The sinuses are spaces in the bones in the front part of the face: in the forehead, between
the eyes, in the cheeks and behind the eyes and they’re air filled spaces with a membranous
lining and this lining produces mucous. The mucous drains from the sinuses into the nose
through narrow openings and then passes backwards and down the throat. Now, if those openings
get narrowed in any way, it causes sinusitis. Anything that makes the lining swell, such
as infection or allergy, blocks the sinuses and they can’t drain properly and that causes
the symptoms of sinusitis.
Sinusitis can be categorised into acute sinusitis
lasting for days or weeks or chronic sinusitis with longer lasting symptoms. Acute sinusitis
usually occurs after a cold which causes swelling in the lining of the nose and this blocks
the sinus’ draining, causing symptoms of pain, throb, headache, sometimes a bad smell
in the nose and bad taste and colored nasal discharge.
Chronic sinusitis has longer lasting symptoms of nasal congestion, catarrh, cough,
lethargy, headaches and pressure which is usually in the forehead between the eyes or
in the cheeks. These symptoms can have significant effect on quality of life. Individually, symptoms
do not sound so serious but the cumulative effect has a big effect on the quality of
life, productivity at work, sleep quality, and affect on relationships as well. So the
effect is quite significant.
Sinusitis can be treated medically or surgically.
Medically refers to treatment with medication and lifestyle change. The aim of medical treatment
is to try and reduce the swelling in the lining of the nose and sinuses to encourage
the sinuses to drain naturally so the infection settles. This may involve a number of modalities.
There are certain things that can trigger sinusitis like allergy or environment so this
needs to be addressed. There are washes that can be used in the nose to irrigate the nose
to flush out mucous and infected discharge. There are medical drops or sprays that can
decongest the nose to make the lining of the nose shrink down quite rapidly to improve
the sinus drainage. But these are only safe for short term use.
For longer term use, one can use nasal steroid sprays or drops and these have a better effect
using them longer term in the same way that one might use steroid inhalers for asthma.
If allergy’s underlying the sinusitis, then antihistamines have a role and antibiotics
are obviously important in treating infective sinusitis.
Now, if patients do not respond to medical treatment, then we have a number of surgical
techniques to try and open up the sinuses and help them drain better but these techniques
have evolved such that they are performed in a very conservative way to try and help the sinuses
drain naturally without destroying the natural function of the sinuses.
The surgical treatment of sinusitis has evolved dramatically over the last 20 years and even
more so in the last 10 years or so. Traditionally, the treatment of sinusitis included washing
out the sinuses called a antral washout. This was a very basic technique aimed at flushing
infection out of the sinuses. It rarely provided long term benefit. Then understanding
of how we operate in sinuses evolved and it’s geared towards helping the natural drainage
pathways of the sinuses to work better and to try and conserve normal anatomy to help the
nose and sinuses function more naturally. More recently, a technique called balloon
sinuplasty has developed where rather than removing tissue at all, we try to enlarge the openings
into the sinuses by expanding a balloon in the openings to create a more natural sized
opening without causing trauma and removing normal tissue.
Benefit of these new techniques is that the surgery can be performed as day case procedures
and more recently even under local anaesthetics sometimes and the recovery can be much, much quicker.
There’s no need for nasal packing after sinus surgery now which most patients found very
traumatic in the past. You can go home the same day and return to work quicker also.
Hence the downtime after surgical treatment is much reduced and recovery is much quicker.