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 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 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.
What Causes Sinusitis?
Sinusitis is the number one reported chronic condition in the United States, affecting an estimated 37 million Americans. It’s most often caused by an infection brought on by a cold or allergies, but may also be the result of nasal polyps, a deviated septum, trauma to the face, hay fever, complications from immune system disorders or tumors.
What Are the Symptoms of Sinusitis?
Individuals suffering from sinusitis experience a variety of cold-like symptoms such as nasal congestion and discharge, postnasal drip, sore throat, facial pressure and swelling, loss of smell and taste, headache, fever, fatigue and bad breath.
Complications can include asthma attacks, meningitis, vision problems, aneurysms and stroke.
How Is Sinusitis Diagnosed?
In addition to a physical examination and a review of your medical history, your doctor will inspect your nasal passages for polyps and other abnormalities and check for inflammation and a buildup of fluid. Additional tests utilizing nasal endoscopy, CT scans, MRIs and allergy tests can be used to help confirm the diagnosis.
How Is Sinusitis Treated?
Treatments will vary depending upon the severity of your sinusitis and whether it’s an acute or chronic condition. Saline nasal sprays and corticosteroids are useful for rinsing your nasal passages and relieving inflammation. Decongestants are a good short-term solution, but extended use can actually worsen the condition. Antibiotics are usually prescribed for bacterial infections.
Antihistamines, nasal steroid sprays, saline washes and oral steroids all provide long-term relief. More permanent solutions such as immunotherapy (allergy shots) or surgery can bring relief to those suffering from chronic sinusitis.
Call Eastern Carolina ENT Head & Neck Surgery at 252-752-5227 for more information or to schedule an appointment.
