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
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
* Facial pain and
pressure in the sinus area
* Facial congestion and fullness
* Nasal or postnasal drainage, usually yellow or otherwise
* Nasal obstruction and blockage
* Loss or reduced sense of smell
* Bad breath
* Ear pain, pressure or fullness
* Sore throat
* General malaise or fatigue
* Dental pain
Any of these symptoms may
be present however; 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
How is sinusitis
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
How is sinusitis
In most cases, a ten-day course of antibiotics will clear up a 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
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. Click Here for more
information about our allergy treatment protocol.
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 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 a thousand sinus operations.
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
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.