Sinusitis

Sinusitis

The para-nasal sinuses are air filled spaces in the bones of the skull that connect to the nasal cavity. They are lined by specialized cells called mucosa. The sinuses require free flow of gases and secretions into the nose.  Sometimes the pathways that connect the sinuses to the nose become blocked and the mucosa becomes unhealthy. The sinuses get infected and filled with secretions, pus and polyps. Pressure builds up and can result in pain. Acute sinusitis is a condition characterized by fever, severe facial pain and unpleasant muco-pus from the nose.

Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They form as a result of chronic inflammation due to recurring infection such as chronic sinusitis, allergies or immune disorders.
Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, an altered sense of smell and frequent infections. Other signs and symptoms of chronic sinusitis with nasal polyps include a runny nose, post nasal drip, facial pain or headache, persistent stuffiness, snoring or pain in your upper teeth.
 
Sinusitis may be acute or chronic:
  • Acute sinusitis - occurs due to an attack of the common cold or flu. It develops quickly and lasts for around 12 weeks.
  • Chronic sinusitis - develops late and the symptoms last for more than 12 weeks.
 There are four pairs of sinuses in the body i.e. frontal sinuses, ethmoid sinuses, sphenoid sinuses and maxillary sinuses. The most commonly affected sinuses are maxillary.
 
What are the causes of sinusitis?

There are numerous causes that make your sinuses inflamed or blocked and these are:
  • Tooth infection - The infective pathogens travel through the sinuses and cause an infection in the sinuses.
  • Viral infections - Common cold or flu may spread the infection from the upper air way to cause inflammation in the sinuses.
  • Allergies such as rhinitis, asthma, and hay fever may predispose to the development of sinusitis.
  • Cystic fibrosis is a genetic condition in which there is thick mucus production that blocks the air ways and makes the body more prone to infection.
  • Structural problems in the nose predispose to the development of sinusitis.
 
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What are the symptoms?
 
The most common symptoms include:
  • Pain and tenderness in the face when moving the head or while eating
  • Raised body temperature
  • Runny nose with yellowish or greenish mucus suggesting a bacterial infection
  • Nasal stuffiness
 
The rare symptoms of sinusitis are:
  • Cough
  • Headache
  • Pressure in the ears
  • Bad breath
  • Loss of taste and smell
  • Pain and tenderness in the teeth
 
What are the treatment options?

Sinusitis can be treated initially with home remedies and other medications
Home remedies:
  • Drink plenty of fluids to keep the mucus thin.
  • Breathe warm and moist air from a hot bath.
  • Blow your nose to keep it clear from mucus.
Medications:
  • Antibiotics are prescribed if the symptoms persist beyond a week.
  • Decongestants reduce the swelling in the mucous membranes.
  • Analgesics help to reduce the pain.
  • Corticosteroids reduce the inflammation in the nasal passages. They are available as sprays or drops and are used to treat chronic sinusitis.
  • Mucolytics help in thinning the mucus.
 
Surgery: Based on the effectiveness of medical treatment, your surgeon may recommend surgery.
 
FESS stands for Functional Endoscopic Sinus Surgery. It is the modern approach to sinus surgery using endoscopes and minimally invasive techniques. The intent of this surgery is to re-establish the natural pathways of ventilation between the nasal cavity and the sinuses and so improve the "function" of the nose. It also allows drugs in the form of nasal sprays, to penetrate deeper into the sinuses which are opened to the inside of the nose.
 
What happens during the surgery?

FESS is usually performed under general or local anaesthesia and the surgical procedure is performed inside the nose. By using special telescopes and surgical instruments, the surgeon removes the block inside by removing the swollen linings. Some patients with sinusitis also develop nasal polyps and these are also removed during FESS. In some cases the surgeon may find it necessary to straighten the nasal septum (the midline partition between the two nasal cavities) in order to gain access to the sinuses.
The surgery may take for 2-3 hours. Once this is done, the inflammation settles and symptoms gradually start abating.  
Though considered a safe procedure, this surgery is not free from side effects. However, these are rare and include bleeding, eye problems and spinal fluid leak.
 
Balloon Sinuplasty
 
Balloon Sinuplasty is a relatively injury free alternative to open up blocked sinuses by enlarging the natural openings. In the process, the patient is relieved from the symptoms of headache, facial pain, the feeling of heaviness in the head, nasal discharge and fever associated with sinusitis.
 
When is surgery advised?

You may be advised surgery if you have the following:
  • you have chronic sinusitis
  • treatment for longer than 6 weeks with medications has not relieved your symptoms
  • your  CT scan after 6 weeks of treatment shows nasal polyps
  • if the infection is due to a fungal infection
  • if the infection has spreads beyond the sinuses
 
How do you prepare for the surgery?

Before undergoing surgery you should consider the following:
  • You need to tell your surgeon if you are using any medications. This is because you may have to stop taking certain drugs such as aspirin and ibuprofen that may increase the risk of bleeding.
  • You must stop smoking 3-4 weeks before the scheduled date of surgery.
  • You should get examined by a physician who will review your basic tests and certify you fit medically.
  • Your surgeon may suggest certain medications before and after the surgery; you should use them as prescribed.
  • You should not eat or drink for at least 8-10 hours before surgery (after midnight of the night before) and have only a light dinner. You should take your medicines before the surgery with only sips of water.
 
What can you expect post-surgery?

During the first few weeks after surgery:
  • You may have thick, discolored drainage from your nose as the collected secretions from the sinuses drain out. It is normal and is not a sign of infection.
  • Change your bandage under the nose regularly until there is no drainage.
  • You may have to visit your surgeon as required for follow up. Your surgeon will inspect the site of surgery and remove any scar tissue.
  • Have a lot of fluids to prevent dryness of your mouth.
  • In case you have any nasal bleeding, use an ice-pack over the nose and the cheeks.
  • Do not touch your nose or massage it in any way without specific instructions from your surgeon.
 
 
When can the patient return home after the surgery?

FESS: You can go home on the same day of surgery or the next day depending on the extent of the surgery.
Balloon sinuplasty:You may return home after a few hours of the surgery i.e. after the effects of the anaesthetic wear off.
 
Residual effects of anaesthesia may last a while, so you should not drive and have somebody to take you home.  

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