Frequently Asked Questions

What is sinusitis?

Sinusitis is an inflammatory process that occurs within the mucus membranes that line your paranasal sinuses. Symptoms include nasal congestion/difficulty breathing through your nose, smell and taste loss, nasal drainage, runny nose, post-nasal drip, and facial pain/pressure.


What are the paranasal sinuses?

These sinuses are air-filled cavities within the skull. Everyone has the four pairs of paranasal sinuses, including the maxillary sinuses (behind the cheeks), the ethmoid sinuses (between our eyes and the nasal bone), the frontal sinuses (behind the forehead) and the sphenoid sinuses (behind our eyes). These sinuses are typically filled with air only. They are lined by mucous membrane that is constantly secreting mucous which is being transported via cilia (small hair cells) into the back of the nose.


What causes sinusitis?

Triggers for sinusitis include infections, allergies, and an abnormal inflammatory response by the patient’s sinus mucosa. Infectious causes can be viral, bacterial or fungal. Certain patients are predisposed to developing sinus problems, and many patients have other family members with sinus problems, allergies, or asthma. When the inflammation is bad enough, the sinus drainage pathways are blocked leading to worse symptoms such as nasal congestion and facial pressure. Some sinusitis develops in patients with tooth infections. Other patients have trapped fungus balls.


What anatomic abnormalities may lead to sinusitis?

Common anatomic abnormalities include a deviated septum, a nasal bone spur, an enlargement of one of the turbinates, a condition called a concha bullosa, nasal polyps, and narrow ethmoid sinus cells that block drainage from the maxillary and frontal sinuses.


How long does sinusitis last for?

Acute Sinusitis refers to symptoms lasting up to 4 weeks. Recurrent Acute Sinusitis is several attacks within a year. Chronic Sinusitis refers to symptoms lasting longer than 12 weeks.


What are the symptoms of acute sinusitis?

Often, acute bacterial sinusitis is preceded by a viral illness leading to progressive and worse nasal congestion and facial pressure. Patients typically develop facial pain and tenderness along the distribution of the sinuses on the face. This pressure can increase when bending over. There may be headaches in the frontal (forehead) or occipital region (back of the head). The patient may also develop nasal congestion and obstruction, post-nasal drip, cough, halitosis (bad breath) and nasal discharge/drainage. The nasal discharge may be clear (serous) or mucopurulent (white/ yellow/ green).


What are the symptoms of chronic sinusitis?

Chronic Sinusitis refers to symptoms including nasal drainage, nasal congestion or difficulty breathing through your nose, smell and taste loss, and facial pain or pressure lasting longer than 12 weeks. Patients can also experience allergy symptoms including sneezing, watery eyes, fevers, malaise, cough, ear popping or fullness and dental pain.


What imaging studies can help diagnose sinusitis?

Your doctor will typically order a CT scan of the sinuses. This is the best imaging study to evaluate the bony anatomy of the sinuses. He will evaluate the CT scan for mucosal disease or thickening of sinus mucosa, as well as look for blockage of the normal drainage pathways. Often, air-fluid levels are seen indicating trapped mucus. He will also evaluate the anatomy of the sinuses including the patency of the ostia (sinus openings), deviation of the septum or for concha bullosa.


What other studies can be requested?

Your doctor may order an MRI of the sinuses. This imaging modality is better to evaluate soft tissue and is important in the evaluation of sinonasal tumors. He may obtain cultures directly from the sinuses during the nasal endoscopy to help with choosing the appropriate antibiotics. Finally, your doctor may request allergy testing which is done in conjunction with an allergist.


How is acute sinusitis treated?

The mainstay of treatment for acute bacterial sinusitis is antibiotics. Nasal saline irrigations are also important to help clear mucus buildup within the nose. Some patients may benefit from steroids. Topical decongestants, mucolytic agents and humidity are also beneficial.


How is chronic sinusitis treated?

Chronic Sinusitis is defined as symptoms lasting longer than 12 weeks. Treatment plans are catered to the individual patient. Many patients respond to medical therapy, which may include a longer course (3-6weeks) of antibiotics. A course of low dose oral steroids (prednisone) may be used to decrease the inflammation. A nasal corticosteroid spray (i.e. flonase/nasonex/Qnasal) or antihistamine spray (astelin/astepro/patanase) may also be added. For patients with symptoms despite medications, endoscopic sinus surgery or in-office balloon dilation (balloon sinuplasty) may be needed.


How does sinusitis differ in children?

Some of the paranasal sinuses, the sphenoid and frontal sinuses, develop later in children. Sinusitis in children usually involves the maxillary and anterior ethmoids. The infection typically presents with symptoms consistent with a common cold. However, the cold may develop a cough from postnasal drip, halitosis (bad breath), nasal obstruction, nasal discharge and low grade fevers. Some children with enlarged adenoids may demonstrate the same clinical symptoms as chronic sinusitis.


Does treatment differ in children with sinusitis?

The main treatment, antibiotics does not differ. Other adjunctive agents such as saline irrigation, nasal steroids, decongestants and mucolytics can also be used. In addition, the child will be evaluated for allergy problems. Children can also have sinus problems secondary to enlarged adenoids which may need to be treated.

What are some complications associated with sinusitis?

Untreated sinusitis, or long-standing sinusitis can progress into much more serious infections. An infection of the ethmoid sinuses can progress towards the eye, causing orbital cellulitis or an orbital abscess. This typically requires hospital admission followed by IV antibiotics and possible surgical decompression of the eye. Other serious complications include spread of the infection towards the brain causing bacterial meningitis, intracranial abscess, or cranial nerve palsies. These more serious complications are more commonly associated with frontal or sphenoid sinusitis.


What is functional endoscopic sinus surgery (FESS)?

After careful clinical examination and review of your CT sinus images, your doctor may recommend surgical intervention for your sinusitis. Endoscopic Sinus Surgery is an option for patients with Chronic Sinusitis and/or Nasal Polyps that suffer from persistent nasal obstruction/congestion, nasal drainage, facial pain/pressure, and smell loss despite medical therapy. Endoscopic Sinus Surgery is performed under general anesthesia with fiberoptic telescopes and precise instruments through the nostrils. There are no facial incisions and rarely mild facial swelling after surgery. Most patients can go home the same day as surgery. After surgery, your surgeon will carefully go over all postoperative instructions, so that you can heal quickly and return to feeling like yourself!


What are the goals of sinus surgery?

The goals of Endoscopic Sinus Surgery are to remove inflamed tissue and nasal polyps, open up the normal sinus drainage pathways, and create large openings into the sinuses to allow for more efficient distribution of saline irrigations and topical medications and sprays. With open sinus cavities, the topical medications can reach the inflamed sinus mucosa and more effectively decrease symptoms. For patients with Recurrent Acute Sinusitis, Endoscopic Sinus Surgery can often decrease the severity and frequency of sinus infections. Many patients may also have an improvement in taste and smell.


Am I a candidate for balloon sinus dilation (balloon sinuplasty)?

Our surgeons perfom balloon sinuplasty both in the office under local anesthesia and in the operating room under general anesthesia. Certain patients with sinus problems may be candidates for balloon sinus dilation. Sinus Balloons can enlarge the outflow tracts without the need for the removal of tissue. When used appropriately, sinus balloons can relieve symptoms with less bleeding and a shorter recovery time. Most patients can undergo balloon sinus dilation in the office under local anesthesia. By atraumatically dilating the sinus openings, trapped mucus can be suctioned out of the sinus cavities and normal drainage pathways restored.

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