A. If you think that you are alone
you are not. Over 40 million Americans suffer from at least
one episode of sinusitis each year.
A. Sinusitis is an inflammation
of the membrane lining of any of the paranasal sinuses.
Acute sinusitis is a short-term condition that responds
well to antibiotics and decongestants, this usually clears
in two weeks or less; chronic sinusitis is characterized
by persistent sinus infection or recurring sinusitis. Either
medication or surgery is a possible treatment.
A. Sinusitis is caused by inflammation
secondary to the following four etiologies: the environment,
allergy, infection (bacteria, fungus (otherwise known as
mold), or virus) and may be exacerbated or precipitated
by narrow sinus passageways. The prevalence of sinusitis
has soared in the last decade possibly due to increased
pollution, urban sprawl, and increased resistance to antibiotics.
In New York and the surrounding areas 9-11 worsened the
air quality and caused significant sinus and lung problems
for patients. For patients that have bad mold in their environment,
some of these patients have developed severe sinus infections.
A. For acute sinusitis, symptoms include
facial pain/pressure, nasal obstruction, nasal discharge,
diminished sense of smell, and cough not due to asthma (in
children). Additionally, sufferers of this disorder could
incur fever, bad breath, fatigue, dental pain, and cough.Acute
sinusitis can last for up to four weeks. However, if it
lasts longer than you should consider that the infection
is not just acute but that you may be suffering from a chronic
condition or worse. This condition may be present when the
patient has two or more symptoms and/or the presence of
thick, green or yellow nasal discharge. Acute bacterial
infection might be present when symptoms worsen after five
days, persist after ten days, or the severity of symptoms
is out of proportion to those normally associated with a
A. Acute sinusitis is generally
treated with ten to 14 days of antibiotic care. With treatment,
the symptoms disappear, and antibiotics are no longer required
for that episode. Oral and topical decongestants also may
be prescribed to alleviate the symptoms. It is important
that care be used with topical decongestants.
A. Victims of chronic sinusitis may
have the following symptoms for 12 weeks or more: facial
pain/pressure, facial congestion/fullness, nasal obstruction/blockage,
thick nasal discharge/discolored post-nasal drainage, yellow
green mucus, pus in the nasal cavity, hoarseness, cough,
snoring and at times, fever. They may also have headache,
bad breath, and fatigue.
A. Warm moist air may alleviate sinus
congestion. Experts recommend a vaporizer or steam from
a pan of boiled water (removed from the heat) (PATIENTS
NEED TO BE CAREFUL THAT THEY DO NOT BURN THEMSELVES). Humidifiers
should be used only when a clean filter is in place to preclude
spraying bacteria or fungal spores into the air. Warm compresses
are useful in relieving pain in the nose and sinuses. Saline
nose drops, sprays and irrigations are also helpful in moisturizing
A. Use of nonprescription drops or
sprays might help control symptoms. However, extended use
of non-prescription decongestant nasal sprays could aggravate
symptoms and should not be used beyond their label recommendation.
These products can very often be very harmful and should
be used with caution. Saline nasal sprays, drops or irrigation
is safe for continuous use. Over the counter products will
resolve minor acute sinus infections and will aid in maintanence
care but for any problem that is chronic patients are advised
to seek care from a sinus swpecialist.
A. To obtain the best treatment option,
the physician needs to properly assess the patient' s history
and symptoms and then progress through a structured physical
examination. After that he needs to order and evaluate appropriate
tests such as a CT scan. The physician should always read
the films himself and should not rely on the report.
A. Fungal sinusitis is caused
when the sinuses are infected with mold. Like the mold on
bread or around your shower tiles. There are various tests
that your physician may perform to reveal fungal infection.
Cultures for fungus are still far from perfect and there
are many false negatives. Therefore the physician must be
very familiar with fungal sinusitis and be a good diagnostician
to properly diagnose fungal sinusitis. Very often sinus
infections can be a mixed infection with both bacteria and
fungus causing the disease., Therefore the problem and it’s
solution becomes more complex. When the sinuses are infected
with fungus, it is important for the sinuses to be drained.
Continued and appropriate medical regiments must accompany
the drainage procedures that need to be performed to remove
the fungus from the sinuses. Environmental control and diet
play an important role in the treatment.
A. At a specialist' s office, the patient
will be asked questions about the history of his problem
as well as past medical history. No matter how irrelevant
you may think something is you should always mention it
during the history taking process. The patient should receive
a thorough ear, nose, and throat examination. During that
physical examination, the physician will explore the facial
features where swelling and erythema (redness of the skin)
over the cheekbone exist. Facial swelling and redness are
generally worse in the morning; as the patient remains upright,
the symptoms gradually improve. The physician may feel and
press the sinuses for tenderness. Additionally, the physician
may tap the teeth to help identify an inflamed paranasal
sinus. The physician should evaluate the ears, nose, throat
and neck as they are all related.
