Posts for tag: Sinusitis
What is Chronic Sinusitis?
It all starts with a congested nose due to a viral cold or allergy. Not much to do about the virus, it should resolve within 10 to 14 days. Chicken soup is a good idea for a cold. Antihistamines, decongestants, and nasal steroid sprays for allergy control don’t even seem to be enough. But, you just don’t seem to improve even after a couple of weeks.
Facial pressure and pain (particularly when you bend over to tie your shoes), fatigue, persistent discolored nasal mucous, cough, and even wheezing are signs that the congestion has progressed to something more: sinusitis. Now we call in the big guns – antibiotics and even oral steroids like prednisone. Most of the time that infection gets better. But, sometimes all the medicines you have taken can’t get you better.
You may end up in your friendly neighborhood ENT office. But not to worry, there is a way out. Your Otolaryngologist (medicalese for ENT) will likely take a look around, even to the point of putting a scope in your nose to see where the problem resides. And if you are both convinced that you have run out of rational medical options you have to begin to consider surgery. Yes, it comes to that sometimes.
Before you can have any type of procedure the precise nature and location of your infection needs to be found. CT scans are our best bet for this. It is an X-ray, which means radiation exposure. We know and take that into account. But don’t worry, a screening CT is fast, painless (no needles I promise), and has minimal X-rays involved. Without this critical piece of information, a sinus surgeon would just be operating blind – and you don’t want that I promise.
So, now know you know what is going on and you can make decisions based on information. Sinus surgery is surgery (duh) but it is usually VERY effective at relieving those unremitting, chronic sinus infections.
The prevalence of concha bullosa and nasal septal deviation and
their relationship to maxillary sinusitis by volumetric tomography.
Smith KD, Edwards PC, Saini TS, Norton NS - Int J Dent (2010)
Mark T. Brown, MD, FACS
I may be correct in saying that nobody ever really WANTS to have surgery. It involves IVs, anesthesia, uncertainty, and it HURTS. That being said, surgery is often the solution to a medical problem that is not fixed by medication. Sinus surgery has changed tremendously over the last few decades. This blog is intended to dispel myths that often frighten people about it and/or cause them to postpone treatment and prolong suffering.
Sinusitis is inflammation of the sinuses-these are air filled cavities in the face-the exact purpose of which is unknown. However, we think the sinuses humidify the air we breathe, lighten the skull, and resonate the voice. That being said, they can fill with infection, lead to pain, drainage, fatigue, and infect surrounding structures. For acute sinusitis (less than 4 weeks), an antibiotic with a nasal steroid and sinus rinse will usually fix the problem. Occasionally, this doesn’t work and the infection becomes chronic (lasting 12 weeks or more). Often, a prolonged course of antibiotics (3 weeks!), nasal and oral steroids, and a sinus rinse will solve the problem. When this does not do the trick and we see evidence of persistent disease on a CT scan, we will recommend surgery. Obviously, this is an oversimplification-but-you get the point.
When surgery is the “next step,” we often hear the following questions/concerns:
Q: “MY (insert relative here) had sinus surgery 20 years ago and they PACKED his nose-He said it was the WORST thing in the world…do you pack the nose?”
A: No, we do not pack the nose. This is something that surgeons used to do quite frequently after surgery to prevent bleeding or scar tissue growth. Today, we have absorbable packing and ointments we can place in the nose to prevent bleeding, and our surgical techniques have changes to minimize risk of scarring
Q: “Do you SCRAPE the sinuses??”
A: No, we do not scrape the sinuses. The point of surgery is widen the opening where the sinuses naturally drain, and to avoid damage to the mucosa (tissue lining the sinuses) as much as possible. We can irrigate the sinuses and remove inflamed growths such as polyps. But, no scraping.
Q: “Will sinus surgery prevent me from ever having another sinus infection?”
A: Unfortunately, no. The purpose is to open the sinuses up and remove diseased tissue. You can still get sinus infections in the future, but we may treat them with “topical” antibiotics and steroids (in the sinus rinse) which will reach the cavities better because they are more open. Your risk of developing future problems depends on why you had this in the first place (severe allergies, polyps, fungus, etc.)
Q: “I had sinus surgery 10 years ago, and now I am having problems again. What are you going to do differently?”
A: You may have recurrent disease for a number of reasons; however, our goal in surgery is the same. Because you had surgery before, things may scar certain ways that predispose you to infection again-Often, we will use “image guidance” which is a new technology that helps us identify structures in the nose during surgery to ensure good drainage (and correct identification of infected areas).
Q: “Are you going to use balloons on me?”
A: Balloon sinuplasty is a new technology that uses a balloon to widen the natural opening of the sinuses. It can be a helpful tool in sinus surgery (especially the frontal sinus) or used alone. Not all doctors offer this procedure, and some patients are not good candidates for this technology, so this will need to be a discussion between you and your physician.