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, some people do not respond and are left with persistent
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 that 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 not responding to medical management,
a CT scan is commonly
ordered. Patients who are having recurrent sinus infections may also be evaluated with CT scan or other testing. 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. For some patients, a computerized navigation system may be used. Eastern Carolina ENT also offers balloon sinuplasty in certain situations, this new technology has some nice advantages for patients. Occasionally,
some packing is placed in the nose overnight.
Most patients are able to go home on the same
day of their surgery. To learn more on
endoscopic sinus surgery on the various sinuses,