Sinusitis


What is sinusitis?

What is SinusitisSinusitis is a common and significant healthcare problem characterized by infection or inflammation of the paranasal sinus. Patients suffer from headache, facial discomfort, nasal congestion, nasal drainage, loss of the sense of smell and fatigue. Sinusitis significantly reduces quality of life and is responsible for loss of workplace productivity and major healthcare expenditure. In the United States alone, millions of patients suffer from sinusitis and several billion dollars is spent on treatment every year.

Most adults have experienced sinus symptoms in their lifetimes. During a “cold” or viral illness patients experience nasal pressure, nasal congestion, a “runny nose” and fever. Typically, this resolves on its own in a short few days. However, if symptoms persist, a bacterial infection of the sinuses or “sinusitis” can develop. This is called “acute sinusitis” and antibiotics are often prescribed to treat this condition. If the condition does not respond to repeated treatments with medication and lasts several weeks to months, it is called “chronic sinusitis”.

In addition to acute and chronic sinusitis, other kinds of sinus conditions include allergic or allergic fungal sinusitis.  Sinusitis can arise in the setting of other conditions, for example, Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter's Triad.


What causes sinusitis?

Multiple factors cause sinusitis. Obstruction of sinus drainage is one consideration. Each sinus has a small opening called an ostium is for drainage. Each sinus produces mucus and transports it through the ostium into the nose where the mucus moistens the nasal lining and protects the inside of the nose from impurities such as dust, pollutants and bacteria. If the membrane around the ostium becomes swollen from infection or allergy, the sinus can become blocked and unhealthy and sinusitis can occur. In addition to obstruction and infection, allergy inflammation can be a major consideration in chronic sinusitis. The underlying cause of inflammation can be poorly understood in some cases, making it difficult to treat.

Sinusitis

Sinusitis Figure 1a - CT scan of a patient with nasal congestion and headache. The arrows point to the sphenoid sinus; the gray area is abnormal and consistent with sinus disease. A previous physician recommended surgery, but the patient consulted Dr. Bolger to explore options to avoid surgery.

Sinusitis

Sinusitis Figure 1b - CT scan after several weeks of additional medical therapy that we recommended. The arrows point to the sphenoid sinus, which has returned to its normal appearance represented by the black area. The patient’s nasal congestion and headache resolved and surgery was avoided.


How is sinusitis treated, and what are the treatment options?

Sinusitis is treated initially with medication. Usually, antibiotics or topical nasal steroid spray are used to reduce mucosal swelling, fight infection and relieve obstruction at the sinus ostium. Sinus surgery is another treatment option, but is reserved for those patients whose symptoms and ostial obstruction persist despite medical therapy.


How does sinus surgery work to relieve sinusitis?

Surgical therapy for sinusitis attempts to restore sinus health by directly relieving sinus ostial obstruction. Specialized instruments are used to remove tissue and enlarge the sinus opening. Endoscopes are placed through the nostrils to help the surgeon see during surgery. Endoscopic sinus surgery is considered minimally invasive as facial incisions are not required to access the sinus ostia. Endoscopic sinus surgery represents a major contribution to patient care.


How can I tell if I have sinusitis?

Symptoms associated with sinusitis:

  • Facial pain, pressure, congestion or fullness
  • Nasal obstruction or blockage
  • Discharge of discolored mucus from the nose
  • Discolored postnasal drainage
  • Loss of the ability to smell odors or fragrances

Additional symptoms possibly associated with sinusitis:

  • Headache
  • Bad breath
  • Fatigue
  • Cough
  • Dental pain

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