Sinusitis

What is sinusitis?

Sinusitis is one of the most common problems that brings patients to physicians’ offices. The symptoms of sinusitis (infection or inflammation of the sinuses) are well known to most people. These symptoms include nasal congestion, facial pressure, and nasal discharge or post nasal drip. The treatment of acute sinusitis is most commonly antibiotics, and often decongestants are used as well. The majority of patients will respond to this initial therapy; however, a smaller subset of people do not respond and are left with persistent symptoms.

What if the antibiotics do not relieve the symptoms?

For patients who fail this initial therapy, the patient’s medical history is again carefully reviewed to look specifically for disorders which might put them at higher risk for problems with sinusitis. Specifically, the physician looks for signs, symptoms, or history suggestive of allergic disorders or inflammatory disorders. Since the openings of the individual sinuses are quite small, a very small amount of swelling around the sinus opening can cause it to be completely blocked, thus leading to infection in that sinus. If an associated disorder, such as nasal allergies, is identified, then medical therapy is instituted to control the allergies. In addition, frequently a longer course of antibiotic is then used to attempt to clear the infection. Often up to several weeks of antibiotics will be required to clear a difficult sinus infection.

For patients who are having difficulty clearing an infection or are having recurrent sinus infections, often the physician will recommend nasal endoscopy. Nasal endoscopy is performed in the office with a medication sprayed in the nasal cavity to minimize any discomfort. This fiberoptic telescope allows the physician to study the structure of the inside of the nose and look specifically at the area where the sinuses drain. This might reveal a narrow opening or something obstructing the opening, such as polyps. Polyps are simply swelling of the internal lining of the nose that becomes so severe that the lining hangs down and causes obstruction of the sinuses. Nasal endoscopy is often very helpful in selecting patients who may benefit from sinus surgery.

What if medical therapy fails?

For patients who have a sinus infection that is unresponsive to all of the above measures, frequently a CT scan (x-ray) of the sinuses is ordered. These films are reviewed with the patient and help the physician identify structural problems of the sinuses that are preventing normal drainage. It also helps identify which sinuses are infected. The findings on x-ray and the patient’s history then guide the physician and the patient in considering the need for sinus surgery.

Sinus surgery (endoscopic sinus surgery) is performed with the same fiberoptic telescopes as are used for nasal endoscopy in the office. The procedure can be done either with sedation and local anesthesia or under general anesthesia (the patient is completely asleep). Essentially, working through the nostrils and using the fiberoptic telescope and small dissecting instruments, each of the blocked sinuses are opened and good drainage is established. Occasionally, some packing is placed in the nose overnight. Most patients are able to go home on the same day of their surgery. To see some diagrams of endoscopic sinus surgery on the various sinuses, click here.