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Sinus Problems

Millions of individuals are significantly affected by chronic or recurring sinus problems. The market for medications to treat these disorders is a multi-billion dollar industry for both over-the-counter and prescription products. Sinus disorders are some of the most common of all medical problems, affecting at least 40 million individuals annually. The loss of productivity due to sinus related disorders is estimated to be in the multi-billion dollar range. A great number of individuals needlessly suffer from chronic pain, drainage, nasal congestion and chronic infection related to sinus disease. When sinus disorders become more chronic in nature, accurate and appropriate diagnosis will lead to cure in the vast majority of individuals. Our goal at Northwest ENT Associates is to provide accurate and efficient diagnostic and therapeutic services to help individuals eliminate their chronic sinus problems.

Patterns of Sinusitis

Acute Sinusitis

This diagnosis indicates an isolated, acute sinus infection that generally responds well to simple medical management and does not progress or recur.

Recurrent Sinusitis

This diagnosis is manifested by recurring bouts of sinus infection which do respond well and quickly to treatment but which tend to reoccur with inappropriate frequency.

Chronic Sinusitis

In this instance there is almost constantly some degree of sinus infection or some other signs and symptoms; they are inadequately remedied by medical treatment.

Barosinusitis

This diagnosis constitutes a wide spectrum of sinus disorders, referable to or caused by paranasal sinus dysfunction; often infection may not play a role.

Signs & Symptoms

Sinus problems can result in a wide variety of different symptoms- some major and very significant; others relatively minor but annoying. The major symptoms of sinus disease include facial pain and pressure, discolored nasal drainage, and nasal airway obstruction. Other symptoms include a decrease in the sense of smell or taste, ear clearing problems, chronic sore throat, cough, hoarseness, lump feelings in the throat, bronchitis or asthma problems, and even bad breath.

Major Symptoms

Common

  • Purulent rhinorrhea (discolored drainage)
  • Facial pain and pressure
  • Nasal airway obstruction

Rare

  • Meningitis/ Brain abscess
  • Orbital complications/ Blindness
  • Vascular complications/ Central venous thrombosis

Minor (Secondary) Symptoms

  • Post nasal drainage
  • Chronic cough
  • Eustation tube dysfunction leading to ear clearing problems, ear infections, or chronic ear fluid
  • Hoarseness
  • Chronic bronchitis and recurring pneumonia
  • Halitosis - bad breath
  • Globus
  • Fatigue
  • Dysequilibrium
  • Blurred vision
  • Hyposmia/ Dysgusia - decrease in sense of smell or taste
  • Exacerbation of migraine headaches
  • Exacerbation of asthma / bronchospasm
  • Sleep disturbances and snoring

Causative Factors

There are a number of factors that are related to the development of sinus disease. One's individual facial structure is an important predisposing component for the development of sinus problems. The size of drainage openings that are present in one's sinuses determines the susceptibility of the individual to developing infections or obstruction problems.

Family History: Family members often experience an increased risk of problems if one or both parents have sinus problems. This is likely due to an inherited similarity of anatomical features and possibly some inherited environmental sensitivity.

Environmental Factors: Living in an industrialized society represents one of the main causative factors for disorders of the sinuses. Exposure to irritants, either home, outdoors, or at the workplace, is a potentially significant cause for sinus inflammation that leads to worsening problems. In the Pacific Northwest there seem to be virtual year-round sources for potential sinus irritants. Smoking obviously introduces additional significant irritants - both on a direct basis, but also by paralyzing the natural flow of mucus from the sinuses.

The underlying cause for virtually all problems with the sinuses is one of obstruction. Sinuses that are unobstructed and well-draining are highly unlikely to cause any difficulties. On the other hand, obstructed openings leading to the sinuses are susceptible to becoming infected and further restricted, resulting in chronic headaches, discolored nasal drainage and other related problems. The goal of therapy, whether through the use of medication or surgical intervention, is to restore normal and effective ventilation and drainage of the sinuses. Once adequate ventilation has been reestablished, problems related to the sinuses generally disappear on a permanent basis.

Many individuals find that their pattern of difficulties seems to increase as they age. Some individuals are able to date the onset of their sinus problems to very specific episode of infection. There is often a subsequent sense of a "snowballing" effect that takes place, since with each infection additional inflammation and scaring takes place - which leads to further narrowing of sensitive openings, which in turn results in an added probability for further sinus infection. Medical or surgical intervention is directed towards restoring the ventilation to the sinuses, which will in turn will allow for elimination of the sinus problems on a permanent basis.

Diagnosis

History

The individual's history is the single most important means of formulating a likely diagnosis and for implementing effective and efficient sinus treatments.

