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What causes sinusitis?
Sinusitis starts as a result of blockage of the drainage pathway of the sinuses. This blockage can occur as a result of an anatomical obstruction, swelling due to a cold or allergy, or chronic recurrent sinus infections. When this occurs, mucus that normally is expelled from the sinus builds up in the sinus. This can cause pressure or pain. In addition the mucus is an excellent culture medium for bacteria. If the mucus is not cleared immediately, a bacterial infection exists until the blockage is cleared and the sinuses drain nornally again. Sinusitis is one of the most common medical problems affecting approximately 30% of the population at some point. Acute sinusitis commonly follows a cold and typically lasts for up to three weeks. After three weeks it becomes defined as a chronic sinusitis and may become much more difficult to treat.
| Normal Sinus Drainage | Block Sinus Drainage Resulting in Sinusitis |
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It may be extremely difficult to diagnose a sinus infection early in the course of the disease. After taking a careful history, which is extremely valuable in helping diagnose sinusitis, and doing a physical exam, the diagnosis is typically made by looking inside the nose with a flexible rubber tube called an endoscope.
Depending on what is found at the time of the endoscopy, an x-ray (CT scan) of your sinuses may need to be done. Previously, x-rays of the sinuses were done. Now CT scans are ordinarily done because a much greater amount of information can be gleaned from the CT scan, and at a very slight increase in the cost. If you need to have surgery, a CT scan will ordinarily be done prior to surgery. Endoscopy and CT scans are now done very commonly for sinus infections. Dr. Sinha will also look inside your inside with an endoscope in the office to look directly at the sinus openings as part of the complete diagnostic process.
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Nasal Polyp Obstructing the Sinuses
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Deviated Septum Obstructing the Sinuses
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The commonly accepted treatment strategy is a combination of antibiotics, decongestants, mucous thinners and saline washes of the nose. Occassionally, topical nasal steroids sprays or systemic steroid pills are also added. Commonly used antibiotics such as penicillin, erythromycin, and tetracycline do not generally work because usually the bacteria are resistant. Usually, 3-6 weeks of therapy are prescribed before any surgical options are considered. In addition, allergy evaluation, vaporizers, and other such treatment is also explored where appropriate. There is a lot of eveidence that a chronic mold infection may be the cause of chronic sinus disease as well. The treatment for fungal sinusitis usually involves aggressive allergy, steroid and surgical treatment.
When there is a failure of medical therapy, supported by CT scans that demonstrate chronic disease despite the medicine, sinus surgery becomes a viable option. Although Dr. Sinha is board certified surgeon specializing in sinus surgery, he does his best to avoid surgery if possible. However, when the surgical option (which usually includes Functional Endoscopic Sinus Surgery or FESS) is undertaken, a significant number of patients note a vast improvement, if not a complete resolution of sinus symptoms. However, continued vigilance in treating the causes that lead to the sinus condition in first place must be undertaken post-operatively, otherwise there is a risk of relapse.
A further discussion of sinusitis or a more detailed explanation of the above is available through a personal consultation and evaluation with Dr. Sinha by making an appointment at 404/257-1589.