Sinusitis: causes and treatment
Sinus disease, or sinusitis, is an inflammation of the sinus. In this article, Mr Dheeraj Karamchandani, a consultant ENT surgeon, explains what causes sinusitis, and how it can be treated.
What is sinusitis?
The sinuses are cavities or air in the face around the forehead, nose, and cheeks. Sinuses serve to warm and add moisture to inhaled air while filtering out dust and pollutants by producing mucus. Sinusitis is when the sinuses become swollen, typically due to infection (viral or bacterial) or allergies. They can commonly occur after contracting a cold or the flu. With sinusitis, the sinuses also become obstructed and they fill with fluid, causing facial pressure build-up which can lead to pain and a blocked nose.
Other common symptoms of sinusitis include:
- Postnasal drip
- Thickened green or yellow mucus
- Cough
- Bad breath
- Headaches
- Fatigue
There are several types of sinusitis, such as:
- Acute, where the infection lasts less than a month, often caused by the common cold.
- Subacute, where the infection can last between one to three months.
- Chronic, where the infection, typically bacterial in nature, that lasts for at least three months.
- Recurrent, where the infection reoccurs multiple times throughout a year, though acute in duration.
How is sinusitis treated?
Sinusitis doesn’t typically require treatment beyond waiting for the infection to pass or with over-the-counter medications.
Patients may alleviate discomfort with facial massages, acupressure, and acupuncture treatment, to help induce drainage and reduce pressure.
But for patients who have recurrent sinusitis, have sinusitis caused by bacteria (and very rarely fungi) where there is a risk of the infection spreading to the brain and other structures of the head, or their sinusitis has lasted longer than two weeks, then proactive treatment can be recommended, based on the underlying cause or conditions which contribute to the sinusitis. These can include:
- Steroid nose sprays
- Antihistamine medications
- Antibiotics, such as amoxicillin, cefixime, clindamycin
- Surgery to address structural abnormalities that facilitate sinusitis or fungal infections, such as image-guided sinus surgery.
How can sinusitis be treated with surgery?
Image-guided surgery is an emerging technique to treat sinusitis. It involves using CT scans to create a visual of the sinuses in 3D, allowing the surgeon to see the location of the sinuses and vital structures like the eyes, major blood vessels and nerves.
With this information, surgeons can use an endoscope, which is a long, flexible tube with a camera and light at the end that they insert in the nose through the nostrils, to treat the exact part of the sinuses that is inflamed without disrupting healthy tissues. They can either remove the diseased tissue or small bones along the opening of the sinus, excise polyps and other obstructions or inflate a balloon in the passageway, in order to open up the sinuses to promote drainage.
The benefit of this technique is that there is less – if at all – visible scarring, less tissue trauma, and less blood loss. This means there is less bleeding during the procedure, and less pain during recovery, which is also projected to be shorter than that of more invasive procedures.