FAQ about SINUSITIS ,NASAL POLYPS AND MANAGEMENT

Q. 1 What is sinusitis?
A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. It is of two types viz. Acute and chronic. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Q. 2 What are the signs and symptoms of acute sinusitis?
A. Facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough . Additionally, sufferers of this disorder can have fever, bad breath, fatigue, dental pain, and cough.
Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Q. 3 What are the causes of Sinusitis & how is Sinusitis treated?
A. The causes of sinusitis may be categorized in the following ways:
Anatomical Causes - The anatomy of the sinuses varies tremendously from person to person. In some individuals, anatomical differences may affect breathing and block nasal drainage. Common anatomical causes of sinusitis are a deviated septum and swelling of the turbinates.

Lifestyle Causes - Pregnancy, working with children, and smoking are some of the lifestyle choices that increase one's susceptibility to sinusitis. Read more.

Inflammatory and Infectious Causes - Sinusitis can be caused by bacterial, viral, and fungal infections, as well as allergies, polyps and reflux disease. Read more.

Developmental Causes - Developmental disorders, such as cystic fibrosis, can lead to sinusitis. Read more.

Tumors - Sinus and nasal tumors can block critical drainage pathways and possibly lead to sinusitis. Read more.

Acute sinusitis is generally treated with 10 to 14 days of antibiotic care. With treatment, the symptoms disappear and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Q. 4 What are the signs and symptoms of chronic sinusitis?
A. Facial pain/pressure, facial congestion/fullness, nasal obstruction/ blockage, thick nasal discharge/ discolored post-nasal drainage, pus in the nasal cavity, and at times, fever lasting for 12 weeks. They may also have headache, bad breath, and fatigue.

Q.  5 Can sinusitis cause sinus headaches?
Headaches are a common symptom associated with sinusitis. However, it is important to remember that headaches in the sinus region can also have non-sinus causes, such as migraine and temporomandibular joint (TMJ) arthritis. Your sinus doctor can help to sort out these various causes.

Q.  6 What measures can be taken at home to relieve sinus pain?
A. Warm moist air may alleviate sinus congestion. A vaporizer or steam from a pan of boiled water (removed from the heat) are both recommended (humidifiers should have a clear filter to preclude spraying bacteria or fungal spores into the air). Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are safe for use at home.

Q.  7 How effective are non-prescription nose drops or sprays?
A. Use of nonprescription drops or sprays might help control symptoms. However, non-prescription drops should not be used beyond a certain period or dose.

Q.  8 How does a physician determine the best treatment for acute or chronic sinusitis?
A. To obtain the best treatment option, the physician needs to properly assess the patient’s history and symptoms and then progress through a structured physical examination.

Q.  9 What should one expect during the physical examination for sinusitis?
A. A thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exists. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.

Q.  10 What other diagnostic procedures might be taken?
A. Other diagnostic tests may include a study of a mucus culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

Q.  11 What is nasal endoscopy?
A. An endoscope is a special instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas. These are of two types-rigid telescope and fibreoptic.

Q.  12 Why does a physician specialist carry out nasal endoscopy?
A Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient’s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the structure of the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that will cause the patient to suffer from recurrent sinusitis.

Q.  13 What course of treatment will the physician recommend?
A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies. Antifungal medicine will be the treatment for any fungal infection.

Q.  14 What are the various types of surgery being performed these days days for sinusitis?
A. In summary, sinus surgery is usually reserved for chronic sinus conditions. Nowadays, surgical procedures are likely to be less invasive than in the past. The most widely used method is endoscopic surgery. A list of surgical procedures is shown below.
-> Adenoidectomy
-> Ethmoidectomy
-> Endoscopic Sinus Surgery
-> Extended Endscopic Frontal Sinus Surgery
-> Frontal Sinusotomy
-> Functional Endoscopic Sinus Surgery (FESS)
-> Maxillary Sinusotomy
-> Open Frontal Sinus Surgery
-> Polypectomy
-> Reduction Removal of Inferior Turbinate
-> Reduction Removal of Middle Turbinate
-> Septoplasty
-> Sphenoidotomy
-> Tumor Removal

Q.  15 Will any changes in lifestyle be suggested during treatment?
A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.

Q.  16 When is sinus surgery necessary?
A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell ,like a broom). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

Q.  17 What does the surgical procedure entail?
A. The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.

Q.  18 What does sinus surgery accomplish?
A. The surgery should enlarge the natural opening to the sinuses. Surgeons have found endoscopic surgery to be highly effective in restoring normal functioning to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus and proper aeration of the sinuses.

Q. 19 What are the consequences of not treating infected sinuses?
A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Q.  20 Where should sinus pain sufferers seek treatment?
A. If you suffer from severe sinus pain, you should seek treatment from a physician who can treat your condition with medical and/or surgical remedies.

Q.  21 What is "FESS"?
This is an acronym for functional endoscopic sinus surgery. When we use telescopes to visualize the small openings of the sinuses and enlarge them, we are hoping to restore function to the sinuses so the patient will have relief of their sinus symptoms. Depending on the cause of the sinusitis and the surgery performed, normal function is not always restored. Some clinicians, therefore, choose to describe sinus surgery using the endoscopes as ESS or endoscopic sinus surgery.

Q.  22 What is a sphenoidotomy?
"Sphenoid" refers to the sinus located at the the very back of the nose which opens into the nasal cavity approximately 30 degrees above the floor of the nose. "-otomy" means to make an opening into. Therefore, a sphenoidotomy is making an opening into the sphenoid sinus. The sphenoid sinus is sometimes referred to as the hidden sinus. Symptoms of sphenoid sinusitis include pressure or pain on the top or back of the head. The sphenoid sinus is surrounded above and to the side by the brain and vital structures such as the optic nerve and carotid artery.

