Sinusitis means inflammation of the paranasal sinuses. There can be many explanations for inflammation in the sinuses. The majority of infectious causes of sinusitis are viral infections such as the common cold. Bacterial infections are frequent problems. In Melbourne, Florida, ENT (Ear, Nose, and Throat) doctors may frequently see fungal infections in the sinuses. Other causes of sinus inflammation may include trauma, dental conditions, or allergies.
The National Center for Health Statistics reports that 1 in 7 adults in the United States is affected by sinusitis.
Nasal obstruction, nasal stuffiness, pain or pressure in the face, cheeks or around the eyes, or cloudy or discolored nasal secretions are common symptoms. Patients may notice symptoms that are present 10 days or more after a cold. Patients may also notice symptoms that worsen 10 days after an initial improvement.
Many physicians use the term rhino-sinusitis instead of sinusitis. Usually when there is inflammation of the sinus linings there is also inflammation of the nearby nasal linings. The term rhino-sinusitis emphasizes that there is inflammation of both the nasal linings and the sinus linings.
Doctors take a history and perform a physical exam. ENT specialists may examine the nose with an endoscope that allows them to visualize the small passages deep within the nose. Computed tomography (CT) scan is the radiologic test most ENT specialists use to evaluate chronic sinusitis. A CT scan can provide images in many different directional planes. A CT scan evaluates the fine bony anatomy of the sinuses well. Usually a sinus CT scan is done without contrast injection. It is rare for patients to feel claustrophobic in a CT scanner.
Many ENT specialists prefer to start a course of medical treatment before the CT scan. This treatment may reduce inflammation of the mucosa linings and help make the images of the fine bony anatomy more clear.
X-rays may show air-fluid levels in the frontal and maxillary sinuses. However, because bony structures are superimposed, it is difficult to evaluate the ethmoid sinuses. A magnetic resonance imaging (MRI) scan better visualizes the soft tissue than the CT scan; however MRI does not visualize bone well. Therefore the fine anatomy of the bony drainage passages of the sinuses is not as well seen on MRI.
Sinusitis or rhino-sinusitis may be classified by duration. Acute sinusitis is sinusitis that lasts less than 4 weeks. Subacute sinusitis is sinusitis that lasts 4-12 weeks. Chronic sinusitis is sinusitis that lasts more than 12 weeks. When a person has more than 4 or more episodes a year of acute bacterial rhino-sinusitis, the condition may be called recurrent acute rhino-sinusitis.
Viral infections usually resolved spontaneously. Viral infections are typically treated by supportive care with oral analgesics, fluids, steam, and saline nasal drops. Ipratropium nasal spray, a prescription nasal spray, may help decrease the amount of runny mucus. However ipratropium nasal spray usually does not relieve nasal congestion or sneezing.
Prevention is of course important. Hand washing and alcohol containing hand gels may decrease the spread of viruses due to hand contact. Persistent nasal congestion and symptoms for over 10 days suggests acute bacterial sinusitis. Topical decongestants, systemic decongestants, oral antibiotics may be prescribed. Smoking cessation is very important.
For patients with chronic sinusitis that persists despite medical therapy, other treatment options may be considered. Endoscopic sinus surgery uses a small endoscope to allow the ENT specialist to look inside the nose with intense light and magnification. Inflammatory disease such as polyps and anatomic obstruction such as bone abnormalities may be removed with surgical instruments. Usually ENT doctors try to preserve mucosa lining the sinuses to encourage normal sinus clearance after surgery.
In balloon sinuplasty, specially designed balloons are placed through the nostril then into the natural openings of the sinus. The balloon is then inflated, thus opening up the natural drainage passage. The balloon is then deflated and removed. No tissue or bone is removed. This procedure may be done under a local anesthetic or a general anesthetic.
In 2013 Dr. Karanfilov reported the results of a total of 552 sinuses were dilated with balloon sinuplasty in 203 patients. Patient questionnaires and CT scans showed significant improvement. There was one procedure related adverse event related to swelling around the eyes, which resolved spontaneously shortly after procedure. Twenty-four week follow-up demonstrated clinical and statistical improvement in patient quality of life and radiographic outcomes.