New Options for Treating Sinusitis

Sinusitis is one of the most misdiagnosed and misunderstood of all common medical problems, affecting an estimated 30 million people in the United States today.

The Basics: We humans have four pairs of air-filled spaces (frontal, maxillary, ethmoid, sphenoid) that are located basically above, behind and below the eyes — in the bones of our forehead, nose and upper jaw. The spaces contribute significantly to the quality of voice sound (which is why our voice sounds so nasal when they are plugged up) and they presumably help to clean and warm the air we breath in through our nose. However, their main activity too often seems to be causing a literal pain in the head when they become inflamed and infected. Inflammation can result when there is a blockage of the pinpoint openings that drain from the sinuses into the nose. The blockage causes mucous to build up in the sinuses, providing the perfect breeding ground for infectious bacteria.

The combination of blockage and infection produces the typical symptoms of acute sinusitis — feelings of pressure and congestion in the face, headaches and fever. In severe cases, shaking chills may also be experienced when the infection spreads to the blood. Many cases of acute infection are misdiagnosed simply as "head colds" or even as "the flu." Chronic sinusitis — an infection that last more than three months — can further produce confusing bodywide symptoms that can be misdiagnosed as all sorts of other problems including chronic fatigue syndrome, arthritis, etc. Prevention and Risk Factors: Nasal allergies, nasal polyps, serious colds — anything that can block the openings into the sinuses — can lead to sinusitis. Therefore, preventing or treating such problems quickly can reduce the risk for actual sinusitis. Other practices designed to keep the nasal passages clear include frequent, gentle blowing of the nose, lots of fluid consumption to keep nasal and sinus mucous flowing, warm facial packs, and periodic steam inhalation.

Diagnosis and Early Detection: As I indicated above, one of the reasons sinusitis so often turns into a troublesome chronic problem is that it is so often misdiagnosed as something else. I would therefore recommend that anyone who has unexplained facial or head symptoms see an ENT (ear, nose and throat) doctor who specializes in sinus problems. One tool that has revolutionized the diagnosis of sinus problems is the nasal endoscope, a very thin fiber-optic tube that can be inserted into the nose for a direct visual examination of the openings into the sinuses. The other tool that can be extremely helpful in diagnosis is a CT scan of the sinuses, which shows very clearly which ones are blocked.

Treatment: There are many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (suction through the endoscope, flushing, etc.) that can be used to treat acute sinusitis. However, when infections are recurrent and/or non-responsive, surgery to enlarge the openings that drain the sinuses should be considered.

Old-style sinus surgery involved incisions in the face or mouth and was very traumatic and potentially dangerous. Modern sinus surgery involves the use of an infrared guidance system that allows the surgeon to avoid any incisions. Doctors visualize the sinuses through a small camera at the end of a thin flexible tube inserted through the nose, and remove bone and enlarge openings in a very precise and safe manner with a similar approach through the nasal passages. However, this surgery does requires a great deal of experience and skill, and should be done only by physicians who truly specialize in this kind of procedure. There are now approximately 300 image-guidance systems for sinus surgery in the United States, so this surgery is becoming more available. It should be done only when non-surgical measures are inadequate, but in the right hands it can provide huge relief to people who suffer from severe, chronic sinusitis.