What are Sinuses?
- Maxillary Sinuses: The largest sinuses, they are located in the cheek region.
- Ethmoid Sinuses: The most commonly infected sinuses, the ethmoids are actually a collection of many small sinuses located primarily between the eyes.
- Frontal Sinuses: The most susceptible to pressure discomfort, the frontals are located in the lower forehead.
- Sphenoid Sinuses: Infected less frequently, the sphenoids are located at the very back of the nasal cavity—almost in the center of the head.
In the normal state, mucus produced within the sinuses flows through tiny openings into the nose itself, helping the nose clean itself of pollens, dust, and bacteria inhaled throughout the day.
What is Sinusitis?
Sinusitis simply means inflammation (“-itis”) of the sinuses. Sinusitis can arise from many causes, and may or may not be associated with a true infection. It typically presents with facial pressure, congestion, discolored post-nasal drip and decreased smell. The most common sinus infections are viral, and often resolve on their own with time.
Sinusitis is most often diagnosed by primary or urgent care providers clinically, by a history of symptoms and a brief physical exam. As specialists in sinus disease, otolaryngologists can perform a variety of in-office procedures including nasal endoscopy, sinus cultures, and imaging to get to the most accurate diagnoses. Once diagnosed, sinusitis is often classified due to the duration of symptoms—and treated accordingly.
The most common type of sinusitis, acute sinusitis, refers to sinus inflammation or infection lasting less than 4 weeks in duration. Some are viral in nature, but all acute sinusitis has the potential of clearing on its own within 7 days. Cases that are more severe, or last more than a week, may require medical treatment. Typically a short course of antibiotics is all that is needed.
Recurrent Acute Sinusitis
There are many patients who get acute sinusitis several times each year. At some point, the cycle of sickness and antibiotics can be a significant nuisance that affects the patient’s quality of life and productivity. For those suffering four or more infections annually, the focus shifts to accurate diagnosis as to why the infections keep recurring. Allergy testing, CT imaging and/or nasal endoscopy often reveal the keys to breaking the cycle of recurrent sinusitis.
Those who get symptomatic sinusitis lasting more than 3 months in a row are diagnosed with chronic sinusitis. Chronic sinusitis is very common, affecting about 15% of the U.S. population and costing the American healthcare system over $4 billion annually. Chronic sinusitis usually requires intensive treatment over 2-4 weeks, often with oral or topical antibiotics, steroids and saline rinses. When treatment fails to break the cycle of chronic sinusitis, surgery may be necessary to get symptoms under control and prevent future infections.
Complications of sinusitis
Most sinusitis certainly makes patients miserable, but in rare cases untreated sinusitis can become quite dangerous—or even a medical emergency. Some complications of untreated sinusitis include:
- Orbital (eye) cellulitis or abscess
- Brain abscess
- Septic shock
Avoiding complications and getting lasting relief starts with the proper workup and plan of care. The physicians of Midwest ENT Centre have the tools and expertise to get your sinus problems accurately diagnosed and effectively treated—in the easiest, least invasive way that brings you relief. For those patients who don’t respond to medical therapy, sinus surgery may be an option. To learn more about how modern sinus surgery can bring you relief with limited downtime, click here.
Surgery for Sinusitis
Sinus surgery is reserved for those patients who have undergone medical therapy and continue to have bothersome symptoms and evidence of residual disease. This often happens when the natural tract connecting the sinus cavity to the nose becomes obstructed, preventing adequate drainage and causing infected secretions to accumulate in the sinus. The aim of sinus surgery is to open up these blocked sinus drainage pathways—clearing the current infection and helping prevent future infections.
Regardless of the method used, endoscopic sinus surgery has come a very long way since its introduction in the 1980’s. It has a remarkably good safety profile, and requires much less down time than in days past. Gone are the days of nasal packing, black eyes, extensive bleeding and prolonged discomfort. All surgery is done endoscopically (through the nostrils), and is minimally-invasive by its very nature. Oftentimes, absorbable nasal dressings are used after surgery that maintain natural nasal breathing, prevent bleeding and limit scar tissue formation—all while eliminating the need for painful packing removal.
Conventional Sinus Surgery
Functional endoscopic sinus surgery (also known as “FESS”) may be indicated for chronic or recurrent acute sinusitis when medical management fails. FESS is a wonderful option for many with chronic sinus issues, as the technique offers flexibility to appropriately treat almost any sinus problem that presents. The basic goal of a FESS procedure is the surgical enlargement of the small openings that connect diseased sinuses to the nasal cavity. It involves some minimal and select tissue removal, but preserves natural nasal and sinus anatomy as much as possible. It can be used to address every affected sinus, and can easily be combined with other procedures to improve the nasal airway, including nasal septoplasty and turbinate reduction.
New technologies and techniques have brought sinus surgery a long way in the last 10 years. Improvements in imaging and new safety-minded technologies have dramatically improved the patient’s sinus surgery experience—a far cry from the days of old. Nasal packing is also a thing of the past, with few exceptions. New absorbable materials can be placed immediately after FESS is complete, which dramatically improve healing and limit the risks of postoperative bleeding and scarring. Many patients return to their normal activity level within days. Most sinus surgery performed in the U.S. today is performed in this conventional manner, in the operating room under general anesthesia.
Also known as balloon sinus dilation, balloon sinuplasty is a less-invasive way to restore natural sinus drainage from infected sinuses—quickly, and in the office. Just like conventional sinus surgery, balloon sinuplasty permanently widens the outflow paths from the sinuses into the nose. With FESS, this is accomplished using small, precise cutting instruments. Balloon sinuplasty utilizes a small, flexible balloon catheter to achieve the same goal. The catheter is gently advanced into the sinus opening and inflated, gently remodeling the drainage pathway. Since no tissue is removed, there is little bleeding and very minimal pain. Downtime is negligible, and patients are usually back to their normal activity level in 1-2 days.
More balloon sinuplasty procedures are performed at Midwest ENT Centre than at any other facility in the region. If you have been suffering from chronic sinus pressure or recurrent infections, it may very well be a great option for you. To learn more, watch the video below and call Midwest ENT Centre today to schedule a consultation.
STEP 1: A balloon catheter is inserted into the inflamed sinus
STEP 2: The balloon is inflated to expand the sinus opening
STEP 3: Saline is sprayed into the inflamed sinus to flush out the pus and mucus
STEP 4: The system is removed, leaving the sinuses open