Sinusitis is inflammation and swelling of the tissues that line the sinuses. This interferes with normal mucus drainage, leading to breathing difficulties, pain and pressure. When the condition persists for 12 weeks or longer, it is considered chronic.
Sinusitis is the number one reported chronic condition in the United States, affecting an estimated 37 million Americans. It’s most often caused by an infection brought on by a cold or allergies, but may also be the result of nasal polyps, a deviated septum, trauma to the face, hay fever, complications from immune system disorders or tumors.
In addition to a physical examination and a review of the patient’s medical history, the doctor will inspect the nasal passages for polyps and other abnormalities and check for inflammation and a buildup of fluid. Additional tests utilizing nasal endoscopy, CT scans, MRIs and allergy tests can be used to help confirm the diagnosis.
Individuals suffering from sinusitis experience a variety of cold-like symptoms such as nasal congestion and discharge, postnasal drip, sore throat, facial pressure and swelling, loss of smell and taste, headache, fever, fatigue and bad breath.
Treatments will vary depending upon the severity of sinusitis and whether it’s an acute or chronic condition. The treating physician will determine whether you are suffering from an acute or chronic sinus infection.
Acute: generally this condition involves management of inflammation with or without infection. There are over-the-counter meds such as decongestants, mucolytics, steroid nasal sprays, saline rinses, NSAIDS, antihistamines etc.
*Clinical studies suggests the use of antibiotics for bacterial infections, or symptoms following an acute head cold or allergy flare up that last for greater than 10 days. Symptoms usually include facial pain or pressure, pain in the upper teeth, or purulent nasal discharge.
Chronic: as the name implies, the sinuses have difficulty staying clear. They often experience sinus mucosal thickening, and retained sinus secretions, leading to chronic congestion. These patients can experience either frequent or prolonged infections.
-In some patients, long term management may include immunotherapy (allergy shots) to help reduce sinus inflammation related to their environmental allergies.
Depending on the patient and their sinus condition, there are several surgical sinus procedures available. Below is a list of common sinus surgeries.
- Functional endoscopic sinus surgery (FESS). This procedure involves use of a nasal endoscope and instrumentation to open the natural pathways to the sinuses, and subsequently “improve” sinus function. In most cases, the procedure is completed entirely through the nasal passages (endoscopic), so no external scars are left behind. Swelling is limited, and pain or discomfort is mild. It is usually an outpatient procedure.
- Endoscopic sinus surgery with CT navigation (Image guidance). In addition to removing sinonasal obstruction, this procedure relies on a 3D mapping system using preoperative CT scans. This allows for more accurate instrument use throughout the complex sinus passages and is especially helpful for those with significantly altered surgical anatomy.
- Extended endoscopic sinus surgery (Usually with Image guidance). There are specific conditions, ie. revisions, tumors, polyps where techniques involve the use of powered instrumentation. Often this involves the removal of normal bone boundaries. These surgeries may be scheduled at the hospital with possible overnight stay.
- Balloon sinuplasty. In this surgical procedure, a balloon catheter is inserted through the nostrils into the sinus passages, and gently inflated. This causes the sinus cavity to expand, allowing for easier drainage. The balloon is then deflated and removed. This operation is minimally invasive, provides immediate relief, and results in a much quicker recovery. Many patients are able to return to work the next day.
Recovery from sinus surgery varies depending on the procedure and the patient. The vast majority are performed as outpatient procedures and require several post-op visits for sinus debridement to remove blood clots, dissolvable packing and tissue debris. Time off after surgery is typically three to five days unless other factors require the patient to take off more time. Balloon sinuplasty involves no cutting of tissue or bone, and patients generally recover more quickly.