Sinus Mysteries Solved!

Dec. 7, 2005 — -- Cold and flu season is upon us, and both maladies can trigger a condition that strikes 37 million Americans a year: sinusitis.

Sinusitis is merely the blockage of the sinuses, which are "containing spaces above and below the eyes that normally drain through small pinpoint openings into the nose," said Dr. Ralph Metson, an ear, nose and throat specialist at both the Massachusetts Eye and Ear Infirmary and Harvard Medical School, and the author of "Healing Your Sinuses."

When the sinuses become blocked, they fill up with mucus and bacteria that begin to grow, which can cause an infection, he said. The condition is often confused with a cold or flu because the symptoms are so similar.

"The first [symptom] is pain -- typically facial pressure below the eyes, or a headache, pain above the eyes," Metson said. "The second would be congestion or difficulty breathing through the nose. And a third is drainage -- particularly mucus draining down the back of the throat -- called post-nasal drip."

Technology has made it easier to diagnose sinusitis. Two important diagnostic tools are nasal endoscopy and a CAT scan. An endoscope is a small, thin telescope with very high resolution. With it, a doctor can look inside the patient's nose without causing pain, Metson said.

"The modern, or we'll call it minimally invasive techniques of sinus surgery, are done with a small endoscope again, a very thin telescope that's passed through the nostrils," Metson said. "There's a video camera attached -- a miniature video camera. And with instruments that go alongside that endoscope, the doctor's able to open up the small pinpoint openings that are blocked so the sinuses can drain normally, while leaving the more normal tissue alone. That leads to much more rapid healing."

The CAT scan is a high resolution x-ray, but it's an x-ray which shows various images from different directions through the skull and through the sinuses, Metson said.

These tools help Metson and other doctors find the problem. Once they do, they can begin to treat it. Metson said something as simple as salt water irrigations can make a big difference.

"You would take the bulb syringe and you would fill up the bulb syringe with the salt water, and then you would lean over a sink," he said. "Put the tip of the bulb syringe inside the nostril and squeeze gently. The salt water will run up into the nose and run right back out the same nostril, and bring with it the infected mucus or allergy particles that are causing inflammation."

People can even buy their own ready-filled irrigation bottles of salt water, he said.

Metson called the image guidance system a revolution that is meant for more advanced cases. There are risks because the sinuses are very close to the brain. But nevertheless, Metson said the advances have made dealing with the condition much easier.