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Sinusitis

Sinusitis, or inflammation of the lining of the nose and sinuses, is a common condition affecting 31 million Americans to result in 18 million doctor visits and more than 200,000 sinus surgeries in the US each year. The sinuses are air-filled cavities of the bones around the nose and consist of:

  • Maxillary sinuses in the cheekbones
  • Ethmoid sinuses between the eyes and behind the bridge of the nose
  • Frontal sinuses over the eyes in the forehead
  • Sphenoid sinuses behind the ethmoid sinuses in the middle area behind and between the eyes   

Each sinus has an opening into the nose for the drainage of mucus, and chronic inflammation of the lining (mucosa) interferes with proper sinus drainage by obstruction of these pathways. Any cause of swelling such as an infection or allergic reaction can cause sinusitis by blockage of the drainage pathways, and the trapped and infected mucus secretions can cause symptoms of sinus pressure, pain, and headaches.

Causes of Sinusitis

Acute sinusitis is a bacterial infection lasting less than 4 weeks, while chronic sinusitis lasts for longer than 12 weeks. It is thought that some patients with acute bacterial sinusitis progress to chronic sinusitis, but this has never been proven.

Chronic sinusitis is likely a multifactorial disease in that the disease encompasses a spectrum of conditions where the membranes of the sinuses and the nose are constantly inflamed. Many patients with chronic sinusitis have asthma and/or allergies. Exposure to environmental allergens (e.g. dust mites, mold, pets, weeds) may contribute to chronic inflammation of the sinuses and respiratory system. Other non-allergic environmental triggers for sinusitis may include secondhand smoke and pollution.

Other people who suffer from chronic sinusitis may have polyps. Nasal and sinus polyps are grape-like out-pouchings of the mucus membranes that protrude into the nasal passages. Polyps can cause nasal obstruction by blocking the nasal cavity as well as sinusitis by blocking the sinus openings.

Chronic sinusitis may also be due to an immune system deficiency or cystic fibrosis. Other people who are prone to chronic sinusitis may be those who have anatomic problems in the nose and sinuses that lead to blockage of the mucus drainage pathways.

Symptoms of Chronic Sinusitis

People with chronic sinusitis may present with a variety of symptoms, and many physicians have tried to classify the condition based on the presence of these common symptoms. Common symptoms include:

  • Facial pain, pressure, or headache
  • Congestion or fullness
  • Nasal obstruction
  • Nasal discharge or pus
  • Postnasal drip  

Less common symptoms of sinusitis may include:

  • Decreased sense of smell
  • Fatigue
  • Odor in nose or bad breath
  • Dental pain
  • Cough
  • Ear pain/pressure/fullness
  • Sore throat  

Health care providers usually take these symptoms into account in the setting of physical findings such as signs of pus or polyps in the nose in order to diagnose sinusitis. In addition, there may be findings of sinus inflammation or blockage on a CT (computed tomography) scan, a form of X-ray.

Medical Treatment for Chronic Sinusitis

The following steps are conventional treatments for inflammation of the mucosal lining of the nasal passages, also known as chronic sinusitis. Although, the mainstay of treatment for chronic sinusitis is medical management, sometimes people may need surgery for successful treatment.

  • Antibiotics may be necessary for a long course to treat chronic sinus infections.
  • Nasal steroid sprays may reduce inflammation and drainage in some people.
  • Saline (saltwater) rinses or irrigations may help mechanically flush secretions and improve function of the sinus mucosa.
  • Management of the underlying disease process contributing to sinusitis (e.g. treating allergies or immune system problems).
  • Oral steroids, such as prednisone, may reduce inflammation and nasal polyp size, but these medicines can have considerable effects in some people, especially when used long-term.
  • Topical delivery of other medications may play a role in medical management as well. For instance, it may be necessary to add antibiotics or steroids to saline rinses in order to deliver medications effectively to the sinuses. 

Surgical Treatment for Chronic Sinusitis

When medical management fails, surgery may be a reasonable option for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. Surgery is usually performed through the nostrils using small telescopes called endoscopes in order to:

  • Enlarge the natural drainage pathways of the sinuses
  • Remove nasal and sinus polyps
  • Fix anatomic structural problems inside the nose and the sinuses that contribute to sinus blockage   

Although surgery is not a panacea for all, most patients who have had sinus surgery report improvement in quality of life and decreased medication use after surgery.