A. Other diagnostic tests may include
a study of a mucous culture, endoscopy, x-rays, allergy
testing, or CT scan of the sinuses.
A. An endoscope is a special fiber
optic instrument for the examination of the interior of
the nose and the sinuses. The endoscope may also be used
to evaluate the ears, and throat.. It allows a visual examination
of the nose and sinus drainage areas.
A. Nasal endoscopy offers the
physician specialist a reliable, visual view of all the
accessible areas of the sinus drainage pathways. First,
the patient' s nasal cavity is anesthetized; a rigid or
flexible endoscope is then placed in a position to view
the nasal cavity. The procedure is utilized to observe signs
of obstruction as well as detect nasal polyps hidden from
routine nasal examination. During the endoscopic examination,
the physician specialist also looks for pus as well as polyp
formation and structural abnormalities that may cause recurrent
A. Flexible fiberoptic nasopharyngolaryngoscopy
is performed to evaluate a patients nasopharynx (the area
above the soft palate) and larynx(voice box). The nasopharynx
is the area behind the nose where the sinuses drain. The
eustachian tubes connect the ears to outside world for pressure
equalization in the nasopharynx. The larynx (voice box)
is visualized for manifestations of post-nasal drip, GE
reflux disease (GERD) and tumors including polyps and cancer.
Snoring may be evaluated as well. Symptoms such as hoarseness,
fullness or foreign bodies in the throat or GERD should
be evaluated by flexible fiberoptic laryngoscopy. Nasal
Obstruction, nasal bleeding and eustachian tube dysfunction
are some of the symptoms that should be evaluated by nasopharyngoscopy.
A. To reduce congestion, the physician
may prescribe nasal sprays, nose drops, or oral decongestants.
Antibiotics will be prescribed for any bacterial infection
found in the sinuses (antibiotics are not effective against
a viral infection). Antihistamines may be recommended for
the treatment of allergies. If this initial course does
not provide relief than the physician may do further testing
and prescribe other medicines and combinations of the above
and other medicines.
A. Smoking is never condoned, but if
one has the habit, it is important to refrain during treatment
for sinus problems. A special diet is not required, but
drinking extra fluids helps to thin mucus. Chicken soup
will help with viral infections.
A. Mucus is developed by the body to
act as a lubricant. In the sinus cavities, the lubricant
is moved across mucous membrane linings toward the opening
of each sinus by millions of cilia (a mobile extension of
a cell). Inflammation from allergy or the environment causes
membrane swelling and the sinus opening to narrow, thereby
blocking mucus movement. If the passageways are narrow then
they are more likely to have obstruction when inflammmed.
If medicines are not effective, sinus surgery can correct
the problem of obstruction of the passageways. When these
pathways are widened with surgery than they are more likely
to drain properly.
A. The basic endoscopic surgical procedure is usually performed
under local anesthesia with sedation. The patient is in
a twilight sleep. Packing is rarely required. The patient
rarely has any black and blues and usually notes that there
is less facial swelling than prior to surgery. The patient
may return to work the next working day. It is advised that
the patient refrain from doing anything that will raise
their blood pressure because this may cause internal bleeding
in their sinuses causing them to heal more slowly. The patient
should not blow their nose for a few weeks after the surgery
but may clear their nose by sniffing in saline solution.
Recover takes about four weeks at which time the patient
may return to full activity. Full healing takes about three
months. And the patient will notice further healing over
the next three years.
A. The surgery should enlarge the natural
opening to the sinuses, leaving as many cilia in place as
possible. Otolaryngologist--head and neck surgeons have
found endoscopic surgery to be highly effective in restoring
normal function to the sinuses. The procedure removes areas
of obstruction, resulting in the normal flow of mucus.
A. Not seeking treatment for
sinusitis can result in continuation of the patients sinus
infections. This can result in continuous nasal obstruction,
post-nasal drip, hoarseness, difficulty sleeping, snoring
and/or fatigue. In other instances the patient may continue
with headaches, unnecessary pain and discomfort. In rare
circumstances, eye abscess, meningitis or brain abscess
and infection of the bone or bone marrow can occur.
A. If you suffer from severe sinus
pain, you should seek treatment from an otolaryngologist--head
and neck surgeon, a sinus specialist who can treat your
condition with medical and/or surgical remedies.
A. If you had sinus surgery in the
past there are newer techniques available that offer sufferers
new hope for relief of their symptoms. It is important for
the patient to pick a physician that specializes in revision
surgery. The highest level of training available in the
United States to find a Board Certified Otolarngologist-Head
and Neck (Ear Nose and Throat-ENT) Surgeon that is fellowship
trained in Functional Endoscopic Sinus Surgery.