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 E N T (Ear Nose & Throat)

March 2012
Sinusitis:Another lifestyle disease?
Dr R Balaji and Dr Deepak Janardhan
 
The sinuses are air pockets within the bones of the skull and face and are connected to the nose via channels. The four main pairs of sinuses are

  • Frontal: in the forehead and above the eyebrows
  • Sphenoid: deep in the head at the back of the nose
  • Ethmoid: between the eye sockets
  • Maxillary: in the cheekbones
Apart from permitting ventilation and drainage of mucous, sinuses add resonance to voice and reduce the weight of skull bones.

What is Sinusitis?
Sinusitis is the inflammation of the mucous membrane lining of the sinuses. Sinusitis, most often an acute condition, is self-limiting and treatable. In some cases, the inflammation in the sinuses lasts for long and it may be termed a chronic case. Nowadays, chronic sinusitis is increasingly being recognized as any other lifestyle disease like diabetes or hypertension.

Causes for Chronic Sinusitis
  • Deviated nasal septum that hinders normal ventilation and drainage of sinuses.
  • Allergy to airborne substances known as allergens like house-dust mite, grass pollen etc.
  • Infection: The common cold, caused by viruses or other bacterial infections, is an example of infective rhinitis. In diabetic individuals, when sinusitis is accompanied by loss of sensation over the cheek, headache and foul smelling black crusts in the
    nose, a dreadful condition called Mucormycosis can occur. In such cases, delay in initiating treatment can be life-threatening.
Symptoms
They depend upon which sinus is affected and whether the sinus infection is acute or chronic.
  • Nasal congestion with nasal discharge.
  • Postnasal drip (mucous drips down the throat behind the nose) often accompanied by a sore throat.
  • Pain or pressure around the inner corner of the eye or down one side of the nose. Pain or pressure symptoms are worse with head bending forward or when coughing,
    straining, or lying on the back.
  • Severe headache in the forehead, in the temple, or surrounding or behind the eyes.
  • Fever is common.
  • Frequent colds, bad breath, dry cough, worsening of asthma, ear block or ache (especially during air travel).
Treatment
Medical Therapy
  • If allergic: antihistamines, steroids and decongestants for two weeks.
  • If infective: antihistamines, antibiotics and decongestants.
  • Presence of polyps needs medical treatment initially, followed by surgery.
  • Deviated nasal septum needs surgical correction
Surgical Intervention
In cases wherein antibiotics, nasal drops, sprays and decongestants have all failed to clear the problem, it is likely that the sinuses are physically obstructed and blocked. In this event, it is necessary to undergo surgery to unblock these passages and restore the normal function of ventilation and drainage. ‘Functional endoscopic sinus surgery’ or ‘FESS’ is the standard procedure for most patients requiring surgical management of chronic sinusitis or polyposis.

Functional Endoscopic Sinus Surgery
FESS is a minimally invasive, intranasal endoscopic technique, in which sinus air cells and sinus ostia are opened under direct visualization. The goal of this procedure is to restore sinus ventilation and normal function. Of the various surgeries, it is the only one that addresses the underlying pathophysiologic mechanism of sinusitis. FESS is done in a very tightly packed area and near vital anatomical structures. Pre-operative assessment including CT scans, medications and follow up are very important for a better outcome and fewer complications. With appropriate postoperative management, FESS has excellent results.

Common Myth!
FESS is not a complete and permanent cure for sinus problems: UNTRUE FESS is highly successful in easing the symptoms in sufferers of chronic sinusitis and offers a permanent and complete cure. Following sinus surgery, the risk of developing common cold is akin to normal population. But patients are symptomatically much better and experience an improved quality of life. Hence, properly performed sinus surgeries in carefully selected patients, offers wonderful results.


    
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