The sinus disease known as sinusitis, or rhinosinusitis, is a condition that occurs when the tissue lining of the sinus cavities becomes swollen and inflamed. The sinuses are normally filled with air, but when sinus passages become blocked due to inflammation or obstructions they cannot drain properly. As a result, mucous builds up in the sinus cavities and can lead to infection. A number of people suffer from sinusitis, and symptoms may be experienced seasonally by some and year round by others. When the symptoms of sinusitis persist for 8 weeks or more, the condition is known as chronic sinusitis or chronic rhinosinusitis. Acute sinusitis has similar symptoms, but is shorter in duration. Acute sinusitis is typically associated with a common cold.
Anatomy of Sinusitis
Sinusitis is a condition involving inflammation in one or more of the sinuses located above the eyes (frontal sinuses), between the eyes (ethmoidal sinuses), behind the ethmoids (sphenoidal sinuses) and surrounding the nasal cavity (maxillary sinuses). When this swelling blocks off the openings (ostia) of the sinuses, trapping mucus and air inside them occurs. This can cause pain and pressure; sometimes, it can lead to bacterial infection.
There are two general types of sinusitis; acute sinusitis and chronic sinusitis:
Diagnosing Acute Sinusitis
Acute sinusitis refers to a sinus infection that lasts less than 4 weeks. Symptoms may include nasal congestion and obstruction, discolored rhinorrhea (nasal discharge), facial pain and pressure, headache, sore throat, cough, decreased sense of smell, foul nasal odor, and fever. These symptoms tend to get worse after 5 days or persist beyond 2 weeks without treatment. A cold or upper respiratory illness caused by a virus tends to get better after 5 days with most symptoms resolving within 2 weeks.
Diagnosing Chronic Sinusitis
Chronic sinusitis is characterized by any of the following symptoms that last longer than 3 months: nasal congestion, nasal obstruction, decreased sense of smell, facial pain or pressure, foul odor, and possibly headache when associated with one of these other symptoms. These individuals may have had recurrent sinusitis (more than 3 episodes of acute sinusitis per year) in the past and now simply cannot breath as well. Often this may initially manifest with nighttime nasal obstruction or increased nasal resistance leading to less restful sleep and morning fatigue. These individuals may have increased headache, ear pain, or discomfort. Others may have a “sinus” infection that never goes away. Others may simply think that they now have “allergies”.
Symptoms of Chronic Sinusitis
There are many symptoms of sinusitis, and symptoms vary based on the individual, the underlying cause of sinusitis, and the location of sinusitis. Some common symptoms include:
- Nasal congestion that makes it difficult to breath through the nose
- Drainage that is thick, and yellow or green in color
- Decreased sense of smell and taste
- Facial pain and tenderness around the eyes, forehead, nose and cheeks
- Ear, tooth or jaw pain
- Frequent or recurrent headaches
Causes of Chronic Sinusitis
- Allergies and allergic reactions causing inflammation of nasal passages
- Nasal tissue growths (polyps) that obstruct the nasal passages and restrict drainage
- Facial trauma such as a fracture or broken bone
- Deviated nasal septum resulting in blocked or restricted sinus passages
- Respiratory tract infections that thicken the sinus membranes
- Bacterial or Fungal infections that do not respond well to treatment
Risk Factors for Chronic Sinusitis
Certain medical conditions and environmental factors can make the development of chronic sinusitis more likely.
- Nasal passage abnormalities like polyps, deviated septum, or tumors
- Regular exposure to pollutants
- Immune system disorders
How to Diagnose Chronic Sinusitis
A diagnosis of chronic sinusitis is made based on an evaluation of symptoms and an exam. In addition to feeling for tenderness and looking in the nasal passages, there are several other diagnostic tools available to doctors to help identify chronic sinusitis and determine the best treatments.
- Imaging studies: CT (computerized tomography) scans and MRI (magnetic resonance imaging) are used to identify physical obstructions and inflammation.
- Nasal endoscopy: A thin, flexible tube with an attached light and camera (an endoscope) is inserted through the nose allowing the doctor to see inside the sinuses and identify problems.
- Cultures: When chronic sinusitis does not respond to treatment, nasal and sinus cultures can help determine if the cause is bacteria or fungi.
- Allergy tests: Allergy skin tests are used to identify allergens that could be causing a patient’s nasal inflammation.
Treatments for Chronic Sinusitis
A variety of treatments are available to alleviate and, in some cases, eliminate the symptoms and occurrences of chronic sinusitis. The treatment recommendation will depend on the severity and duration of symptoms, the cause of sinusitis, and the individual patient. Some common treatments include:
- Nasal and Sinus Saline (Saltwater) Irrigation (Neti Pot)
- Nasal corticosteroid sprays
- Oral or injected corticosteroids
- Decongestants – Caution with the use of nasal decongestant sprays (Afrin®, oxymetazoline)
- Pain relievers
- Allergy shots
Endoscopic Sinus Surgery and Balloon Sinuplasty
When other treatments are not successful in eliminating the symptoms and causes of sinusitis, surgery may be an option. Sinus surgery has dramatically improved in recent years. Endoscopic sinus surgery is performed using an endoscope (a thin, flexible tube with a light). This tube allows the doctor to see the sinus passages. Using small, precise surgical instruments, the doctor can remove diseased tissue and polyps that are blocking the sinus passages.
Balloon sinuplasty or balloon dilation is a procedure in which a small balloon is threaded into the sinuses and then inflated to dilate the sinus openings (ostia). The opened sinus passage can then drain more freely. This is performed in the operating room in conjunction with the surgical correction of nasal obstructions. This procedure can be performed in an office setting using local anesthesia. Dr. Trimble has performed over 400 in-office balloon sinus ostial dilation procedures as a treatment for chronic sinusitis. By staying on the forefront of sinus surgery innovation and technology, Dr. Trimble provides minimally invasive approaches and techniques that result in fewer complications, less bleeding, and faster recovery times.
If you suffer from chronic sinusitis, contact Dr. Monty Trimble at DFWSinus.com or call 817-529-6200. He has offices in Fort Worth, Keller and soon to be Southlake, Texas.