Your Sinuses and Your Health

Commonly asked questions about sinus problems

Taking care of your sinuses is important to your overall health and well-being. Common sinus problems, including sinus blockages, repeated infections, a deviated nasal septum, and narrow nasal and sinus passageways, can have a significant impact on quality of life.

Raj Sindwani, MD, FACS, FRCS, a rhinologist who specializes in endoscopic sinus, orbital and skull base surgery, heads the Section of Rhinology, Sinus and Skull Base Surgery in the Head & Neck Institute at Cleveland Clinic. Here, he answers questions about sinus problems.

How common is sinusitis?

Consider these facts:

  • It is among the top reasons for patients to visit their doctor’s office.
  • It is the fifth most common reason for antibiotic prescriptions and the third most common reason for purchasing over-the-counter medications.
  • Fourteen percent of U.S. adults annually self-diagnose a sinus infection.
  • It costs Americans over $3 billion per year.
  • It has a significant impact on quality of life and productivity.
What is rhinosinusitis?

Rhinosinusitis is a new term, but it is the same as saying “sinusitis.” The terminology has been modified to indicate more accurately that the inflammatory process that causes sinusitis is also associated with inflammation of the nasal passages (hence the addition of the “rhinitis” part). Rhinosinusitis is defined as an inflammation of the nose and sinuses.

Can the body heal itself from a sinus infection? If a sinus infection goes untreated, what are the consequences?

Yes. The body can and does heal itself from infections (for example, viral infections) all the time. That’s the role of the immune system. Taking antibiotics for bacterial infections can help the body fight off the infection faster. Treating severe bacterial infections is important. In rare cases, if these severe infections are left untreated, they can spread to the eye and brain.

What are the signs and symptoms of acute sinusitis? How do they differ from chronic sinusitis?

Signs and symptoms of acute and chronic sinusitis are similar, but tend to be more protracted and duller in chronic rhinosinusitis (CRS). The symptoms include: nasal drainage or post nasal drip, changes in smell, nasal congestion, facial pressure or pain, ear fullness, cough and fatigue. The clinical diagnosis of CRS is usually made based on time course of the disease (symptoms present for more than three months), plus some combination of signs and symptoms, CT scan results and an endoscopic nasal examination.

How is sinusitis treated?

Acute sinusitis is most often due to a virus (e.g., the common cold or upper respiratory infection), and supportive care is all that is normally required (over-the-counter medications to help reduce fever, trial of decongestants, rest etc.). In a small number of cases, these infections are not due to a virus, but rather are due to (or turn into) a bacterial infection, called acute bacterial sinusitis. This can be difficult to distinguish, and the diagnosis of acute bacterial sinusitis is made based on time course of illness (symptoms for more than 7 to 10 days) and a combination of signs and symptoms.

Signs and symptoms that an infection is more likely bacterial than viral:

  • Symptoms worsen after five to seven days or persist more than 10 days, or are out of proportion to those typically associated with a viral upper respiratory infection
  • Unilateral mid-facial, periorbital or forehead pain
  • Unilateral purulent (pus-like) drainage
  • Pain worsened by bending over
  • Facial swelling, conjunctival infection, meningeal, or other signs of spread outside of the sinus(es)

Medical management of bacterial sinusitis includes:

  • Oral hydration, saline sprays, humidification
  • Antibiotics
  • Topical decongestants, such as Neo Synephrine® or Afrin® (oxymetazoline), for less than five    days; oral decongestants, such as Sudafed® (pseudoephedrine)
  • Expectorants to thin mucus (guaifenesin)
  • Oral antihistamines (newer, non-sedating agents do not thicken secretions)
  • Nasal steroid sprays (can diminish edema in sinus pathways)
Do you recommend irrigation devices like neti pots?

Yes. Irrigation devices can be helpful for some sinus problems and for chronic drainage issues. There is some evidence that using a high-volume flush with a squeeze bottle (not spray bottle) may be more effective, especially in patients having had prior surgery.

How effective are over-the-counter nose sprays or drops?

Saline spray may help acute infections. Using topical decongestant sprays (Afrin®) can also help open up the nasal passages but should not be used more than three to five days. They are addictive and can cause rebound swelling, making you worse off than you were before!

When do you consider sinus surgery a necessary treatment?

We consider operating to open blocked sinus passageways after medical treatment has failed and a post-treatment CT scan demonstrates ongoing problems and areas of blockage. Sinus surgery is done to improve quality of life in a patient who continues to do poorly despite medical therapies.

What is involved in sinus surgery? Is it a painful procedure?

Endoscopic sinus surgery is a well-tolerated, minimally invasive procedure performed under general anesthesia. Using specially designed tiny instruments, we look into the nose with a thin telescope (endoscope) and we enlarge the sinus openings. We then clean out any trapped mucus, pus or polyps. Most patients experience mild discomfort for a few days after the procedure. There are no cuts or bruises on the face, and we rarely place any nasal packing.

What does sinus surgery accomplish? Are results predictable?

Sinus surgery opens the drainage pathways and openings into the sinuses and improves the sinuses’ ability to drain naturally. Many studies have shown that sinus surgery done for the right indications decreases patient symptoms, cuts down on the severity and number of infections one experiences, and generally improves a patient’s quality of life. Although there is no cure for chronic sinusitis, the large majority of patients do very well from this surgery and often wish they had it sooner.

How long is the recovery time after surgery? Can I go back to work immediately?

Sinus surgery is a very minimally invasive procedure that leaves no cuts or even bruises on the face. I should point out that there are no black eyes. Patients wake up from the surgery, spend a few hours in the hospital, and go home the same day. The recovery is associated with mild nasal/facial discomfort (especially since I no longer use packing), occasional nosebleeds, and a tired feeling from the anesthetic that lasts for a day or two. The only limitation I give patients post-op is no heavy lifting or straining for five to seven days after surgery. Everyone’s recovery is a little different, but most would take a few days off of work.

Adapted from an online health chat, which took place March 3, 2011. Read the full transcript.

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