Q.  23 What is a deviated septum?
The nasal septum is a wall of bone and cartilage that runs down the middle of the nasal cavity, separating the nasal passage into two equal sides. Trauma or congenital factors may cause the septum to buckle and become crooked, or "deviated." A deviated septum can cause obstructed breathing and can also predispose to sinus infections. A deviated septum can be readily corrected by a surgical procedure called septoplasty (often performed at the same time as sinus surgery).

Q.  24 What is a concha bullosa?
Concha bullosa refers to an enlargement or ballooning of the nasal turbinate (which is a normal structure in the nose). Concha bullosa is a normal anatomic variant, but occasionally, a concha bullosa can be very large and contribute to sinus obstruction. In these cases, the concha bullosa can be readily reduced by surgery.

Q.  25 What are polyps?
Polyps are benign growths in the nose that result from chronic inflammation of the nasal and sinus linings. Polyps may block the sinus drainage pathways and contribute to chronic infection. Polyps can be surgically removed, but they may have a tendency to recur as well, even after surgery. Polyps are generally not cancerous or even pre-cancerous in nature.

Q. 26 What is a septoplasty?
A septoplasty is a surgical procedure to correct a deviated septum . Septoplasty is performed through a small, hidden incision in one nostril. Portions of bone and cartilage are selectively removed to allow straightening of the midline septum wall. The goal of septoplasty is to relieve nasal obstruction and to provide greater room for the sinuses to drain.

Q.  27 What is an ethmoidectomy?
The term "ethmoidectomy" describes a surgical procedure during which ethmoid sinus cells are opened to treat infection or sinus obstruction that has led to chronic sinus problems. Anatomically, the ethmoid sinuses are divided into anterior and posterior regions each with a variable number of sinus cells. Typically the anterior cells are fewer in number and more consistent in their size and structure. The posterior ethmoid cells may number from 1-5 and their size and structure may be more variable. The posterior cells are also associated with several important structures; the orbit (eye), optic nerve, and the sphenoid sinus. Dependent on the extent of sinus disease, the surgeon may elect to open only the anterior cells (anterior ethmoidectomy) or may need to open all the cells (total ethmoidectomy). After opening these cells, drainage of infected mucous and removal of inflamed tissue is accomplished. Surgical treatment of the ethmoid sinus cells is one of the more common components of sinus surgery.

Q.  28  What are the risks associated with a FESS procedure?
A. Because of the intricate anatomy of the sinuses, sinus surgery does carry a small risk of injury to adjacent structures. This includes possible injury to the eyes and to the lining of the brain, called the dura. A tear of the dura may cause brain fluid to leak into the nose, requiring additional surgery to correct it. There is also a small risk of bleeding after surgery, as well as associated risks of anesthesia. Fortunately, complications from sinus surgery are rare. You should discuss the risks of sinus surgery completely with your surgeon before you decide to proceed.


Q. 29 How long is the recovery time after a typical sinus surgery procedure?
A. Most patients can return to work within a week. The surgery is usually performed on an outpatient basis. It may be performed under general local anesthesia with sedation. Some procedures may be performed in the office under local anesthesia. If the patient has required general anesthesia and moderately extensive sinus surgery, they will experience increased nasal congestion in facial pain or pressure and decreased energy for about three weeks postoperatively. Patients who have jobs in dusty or dirty environments are encouraged to stay off work until their nose is totally healed (about 2 to 3 weeks).

Q.  30 How many times will I need to see my surgeon after sinus surgery?

A. Most patients can return to work within a week. The surgery is usually performed on an outpatient basis. It may be performed under general local anesthesia with sedation. Some procedures may be performed in the office under local anesthesia. If the patient has required general anesthesia and moderately extensive sinus surgery, they will experience increased nasal congestion in facial pain or pressure and decreased energy for about three weeks postoperatively. Patients who have jobs in dusty or dirty environments are encouraged to stay off work until their nose is totally healed (about 2 to 3 weeks).

Q.  31 How much pain is involved in sinus surgery?
A. The level of pain perception and tolerance is different for every patient. However, most patients admit that they are pleasantly surprised about the relatively little amount of pain they feel postoperatively. There is significant nasal congestion, which may cause facial pressure or pain in some patients.
There should be little pain associated with sinus surgery. The major complaint is nasal congestion after surgery, not pain typically. Medications are given to control the discomfort and should be more than adequate. If a patient is experiencing a high level of pain then I will immediately re-evaluate the situation. Difficult-to-control pain after surgery is unusual and, may signal a complication.

Q.  32 I have heard people talk about less invasive sinus surgery. What is this? How do I know if I am a candidate?
A. Minimally invasive sinus surgery generally refers to the newer endoscopic sinus surgery techniques that many surgeons are now developing and using. The basis of this concept is gentle and precise tissue handling, minimal disruption of normal structures, preservation of nasal and sinus function, and more rapid recovery with fewer complications. Almost all sinus problems can now be managed via these techniques. Older surgical methods utilized facial incisions and more destructive dissection techniques.

Q. 33 When is surgery necessary for patients with sinus problems?
A. Surgery is necessary if the patient's symptoms cannot be alleviated with medical therapy. Usually this means the patient will have tried a nasal steroid spray and have had an allergy evaluation. If the patient is being treated for infectious sinusitis a culture should be obtained so that the patient can be placed on antibiotics directed by the culture findings. Rarely is surgery necessary for a diagnosis.