Sinusitis

Sinusitis is a leading health care problem. It is believed to be increasing in both incidence and prevalence. It has been estimated that bacterial sinusitis complicates 0.5 to 2% of viral upper respiratory infections (colds). This translates to 20 million cases of bacterial sinusitis in the U.S. every year. The chronic form, lasting more than 12 weeks, has been estimated to affect more than 31 million individuals. This makes it the most common chronic health problem in the United States. The disease frequently presents as "the cold that won't go away."

What are the sinuses?

The sinuses are cavities inside the head, which are connected to the nose. They are lined with a mucus membrane. The mucus membrane has mucus glands, which secrete mucus. The mucus membrane is also covered with tiny hairs, which actively push the mucus from the sinuses into the nose through tiny openings known as ostia. The mucus contains antibodies and other infection fighting substances. It is also sticky and its function once inside the nose is to trap particles in the inspired air and thus it forms part of the nose's filtration system.

What causes sinusitis?

Sinusitis is caused by obstruction of the ostia. When the ostia become obstructed, the mucus backs up in the sinus. When mucus collects it easily becomes infected since there is a large variety of bacteria, which colonize a normal nose. Things, which can cause sinus outflow obstruction, include allergies, viral upper respiratory infections ("the common cold,") and non-specific nasal irritants such as dust and noxious chemicals. In addition, an individual may be predisposed to sinus infections because of anatomic obstructions such as a deviated septum or enlarged turbinates.

What are the symptoms of sinusitis?

Primary:

* Facial pain and pressure in the sinus area
* Facial congestion and fullness
* Nasal or postnasal drainage, usually yellow or otherwise discolored
* Nasal obstruction and blockage
* Loss or reduced sense of smell
* Fever

Secondary:

* Headache
* Bad breath
* Ear pain, pressure or fullness
* Sore throat
* General malaise or fatigue
* Dental pain
* Cough

Any of these symptoms may be present, it usually takes at least one primary and at least two secondary symptoms to consider the diagnosis. They may be quite severe or relatively mild and may be mainly a nuisance. In chronic sinusitis, these symptoms may be present for years. Frequently, chronic sinusitis is described as "the cold that won't go away."

How is sinusitis diagnosed?

The history of the disease process is the most important factor in making the diagnosis. Physical examination may reveal the presence of nasal discharge, nasal polyps, inflammation of the throat, tenderness of the sinuses and swelling of the lymph nodes in the neck. In chronic cases, nasal endoscopy (looking up the nose with a special scope) is usually performed to fully evaluate the deeper passageways of the nose and look for the presence of contributing factors such as polyps, tumors and anatomic abnormalities. Computerized tomography or CT scanning is used to define the anatomy and help determine the extent of disease.

How is sinusitis treated?

In most cases, a ten-day course of antibiotics will clear up sinus infections. If the infection does not clear with a short course of antibiotics, or if the symptoms have been present a long time, a longer course of antibiotics of four to six weeks may be used. Frequently, steroid nasal sprays and systemic corticosteroids are used in conjunction with the antibiotics to reduce the inflammation and swelling in the nose and sinuses. This is frequently successful in opening up the sinus drainage pathways and restoring normal ventilation of the sinuses. Decongestants are often used for similar reasons. The key to restoring the sinuses to health is to unblock the drainage pathways.

Allergies and other medical problems may contribute to recurrent and chronic sinusitis. Appropriate testing and treatment should be pursued if allergies are suspected to be a contributing factor.
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When medical treatment is unsuccessful in clearing the sinus infection or when the infections become so frequent, protracted or severe that they affect the individuals quality of life, then surgical treatment is considered. Surgery is aimed at making the sinus drainage pathways larger to eliminate obstruction. Any anatomic factor, such as deviated nasal septum, which may contribute to sinus obstruction, is corrected also.

Sinus surgery

Sinus surgery is performed as an outpatient. The procedure is called endoscopic sinus surgery. It is technically demanding and very precise work. The surgery is performed in close proximity to the eyes, optic nerves, brain and carotid arteries. The procedure is quite safe however when performed by an experienced surgeon. At Big Sky ENT, we have successfully performed over 15+ years of sinus surgeries.

After surgery, packs are left in the nose for a variable period of time depending on the extent of the surgery. The purpose of the packs is to control bleeding and to stent the sinus outflow passages open during the initial phase of healing.

During the post-operative period, debris and crusting must be cleaned from the sinus passages. This is to prevent recurrent infection, prevent scarring with closure of the drainage pathways, and it also makes the patient more comfortable. This is performed in the office on several occasions over the initial four to six weeks after surgery.

It is important to realize that sinus surgery is only part of the process to rehabilitate the sinuses. By the time most patients undergo surgery, the sinus mucus membranes have been sick a long time. Continued medical management after the surgery is very important. Underlying problems such as allergies must be treated to prevent the infections from recurring. In addition, any recurrence of the sinus infection, which occurs, must be promptly treated to prevent it from becoming chronic.

 


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