If you have a cold or allergies the slits which drain the sinuses can be blocked by the swollen membranes. When this happens, the sinuses become filled with mucus and germs. If the sinuses do not clear within a day or so the germs start to multiply causing even more swelling and this is a sinus infection (acute sinusitis). The symptoms include unpleasant post nasal drainage, pressure and pain in the sinus region, ear fullness, sore throat cough, nasal congestion. Usually this is treated with a course of antibiotics, and most patients improve. If not then typically the antibiotic is changed and steroids are added in the form of a “sinus cocktail shot” or a short course of oral medication. The addition of the steroids directly shrinks the swollen nasal membranes which opens the drainage ports and allows the sinuses to clear.
For many patients this happens once or twice a year an is not particularly worrisome. In other patients, the cycle happens frequently, and they require antibiotics every month or so. The medical term for this is recurrent sinusitis. Frequent colds or allergies can make this situation worse. In other patients, the infection continues to smolder despite antibiotics. Whenever they stop the medicine, the sinus pain, pressure and post-nasal drip recur. These patients have what is medically called chronic sinusitis.
What are the treatments for Sinusitis?
Of course the best treatment for sinusitis is to prevent it in the first place. Our first line of preventative treatment for recurrent or chronic sinusitis involves using salt water rinses and intranasal steroid sprays (such as Flonase®, NasacortAQ® or Rhinocort Aqua®) on a daily basis. Many patients don’t realize that intranasal steroid sprays may require several weeks of daily use to reach full effectiveness. Aditionally, antihistamines (such as Claritin®, Allegra®, Zyrtec®) can be taken by mouth or in the form of a nasal spray(such as Astelin®). Persistent and consistent use of these medications will often prevent the initial swelling of the nasal membranes and subsequent infections. In many patients allergies contribute to swelling of the membranes so we often perform allergy testing as well. If you have signficant allergies we may recommend a course of allergy shots (known as desensitization therapy).
Endoscopic Sinus Surgery
If medical therapy does not work then patients with recurrent or chronic sinusitis are often helped by procedures which enlarge the openings between the sinuses and the nose. In the past the procedures were unpleasant and only partially effective but happily this is no longer case.
Endoscopic sinus surgery involves enlarging the natural drainage openings of the sinuses into the nose so that a little bit of swelling due to a cold or allergies will not lead to the sinus becoming blocked off and then filling with fluid.
The surgery itself is performed at the Shea Clinic Outpatient Surgery Center (on the second floor of our building) so getting in and out is quite convenient. You come to the operating room, have surgery, and go home on the same day (outpatient surgery). During the procedure you are completely asleep (general anesthesia). All surgery is done through the nose with specialized telescopes (known as endoscopes) and specialized equipment (including computer guided instruments if necessary). There are no external incisions.
Occasionally, the wall which divides the left from the right side of the nose (called the nasal septum) is crooked, and can impair breathing and block sinus drainage as well. If this is the case, the wall is straightened at the time of sinus surgery (septoplasty), and often any enlarged membranes (hypertrophied turbinates) are reduced as well to aid in breathing (turbinate reduction).
We do not “pack” the nose with guaze (which can be painful) and most patients take fewer than 10 pain pills after the surgery. We advise patients to take a week off of sedentary work, or about 10 days off of physically demanding work after the surgery.
Most patients experience a dramatic reduction in the frequency and severity of their sinus infections after the surgery. They also breathe better through their nose and almost always find that their sleep improves. Of course allergies themselves are not improved with surgery, and may require specific therapy. This can range from topical nasal steroid sprays to antihistamine tablets to specific desensitization therapy (allergy shots).
Another way to enlarge the openings which connect the nose with the sinuses is known as balloon sinuplasty. In this procedure an inflatable device (balloon) is passed under telescopic visualization (with computer localization if necessary) from the nose through the openings which lead to the sinuses. The balloon is inflated to a pre-determined fixed size thus enlarging the passage between the sinus and the nose. The procedure can be performed in the clinic chair with only local anesthesia. Recovery can be as short as one day. There aWe will discuss the possibility of this procedure with you if you are a good candidate for it.
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