Family doctor

What is sinusitis?

The sinuses are air-filled cavities inside the facial bones that open into the nasal cavity. Sinusitis is an inflammation of the mucous membranes (or lining) of one or more of the paranasal sinuses. Acute sinusitis is common and is often associated with a viral or bacterial nasal infections that spread to the sinuses. When the sinus openings become blocked the cavities fill with fluid, producing pain and pressure. The pain is often made worse by bending, straining, sneezing or coughing. Other symptoms of acute sinusitis are fever, fatigue and postnasal drainage. Chronic sinusitis is a sinus problem that usually follows a single attack or repeated attacks of acute sinusitis. Postnasal or nasal drainage, and nasal congestion are the most common symptoms of chronic sinusitis. Nasal polyps are seen in chronic sinusitis.

Most patients who suffer an acute attack of sinusitis get better by themselves without antibiotics and if they do take antibiotics the majority of patients have no further problems. Treatment of acute sinusitis is designed to prevent complications and to keep the acute process from becoming chronic. Oral antibiotics, decongestants and analgesics are prescribed. Bed rest, local heat and increased fluids are useful in controlling the systemic symptoms.

Many patients with chronic sinus complaints can be successfully treated medically. A course of prednisone and a prolonged course of antibiotics is frequently useful. Treatment may include treatment for allergies or environmental control (stopping smoking).

Is your condition sinusitis?

A major difficulty in treating sinusitis is accurate diagnosis. Many nasal symptoms are rightly or wrongly ascribed to the sinuses. Many patients who have facial pain do not in fact have sinusitis but are more likely to have pain referred from their necks or tender muscles about the face. Allergic symptoms such as nasal discharge and nasal blockage are also often attributed to sinuses. The situation is complicated by the fact that a patient may have more than one problem. For example, patients with allergic rhinitis are more likely to get sinusitis.

Are there other treatments apart from surgery and antibiotics?

In our society many people are looking for the quick fix; surgery and antibiotics are often able to provide these. Scientific evidence for many of the alternative treatments is lacking. The treatment of sinusitis is difficult to evaluate because the patient may have not had sinusitis in the first place and the patient may have got better themselves regardless of treatment. Many people however report that the use of a normal saline spray (salt water), steam inhalations with tea tree oil or acupuncture is effective.

Is surgery necessary?

Any decision to have surgery is a quality of life issue. One has to weigh up the misery of surgery versus the misery of sinusitis. Surgery is only recommended in a small percentage of patients. This may be because of an infection or an inflamed area which does not clear with antibiotics or one which keeps returning when the antibiotics are stopped.

The goal of surgical treatment is to return the nose and sinuses to normal function. Surgery is now frequently done with small telescopes and long instruments. This surgery differs somewhat from the conventional surgery in trying to identify the underlying cause of the problem. This is frequently in the anterior ethmoid sinuses. This location is in the area of the openings of the maxillary or frontal sinuses.

The principle is that if the underlying cause of the disease is identified and corrected, secondary disease in the maxillary and frontal sinuses will be improved spontaneously. There is often less removal of normal tissues and the surgery can be performed on an outpatient basis without the need for nasal packing.

Surgery:

The operation can be performed under general anaesthetic or local anaesthetic with an anaesthetist providing monitored sedation. Usually there is little or no pain in the postoperative period. Although there are potentially very serious risks from the surgery in this area, the incidence is low.

Risks of Surgery:

Complications are rare with endoscopic sinus surgery but do occur.

Bleeding:

Although the risk of bleeding is reduced on rare occasions significant bleeding may require stopping of the procedure and the placement of packing. This occurs in less that 1% of patients.

Spinal fluid leak:

All operations carry a rare chance of creating a spinal fluid leak (the fluid that surrounds the brain). Should this rare complication occur, it would extend your hospitalisation and it might require further surgery for its closure. This complication is extremely rare.

Damage to the tear duct:

This complication too is extremely rare; if it happens then it can be corrected with further surgery.

Anaesthetic risks:

The endoscopic techniques can be performed under local anaesthetic with intravenous sedation. If general anaesthetic is required, you are subject to the usual risks of general anaesthetic.

Is the surgery effective?

Surgery is only able to effect structural changes and removes critical areas of disease improving drainage and aeration of the sinuses allowing them to return to normal. In some patients there may be persisting ongoing medical management for symptoms such as nasal allergy. In general terms surgery offers only a 30% chance of total cure but a 95% chance of a significant improvement in symptoms.