Sinusitis

Sinusitis is a term which refers to inflammation of the lining of the sinuses. This lining is called mucosa.  When the mucosa gets inflamed obstruction of the sinus drainage pathways can occur. Things that can trigger inflammation of the mucosa are a cold, allergies, a deviated septum, reflux disease, nasal polyps and certain chronic diseases.

Types of Sinusitis:

• Acute Sinusitis – Refers to a sinus infection that lasts less than 8 weeks
• Chronic Sinusitis - Refers to a sinus infection that lasts more than 8 weeks but can continue for months or even years
• Recurrent Acute – Repeated acute infections

In general infections can be bacterial or fungal in origin. Bacterial infections are by far the most common. Fungal infections are much less frequent.

Diagnosis

Symptoms alone are not a reliable way to diagnose sinusitis. In our practice we find that most cases of chronic sinusitis result from one or a combination of the following.

• Allergies which block normal sinus drainage
• Anatomy problems such as a deviated septum or narrowed sinus passage
• An acute sinus infection that had not gone away and has become chronic

Medical Treatment

When considering medical treatments it's important to keep in mind that no one treatment will fit everyone.  Treatments are tailored  to each individual depending on symptoms and diagnosis.  Often multiple medications are used at the same time.  Some medications such as antibiotics are taken for several weeks while others such as antihistamines may have to be taken longer.

Common Treatments

Antibiotics - You may be prescribed antibiotics if it is determined that you have an acute, chronic, or reccurent sinus infection.  The amount and duration will depend on your specific problem.  Antibiotics are more commonly prescribed to take orally, but in some cases may be given as a nose spray. 

Steroids - If it is noted that you have a signficant amount of nasal inflammation you may be prescribed an oral steriod (often in combination with an antibiotic) to help decrease the inflammation.  Steriods do not cure sinus problems but will help bring them under control.  They may be prescribed as pills or as a nasal spray.

Saline Irrigation Sprays - Using an over the counter mild saline spray or irrigation system regularly will cleanse and moisten the sinuses. This can cut down on infections.

Mucus Thinning Agent - Mucinex is our preferred mucous thinning agent.  Mucinex acts by making mucus more watery so its easier to clear from your nose and sinuses.  When using Mucinex it is very important to drink plenty of water. 

Antihistamines - Sinus patients with allergies may benefit from the use of antihistamines.  They help reduce congestion, itching, sneezing, and the runny nose associated with allergies.  They are available as either a prescription or over the counter and come in pill form or as a nasal spray.

Decongestants - Available as either a nasal spray or pill.  We do not recommend nasal decongestant sprays as they are addicting and have a high potential for rebound congestion if used for more than 3 days.  The only oral decongestant available is pseudoephedrine.  It acts by reducing blood flow to the nose which shrinks the membranes in the nose.  Pseudoephedrine is a stimulant and there are several drawbacks to its use such as it can raise blood pressure, make you jittery, anxious, and interefere with sleep.

Pain Relievers- Over the counter pain relievers such as Tylenol and Motrin are useful to help with headaches and facial pain associated with sinusitis.

Surgical Treatment

There are times when medications are no longer effective enough to make you feel better.  In those cases surgery needs to be considered.  In the past, sinus surgery was painful, bloody and removed a lot of tissue and bone.  However, over the past few years, there have been great advances in surgical treatments available for chronic sinusitis.  With newer technology, sinus surgery is much less invasive.  Dr. Atkins has been an advocate of Balloon Sinus Surgery since it became available in 2005. This technology is much less invasive and allows for quicker recovery times. Click Here for a summary of Balloon Sinus Surgery.

Although Dr. Atkins may advise surgery in your case, ultimately its your decision.  The key issue for you to think about is quality of life.  Think about how sinus symptoms affect your day-to-day life.  How many sick days to you take? How often are you tired? How do you feel about the amount of medication you are taking?  It’s a very personal decision. If surgery becomes an option for you we will do everything we can to explain things so you feel comfortable making a decision.

Dr. Atkins has been an advocate of Balloon Sinus Surgery since it became available in 2005. This technology is much less invasive and allows for quicker recovery times.