The sinuses are the hollow, air filled spaces in the bones around the nose. There are four sinus cavities on each side-- frontal, maxillary, ethmoid, and sphenoid. The sinus cavities are lined with a mucous membrane that is covered with microscopic hairs that cleans the nose and sinuses. The nasal lining protects the body from dust, pollen, and germs, and also humidifies the air entering the nose. High exposure to environmental irritants (tobacco, chemicals, pollution) can impair the self-cleaning function of the nose and make people more prone to sinus infections. Sinusitis affects about 50 million people in the US each year.
Sinusitis is a condition that is caused by swelling of the lining of the sinuses which then blocks the channels that drain the sinuses into the nose. It may be caused by an acute infection from a virus or bacteria or can be a chronic problem due to thickening in the lining of the sinuses from constant inflammation from allergies, environmental irritants, or autoimmune diseases.
What are the symptoms of sinusitis?
Symptoms of sinus problems vary widely but can include:
- Cloudy or colored drainage from the nose
- Stuffy, congested, or blocked nose
- Pain, pressure, or fullness in the face, head, or around the eyes
- Cold symptoms—cough, sore throat, fever
- Upper tooth pain
- Loss of smell
How will my ENT physician evaluate sinusitis?
Your ENT will first ask questions about your sinuses-- how often you have problems, what times of year you have symptoms, what medications you have tried, family history of nasal problems, prior surgeries or trauma to your nose, history of allergies or environmental exposures. They will then examine your nose. Sometimes a procedure called a nasal endoscopy will be performed. This involves putting a small scope into your nose to examine the inside of the nose and where the sinuses drain. If abnormal drainage is present a culture can be obtained to determine if a bacteria is causing the infection and to help identify which antibiotics will be successful at clearing that particular bacteria from the nose and sinuses.
Another commonly performed test for persistent sinusitis is a CT scan. This allows for a 3D picture of the sinuses that cannot be visualized directly with an endoscope. This can identify sinus inflammation and any problematic sinus anatomy that can contribute to the problem
How will my sinusitis be treated?
98% of cases of acute sinusitis are caused by viruses, not bacteria. Viral sinusitis can be treated with pain relivers (acetaminophen or ibuprofen), steroid nasal sprays (Flonase, Rhinocort, etc), and/or saline (salt water) nasal rinses. Most people will get better naturally. If symptoms persist for more than ten (10) days then antibiotics may be used.
Chronic sinusitis is a sinus infection that lasts more than 3 months. This is due to inflammation of the sinuses. Saline irrigations and nasal steroids are the main treatments. Antibiotics may be used as well. In addition, other factors such as allergies, nasal polyps, and anatomic obstruction can make sinusitis worse and may need to be treated.
If medical therapy fails, surgery is an option. The goal of the surgery is to improve sinus drainage and reduce blockage by enlarging the opening of the sinuses, remove any polyps, and correct any anatomic defects that contribute to the nasal obstruction. While many people have fewer symptoms as a result of the surgery, some may require ongoing medical care to treat causes of inflammation such as allergies.
Do I need surgery for my sinusitis?
Most patients can be treated with medications for sinus infections. When chronic symptoms cannot be controlled with medications and other treatments, surgery for the sinuses can be very effective. Surgery is not recommended for acute sinusitis except in emergency situations. The most common type of sinus surgery is called Endoscopic Sinus Surgery (ESS). Endoscopic means that a small thin lighted telescope with a camera is passed through the nostrils into the nose. There is no incision on the skin or outside of the nose. Small, precise surgical instruments are then used to removal tissue blocking the sinuses. The goal of sinus surgery is to open the natural drainage pathways of the sinuses, allowing mucus to get out and air to get in. It also allows for medications to get into the sinuses better.
Sometimes, patients also have predisposing anatomic problems (ex: deviated septum) making them prone to sinusitis. As a result, nasal secretions become trapped in the sinuses and may become chronically infected. These anatomic problems may need to be addressed at the same time as sinus surgery. Most sinus and nasal surgeries are performed on an outpatient basis.
What is image guided surgery?
Image guided surgery uses a CT scan to create a 3D map of your sinuses. This navigation system is then used real-time during sinus surgery to provide information about the position of surgical instruments during surgery. Using this system your surgeon can navigate safely and precisely through the complex sinus passages. This type of surgery may be recommended when sinus disease is severe, there has been previous surgery, there are altered anatomic landmarks, or where sinus anatomy is unusual.
What is balloon sinuplasty?
Balloon sinus dilation is a treatment option where the sinus openings are made bigger by dilating them with a balloon, rather than removing bone and tissue blocking the sinus. Sinus balloons are similar to the balloons used in angioplasty to expand the blood vessels in someone’s heart. This minimally invasive approach can be performed in the operating room, or in the office. 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 balloon is briefly inflated, and the pressure of the balloon creates micro fractures in the bone around the opening of the sinus, dilating the drainage pathway. 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 are sinus implants?
Sinus surgery removes tissue that blocks the sinuses. But many patients’ problems are due to chronic inflammation. Ongoing inflammation, polyps and scarring can block the sinuses again. Sinus implants, such as PROPEL and Sinuva contain anti-inflammatory medication that is delivered directly to the sinus tissues to decrease inflammation and keep the sinus drainage pathways open.
The PROPEL stent is placed at the time of surgery and delivers medication as it slowly dissolves over 30-45 days. It can be left to dissolve entirely or removed at any time.
The Sinuva implant is for patients who have had previous ethmoid sinus surgery and have polyps. It is placed in the office as an option to try and prevent secondary surgery. It slowly delivers medication over 90 days and may be removed at any time.