Relief for chronic sinusitis

Chronic sinusitis is a pain — literally. It’s usually managed with over-the-counter medications, including sinus rinses, decongestants, nasal sprays and other measures. Some people seek relief with sinus surgery, which has evolved over the years to become a more common and less invasive procedure.

Dr. Keith Jackson, an otolaryngologist (ENT) affiliated with Sharp Community Medical Group, answers some common questions about treatment for chronic sinusitis.

What is chronic sinusitis and what causes it?
Chronic sinusitis is an inflammation and infection of one or all of the paired sinus cavities in your face and head that typically will last more than 12 weeks. The sinus cavities produce mucus, and when the openings that drain into the nose get blocked, infection can result. Some infection is of short duration (acute), but others can last for many months and do not respond to antibiotics completely.

Facial pain, pressure, colored nasal discharge, cough and fatigue are common symptoms. This is the classic presentation of chronic sinusitis.

How is it treated?
Chronic sinusitis is most commonly treated with antibiotics, aspirin, decongestants, nasal sprays and saline (saltwater) rinses. Treating underlying nasal allergies, if they exist, is also helpful.

When should surgery be considered as a treatment option?
Surgery is reserved for those patients who have persistent symptoms despite aggressive medical treatment over a period of at least three months but in most cases over longer periods. A radiographic exam, usually a CT scan, that shows chronic blockage is a key study to determine surgical intervention.

How has sinus surgery evolved?
Modern-day sinus surgery has come a long way. In decades past, large procedures were done through incisions in the forehead, mouth or upper lip. Endoscopic surgery has been around since the mid-1980s in the United States, and has become less and less invasive. Minimally invasive procedures done only through the nose can be very effective and quicken recovery.

The old days of packing the nose with gauze are gone and dissolvable gels are the mainstay following sinus surgery. They are comfortable and do not block the nose. Balloon dilation procedures like blood vessel angioplasties with a balloon (balloon sinuplasty) are very common now and can even be done in an office setting.

Can you explain what is involved in surgery and what it achieves?
Sinus surgery is essentially opening preexisting natural drainage pathways so the sinuses can drain normally into the nose and prevent a buildup of infection in the sinus cavities. Most surgeries are done under anesthesia in an outpatient surgery setting. Most patients go home about an hour after their procedure, which will typically last one to two hours. Full recovery usually takes a few weeks.

What, if any, are the risks and complications associated with sinus surgery?
The risks of sinus surgery — when performed by an experienced surgeon — are very low. Short-term bleeding from the nose or down the throat will occur in the first 24 hours. Very rarely, there have been reported risks of eye injury. Spinal fluid leaks can occur as well but are even less likely. Image-guided technology is available to use during surgery and this has even further reduced the risks during surgery.

Dr. Jackson adds that no surgery can 100% guarantee a “cure” of any disease. Infections can occur despite surgical intervention. However, surgery usually reduces the frequency and severity of sinus infections.

Chronic sinusitis is common. If left untreated, it can lead to a worsening of respiratory diseases, such as asthma, and can have an adverse effect on a person’s quality of life.

“Do not ignore symptoms,” says Dr. Jackson. “And see your doctor. A CT scan of the sinuses is simple and requires no dye injection. If you have chronic sinusitis, surgery may be a good option for you.”