spray to the nose, a narrow (2.7 - 4 mm in width) scope is passed through the nostrils to visualize the inside of the nose and sinus drainage pathways.  This will allow the evaluation for a septal deviation, nasal polyps or other obstructions, and obtain a culture of any mucus or pus that is present.  Results from cultures can determine which type of bacteria is causing the infection, and can help identify antibiotics that will successfully clear that particular bacteria from the nose and sinuses.

Another commonly performed test for persistent sinusitis is a CT scan.  This allows an accurate measure of the degree of sinus inflammation, and a more detailed evaluation of the sinus anatomy potentially contributing to the problem not visible directly through the nose or with an endoscope.  Rarely, other imaging studies such as MRI can be required.

Do I need surgery for my sinusitis?

When symptoms cannot be controlled with medications and other treatments, surgery for the sinuses can be very effective.  Endoscopic sinus surgery (ESS) helps open the natural drainage pathways of the sinuses, restoring their function and health.  In chronic sinusitis, the sinuses are unable to function adequately due to the swelling of the drainage pathways.  Sometimes, patients also have predisposing anatomic factors making them prone to recurrent acute sinusitis.  As a result, nasal secretions become trapped in the sinuses and may become chronically infected.

The goal of surgery is to carefully remove the thin, delicate bone and mucus membranes that block the drainage pathways of the sinuses.  The term “endoscopic’ refers to the use of small telescopes that allow all of the surgery to be performed through the nostrils.  This means there is no need for any skin incisions.  Very precise instruments cut and remove tissue with minimal trauma to the surrounding structures.   ESS is usually done on an outpatient basis.  These new techniques allow for more rapid healing, improved patient comfort, and improved results.  In addition, medications delivered to the surface of the nose and sinuses like sprays and irrigations can get into the sinuses better after surgery.

What is image guided surgery?

Image guided surgery is a mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals.  In this way, surgeons can navigate safely and precisely through complex sinus passages to remove diseased tissue.  This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous surgery has altered anatomic landmarks, or where sinus anatomy is unusual.

What is balloon sinuplasty?

Sinus balloons are devices that can be used to dilate the openings of sinuses.  Similar to balloons used in angioplasty to expand the blood vessels in someone’s heart, sinus balloons have established themselves as a useful tool to treat sinusitis.  This minimally invasive approach can be performed in the operating room under general anesthesia, or in the office with the use of local anesthesia in an awake patient.

A guide wire is passed through the nostril and into the specific sinus that is being addressed.  Once it has been confirmed that the guide wire is in the sinus, a balloon dilating catheter is passed over the wire to the narrowest portion of the sinus drainage pathway.  The high pressure balloon is briefly inflated, and the pressure of the balloon micro fractures bone and moves it outwards, dilating the outflow tract.  The final result is a dilated pathway from the sinus that can be done without actually removing any tissue.

Clinical studies have shown balloon sinus dilation is a safe and effective tool in the management of both chronic sinusitis and recurrent acute sinusitis.  The use of this minimally invasive technique may result in less postoperative pain, and a quicker recovery time.  However, balloon sinus dilation cannot be used in all situations, and it cannot be used in all the sinuses.

What about the Propel sinus implant?

PROPEL sinus implant is a dissolvable drug eluding stent that can help keep sinus drainage pathways open following sinus surgery.  After endoscopic sinus surgery on the ethmoid sinus (sinus between the eyes), a self-expending stent made of polymer is placed into the sinus.  Sustained release technology delivers steroid to the lining of the sinus, decreasing post-operative inflammation and helping to ensure the sinus remains open.

What about the PolypVac?

The PolypVac is a device that allows the removal of nasal polyps in an office setting without the use of general anesthesia.  In carefully selected patients, this procedure can be performed with local anesthesia and significantly decreases post-operative recovery time.  The procedure is often completed within several minutes, and patients can leave the office immediately breathing better through their nose.

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