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Sinusitis & Sinus Surgery

What Is Sinusitis?

Sinusitis, or sinus infection, is the inflammation of the tissue lining the sinuses, which are air-filled pockets located behind the forehead, cheekbones, and nose. This structure produces mucus that keeps the inside of the nasal passages moist and protects against dust, allergens, and pollutants. However, when the sinuses become blocked and filled with fluid, it can lead to pressure and pain in the face, mucus buildup, and then germ growth, which may result in an infection.

What Are the Types of Sinusitis?

Sinusitis can be categorised into two types based on the duration, cause, and persistence of the symptoms. These are:

Acute Sinusitis - This type of sinusitis is typically a short-term condition that lasts for less than four weeks. It occurs when the sinuses become swollen and inflamed due to viral infections, such as the common cold.
Chronic Sinusitis - This is characterised by prolonged inflammation of the sinuses lasting more than 12 weeks. It can be caused by persistent bacterial infections, allergies, or other underlying factors that affect sinus drainage. In some cases, sinus surgery is considered an option when medications, nasal rinses, or other non-surgical therapies are inadequate to relieve symptoms.

What Causes Sinusitis?

Sinusitis may be caused by several factors, including:

Infections - Bacterial or viral infections can cause sinusitis, which are often due to the common cold, flu, or other respiratory infections.
Allergies - Allergic reactions to pollen, dust mites, mould, or animal dander can trigger inflammation and swelling in the sinuses, leading to sinusitis.
Structural Abnormalities - Abnormalities in the nasal cavity or sinuses, such as a deviated septum or nasal polyps, can obstruct the sinus passage and contribute to recurring episodes of sinusitis.
Environmental Factors - Exposure to irritants like cigarette smoke, pollutants, and chemical fumes can irritate the sinuses and increase the risk of developing sinusitis.
Medical Conditions - Certain health conditions, such as allergic rhinitis, cystic fibrosis, and other immune system-related diseases, can make individuals more susceptible to sinusitis.

How Is Sinusitis Diagnosed?

The initial consultation with a sinus specialist generally involves an assessment of symptoms and a physical examination to check for tenderness or pressure in the nose and face. They may also perform additional tests to confirm the diagnosis and rule out other possible causes. Tests include:

Nasal Endoscopy - A sinus doctor inserts a flexible tube equipped with a fibre-optic light at its tip (endoscope) into the nostrils to examine the nasal passages and sinuses. This enables the doctor to identify any signs of inflammation, nasal polyps, pus, or other abnormalities.
Imaging Tests - Magnetic resonance imaging (MRI) or computed tomography (CT) scans may be utilised to show the internal structures of the nasal passages and sinuses. These imaging tests help detect structural issues or blockages caused by a deviated septum or nasal polyps.
Sinus and Nasal Culture - In cases where the sinus infection persists and there is pus within the nasal cavity, the doctor may collect tissue samples or cultures inside the nose and send them to the laboratory to identify bacterial or fungal infections.
Skin Allergy Test - The doctor may recommend this test if sinusitis is suspected to have developed following an allergic reaction. This test helps detect specific allergens that trigger the condition and prevent subsequent flare-ups.

Possible Complications of Sinusitis

If left untreated, sinusitis can sometimes lead to several serious complications, including:

Paranasal Sinus Mucocele - This cyst-like mass occurs when the sinuses are unable to drain mucus properly.
Orbital Cellulitis - This involves an inflammation of the tissues and the spread of the infection to the eye socket.
Sinus Thrombosis - A sinus infection, left untreated, can lead to blood clot formation in the cavernous sinus, a large venous vein at the base of the brain.
Bone Infection (Osteomyelitis) - The bacterial infection from the sinuses can extend to the nearby bone on the forehead.
Meningitis and Brain Abscess - Although rare, a sinus infection may spread to the membranes surrounding the brain, known as the meninges.

When Should You See a Sinus Specialist?