Physical Exam

The findings on examination are relatively limited, as the most critical regions cannot be well visualized. However, pertinent findings include:

TM (eardrum) changes

retraction, effusion, inflammation

Nasal problems

septal deviation, tissue hypertrophy, colored secretions.

Endoscopic Rhinoscopy

This technique uses an endoscope to gently examine the nose to assess the anatomy and any possible disease. This painless technique is performed in the office. Endoscopy is often useful to diagnose nasal and sinus diseases. It is also used for post-operative assessment and diagnosis.

Other Studies

  • Blood tests are generally not helpful in therapeutic decision making
  • Cultures of the nose are rarely useful, as infections are mixed with significant anaerobic components
  • Nasal smears rarely provide any substantive information not already obvious
  • Sinus x-rays have such poor image quality that there is seldom an indication to obtain them nowadays.
  • CT scans are the most important tool in understanding the nature of an individual's problem. Coupled with a good history, the findings of CT scans will often isolate the cause of a chronic problem. The cost of a screening CT is now often less than that of the traditional "sinus x-rays."
  • Allergy evaluations may be useful for some individuals (particularly if they have a suggestive history). Often the basic medical therapy utilizes medications which have a significant effect to reduce allergy related problems.

Treatment

Naturopathic There are a number of simple and effective sinus treatments which may prove beneficial. These include the avoidance of environmental irritants at home, outdoors, or at the workplace, and the avoidance of smoking. Saline and baking soda irrigations are often very helpful. Heat, steam, accupressure, and acupuncture may also play a role.

Medical Therapy: This is the mainstay of sinus treatment for the majority of patients and includes some of the above measures as well as:

Anitbiotic Therapy: Important in the reduction or elimination of sinus infection

Steroid Nasal Sprays: Very valuable in the treatment of a wide variety of both allergic and non-allergic problems often resulting in sinus disease. Long term use may often be required.

Astelin Spray: A one-of-a-kind product, acting both as a rapidly effective anti-histamine, but also as an anti-inflammatory agent. This product is useful in conjunction with the steroid spray.

Atrovent Spray: This medication may be useful in the management of vaso-motor symptoms (watery drainage)

Guaifenacin: A reasonably effective mucolytic (thins secretions) which probably promotes better clearing and may promote more effective ventilation.

Anti-Histamines: These may be of some value for allergy problems; however, they are probably detrimental in treating sinusitis due to the tendency to increase thickness of mucous. The effects are also transient.

Decongestants: These are transient in effect and may provide symptomatic improvement. They probably do not significantly change the progression of sinus disease or expedite resolution of infection. Sprayed, topical decongestants are detrimental in the management of sinus disease.

Steroids: Potentially useful if limited to a brief, tapering oral course.

Turbinate Injection: This is often a highly effective therapy for significant rhinitis with or without sinusitis. It is often able to dramatically accelerate the recovery phase.

Bactroban Solution: This is an antibiotic solution which is often a good adjuvant measure in treating recurrent sinusitis. It is particularly useful in the pediatric age group.

Surgical Management

Read testimonials from sinus procedure patients here.

The goal of surgical management is the complete and permanent resolution of symptoms. This needs to be accomplished with minimal discomfort and recuperative time. There should result a marked decrease or elimination of the need for medication. The basic surgical principle is the reversal of obstruction and restoration of effective drainage and ventilation to the sinus.

Techniques

The standard of medical care is now the use of endoscopic surgery. This has replaced essentially all other procedures except for very rare circumstances. The key elements are:
  • Thorough opening of all affected areas: conservative treatment is to completely address all involved areas as treatment failure invariably is traceable to inadequately opened areas.
  • Minimal disruption to mucosa (membranes) is important. This is accomplished by use of sharp "through cutting" instruments as well as power "shaver" devices. This promotes very rapid healing and normalization of function.
  • Local anesthesia with sedation is most useful in that there is a marked decrease in blood loss as compared with a general anesthetic and recovery is markedly expedited.

Packing is to be avoided as it not only results in pain but also delays healing dramatically. In-office surgery offers a significant cost advantage to hospital based procedures and quality control is much better managed with a consistent team of individuals.

Outcome

The long-term results of endoscopic surgery are excellent and enduring. Only small minorities of individuals have problems which require ongoing treatment of any consequence. Our long-term survey is demonstrating over a 98% success rate in resolving most individuals’ concerns. Most have been able to significantly reduce or eliminate the need for sinus medications.

Summary

The substantial majority of individuals with sinus related problems respond well to medical management. The judicious use of appropriate medication and patient selection based on history will generally be effective. The individuals with more severe problems generally are easily and effectively treated with endoscopic surgery.