Sinusitis
The prevalence of sinusitis has increased dramatically in the last two decades. The reasons for its increase are not clear, although environmental pollution and more resistant bacteria may be contributing factors. Today, sinusitis is the most common chronic condition in the United States.
Fifty million Americans, 20% of the nation's population, suffer from sinusitis and are forced to breathe through their mouth because of the constant stuffy nose. Many people with sinusitis feel there is not much that can be done about this condition and continue to live with it until an uncontrolled acute aggravation of the symptoms forces them to get urgent care from a specialist or emergency room.
Sinusitis is a chronic disease that includes the symptoms of nasal obstruction, chronic nasal drainage, decreased sense of smell, facial pressure, frequent sinus infections, and inflammation which can lead to chronic fatigue, pain in the upper teeth, headaches, and related respiratory ailments such as asthma.
There is widespread confusion among patients on whether they suffer from allergies, a common cold, or a sinus condition. Symptoms for each condition differ. Understanding that each one requires a unique treatment regimen aids patients in making an informed choice for appropriate medical care.
The various types of sinusitis (allergic, bacterial, or fungal) can require medical treatment, surgical treatment, or both. An otolaryngologist, a head and neck surgeon, can discuss the latest diagnostic procedures and provide the optimum course of treatment.
No matter what the medical problem, surgery is almost always a last resort. Physicians favor trying less invasive treatments first, such as medication.
Patients in an urban environment may have aggravated sinuses due to pollution, however, in most environments patients are prone to suffer from allergic sinusitis.
These sinus problems are frequently the body's own response to something inhaled or even eaten. The body's sensitivity to the irritant triggers the release of histamine and other inflammatory mediators, which causes swelling and congestion in the nose and sinuses.
Repeated irritation and swelling can produce a breeding ground for other diseases, often resulting in continual cycles of infection. The swollen tissues in the nose called turbinates cause nasal blockage. Normally, the turbinates warm and humidify the air we breathe.
Chronic patients often have hyper-reactive turbinates, and these swollen tissues restrict the flow of air in the nasal passages. The duration of the problem determines whether or not it's chronic. Generally, if the symptoms last longer than three months, it's considered a chronic condition.
Some sinus problems are not caused by an inflammatory disease. Victims of a facial injury may incur damage to their sinuses. Additionally, sinus pain can be caused by a benign or malignant tumor. In both circumstances, surgical intervention is most likely necessary.
Treatment of Chronic Sinusitis
The treatment of chronic sinusitis revolves around re-establishing ventilation and drainage of the sinus air cells. Nonsurgical options are utilized extensively and may include topical steroids, systemic steroids, newer anti-inflammatories, decongestants, allergy remedies, and antibiotics. Many patients are often treated with antibiotics, although the symptoms will recur unless sinus drainage and ventilation is somehow accomplished. If nonsurgical treatments are unsuccessful, sinus surgery becomes a treatment option.
Sinus surgery is performed using endoscopes (small telescopes) for visualization. Generally, no incisions are required. During surgery, the minimal amount of sinus tissue necessary is removed to re-establish ventilation and drainage of the sinus air cells. This is done in a very precise manner so that healing is quicker and scarring is minimized.
Patients are instructed in the proper technique for irrigating the sinuses which promotes a quicker post-operative recovery. In addition, close endoscopic monitoring and cleaning of the sinus cavities is required to help prevent recurrent sinus problems.
Medical management such as topical steroids, systemic steroids, newer anti-inflammatories, and antibiotics may also be necessary post-operatively to aid in achieving a successful outcome.