Introduction
Sinusitis is a very common disorder that refers to inflammation or infection of the paranasal sinuses (small air-filled spaces in the skull around the nose). Sinusitis may be acute (i.e. resolves with antibiotics), recurrent (recurs after resolving) or chronic (symptoms are present throughout the year).
Many patients complain of having “sinus” all the time when they actually are referring to a blocked nose or hayfever. All of these conditions are treated differently so it is important make the correct diagnosis.
Causes
Despite being so common, the exact cause of sinusitis is not fully understood yet. Acute sinusitis is often caused by a cold or flu that then goes on to involve the sinuses. Dental disease can also cause sinusitis which affects the cheek sinuses.
Some patients with weakened immune systems due to certain conditions or medications are more likely to get recurrent sinus infections.
Chronic sinusitis may occur in patients in patients with lower airway diseases e.g. asthma or with narrow sinus drainage pathways that get blocked. Allergies and fungi are also implicated.
Symptoms
Patients may suffer from the following: blocked nose or congestion, nasal discharge, postnasal drip, decreased sense of smell, a bad smell in the nose or pain/pressure in the region of the sinuses (e.g. cheek area, between the eyes or above the eyes.) All of these symptoms can have a very significant impact on your quality of life, as it may feel like you have a cold or flu all the time.
Pain at the sides of the head or the back of the head is usually not due to your sinuses but rather due to one of the other causes of headaches.
Diagnosis
A thorough history and detailed physical examination with a nasendoscope (small camera that looks inside the nose) is very important. Dr Levin may take a swab of any pus in your nose so that antibiotics can be directed against that specific organism.
A plain X-ray is not usually of benefit, however a low dose CT scan is essential to determine which of the 8 sinuses (4 on each side) are blocked and whether there are anatomical reasons for this.
Dr Levin will usually treat your acute episode with medications and then arrange a CT scan of your sinuses a few weeks later when you are well. This is important as the treatment of acute sinusitis (evident on CT when you are sick) is different to chronic sinusitis (evident on CT when you are both sick and well).
Occasionally MRI scans or blood tests may be requested, in addition to a CT scan.
Treatment
Apart from antibiotics and nasal sprays, there is good evidence to show that children who have recurrent or chronic sinusitis often benefit from adenoidectomy, without having to open their sinuses.
Acute sinusitis in adults may treated with antibiotics, pain-killers, anti-inflammatories, decongestants, nasal sprays or drops and sinus washes. Patients with chronic sinusitis (especially with polyps) may benefit from a short course of oral steroids (e.g. Prednisone). If left untreated, acute sinusitis can very rarely spread to involve nearby structures such as the eyes or the brain.
Acute sinusitis that recurs several times a year or chronic sinusitis that does not respond to medications may benefit from functional endoscopic sinus surgery that widely opens the sinuses, washes them out, and allows them to freely drain in future without getting blocked and infected.
Patients with chronic sinusitis (especially in the presence of lower airway disease e.g. asthma or nasal polyps) should be aware that they will likely require ongoing treatment with nasal washes and medications to maintain healthy sinuses once they have been opened.
Dr Levin has undergone advanced training in nose and sinus surgery. He will be able to assess whether you have sinusitis, and if so, which of the above types you have. He will then recommend a tailored treatment regime for you.
If surgery is recommended, Dr Levin is able to avoid packing the nose (which can very uncomfortable) in the vast majority of cases.