A sinus specialist or ENT doctor should be consulted if an one experiences any of the following:

Persistent or recurrent sinus infections lasting longer than four weeks
When over-the-counter medications do not relieve symptoms
Changes in vision or swelling around the eyes
A reduced sense of smell
Sinusitis is accompanied by high fever (above 39°C), significant headaches, or facial swelling
Nasal discharge that contains blood

In these cases, medical attention is crucial for the proper evaluation of symptoms and appropriate treatment to be given.

What Are the Treatment Options for Sinusitis?

Treatments for sinusitis vary depending on the type and severity of the condition. Treatment can range from conservative methods such as medications to surgical procedures for more serious cases.

Medications

Sinus specialists often prescribe medications as the first line of treatment for sinusitis. These can help reduce inflammation, alleviate symptoms, and clear up infections. Common medications used for sinusitis treatment include:

Nasal Corticosteroids - Commonly in the form of nasal sprays, nasal corticosteroids help decrease inflammation within the nasal passages.
Nasal Irrigation - This method involves the rinsing and clearing of trapped mucus in the nasal cavity and sinuses using salt water or a saline solution to relieve symptoms.
Over-the-counter (OTC) Pain Relievers - Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen help reduce mild pain and fever related to sinusitis.
Antibiotics - In cases of sinusitis caused by a bacterial infection, the sinus doctor can prescribe antibiotics to eliminate the infection.
Antihistamines - This medication can reduce inflammation and relieve symptoms if allergies are the main triggers of sinusitis.
Nasal Decongestants - These help alleviate inflammation, congestion, and nasal obstruction but are recommended for short-term use only. Decongestants usually come in the form of nasal sprays or oral medications.
Mucolytics - These medications help to thin out mucus, facilitating the discharge of blocked sinus passages.

Surgery

In cases where surgery is needed for more serious cases of sinusitis, sinus surgery may be performed to improve the drainage of the sinus cavities, remove any blockages or polyps, and alleviate associated symptoms. Some sinus surgery procedures include:

Functional Endoscopic Sinus Surgery (FESS) - A surgeon will insert an endoscope into the nose to clear nasal obstructions like polyps, bony partitions, or excessive mucus and improve sinus drainage.
Balloon Sinuplasty - During this procedure, a surgeon uses a specialised instrument or catheter to insert a small balloon into the sinus cavity. The balloon is then inflated to widen the sinus drainage tract for improved drainage.

Benefits of IGS

Image-guided surgery is designed for pinpoint accuracy. Considering that there is a considerable number of delicate anatomy around the sinuses, including the brain, optic nerve and blood vessels, accurately locating and removing the sinus blockages is crucial.

It is also a minimally invasive surgery, resulting in less scars, minimal incisions and quicker recovery.

FAQs on Sinus Surgery

While most sinusitis cases can be treated without surgery, sinus surgery may be recommended if and when:

Chronic sinusitis does not improve with medications and other conservative treatments
There are cases of benign growth, such as polyps and bone spurs, in the sinus lining
There are structural abnormalities within the nasal passages or sinuses (e.g. deviated septum)
A sinus infection has led to serious complications, such as swelling in the eyes, double vision, severe headaches, forehead swelling, and meningitis

In rare cases, sinus surgery may lead to certain complications, although there are preventive measures in place to minimise them from happening. These include:

Excessive bleeding
Temporary nasal congestion or discharge
Postoperative pain or discomfort
Infection
Swelling or bruising around the eyes
Changes in the resonance of the voice
Alterations in the sense of smell or taste

Sinusitis can be treated with medical therapies and surgery (if needed), providing long-term relief. Consulting with sinus specialists will allow you to further lower your risks of recurrence.

The risk of sinusitis can be reduced by:

Avoiding known allergy triggers that could worsen your symptoms
Refraining from smoking and minimising exposure to strong chemicals and pollution
Lowering the risk of respiratory infections by avoiding close contact with sick individuals and practicing good hygiene

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