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Useful info on ENT

SINUSITIS-How and Why?

Examination of sinus problems in adults and children

Sinus Facts:
A cold or allergy attack that wouldn't go away? If so, there's a good chance for sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in world. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds or allergies, and many sufferers never see a doctor for proper diagnosis and treatment with an antibiotic.

What is sinusitis?
Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It is preceded by a cold, allergy attack, or irritation by environmental pollutants.

Unlike a cold, or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.

Normally, mucus collecting in the sinuses drains into the nasal passages. During a cold or allergy attack, the sinuses become inflamed and are unable to drain. This lead to congestion and infection.

Diagnostic Tests:
Diagnosis of acute sinusitis is based on a physical examination and a discussion of the symptoms. The Doctor also may use x-rays of sinuses or obtain a sample of nasal discharge to test for bacteria.

Acute Chronic Sinusitis:

	When one is having sinusitis frequently, or when the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.
Acute on chronic sinusitis - indication for suction cleaning by nasal endoscope.

"Treating Sinusitis
Bacterial Sinusitis
Therapy for bacterial sinusitis should include an appropriate antibiotic. If one has three or more symptoms of sinusitis (see chart), be sure to see the doctor for diagnosis. In addition to an antibiotic, an oral (amoxicillin, trimethoprim-sulfamethoxazole) or nasal spray, or decongestant drops may be recommended to relieve congestion, analgesics, although you should avoid prolonged use of nonprescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help relieve sinus discomfort.

Antibiotic Resistance:
It means that some infection-caused by bacteria are immune to the effects of certain antibiotics prescribed by the doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. One can help prevent antibiotic resistance. If the doctor prescribes an antibiotic, it is important that one should take all of the medication just as the doctor instructs, even if your symptoms are gone before the medicine runs out.

Chronic Sinusitis:
If the doctor thinks one has chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis. Chronic sinusitis may respond to prolonged antibiotic therapy.

Procedure for Sinus Surgery
Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease. Surgery can be performed endoscopically inside the nose, under the upper lip, behind the eyebrow or next to the nose or scalp.

Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. Microdebrider equipment allows removal of diseased tissue alone. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on individual circumstances.

Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. Good results require not only good surgical techniques, but also a cooperative effort between the patient and physician throughout the healing process. It is equally important for patients to follow pre- and postoperative instructions.

Preventing Sinusitis:
As always, an ounce of prevention is worth a pound of cure. To avoid developing sinusitis during a cold or allergy attack, keep the sinuses clear by:
· using an oral decongestant or a short course of nasal drop decongestant. (Otrivin, Nasavion)
· gently blowing the nose, blocking one nostril while blowing through the other.
· drinking plenty of fluids to keep nasal discharge thin.
· avoiding air travel. If one should fly, use a nasal drop decongestant before take-off to prevent blockage of the sinuses allowing mucus to drain.
· avoiding contact with things that trigger attacks. If one cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks.

Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances.


Frontal sinus stenting for frontal sinusitis	Healed sinus cavity

Pre op CT scan of sinusitis + deviated nasal septum	Post op CT Scan

When to See a Doctor
The symptoms of sinusitis sometimes mimic those of colds and allergies, one may not realize you need to see a doctor. If one suspects to have sinusitis, review these
signs and symptoms. If one suffers from three or more symptoms, one should see a doctor.

SIGN/ SYMPTOM	SINUSITIS	ALLERGY	COLD
Facial Pressure Pain	Yes	Sometimes	Sometimes
Duration of Illness	Over 10-14 days	Varies	Under 10 days
Nasal Discharge	Thick, yellow-green	Clear, thin, watery	Thick, whitish or thin
Fever	Sometimes	No	Sometimes
Headache	Sometimes	Sometimes	Sometimes
Pain in Upper Teeth	Sometimes	No	No
Bad Breath	Sometimes	No	No
Coughing	Sometimes	Sometimes	Yes
Nasal Congestion	Yes	Sometimes	Yes
Sneezing	No	Sometimes	Yes

A Word about Children
The Child's sinuses are not fully developed until age 20. However, children can still suffer from sinus infection. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Sinusitis is difficult to diagnose in children because respiratory infections are more frequent, and symptoms can be subtle. Unlike a cold or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to prevent future complications.

The following symptoms may indicate a sinus infection in the child:

A "cold" lasting more than 10 to 14 days, sometimes with low-grade fever
Thick yellow-green nasal drainage
Post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
Headache, usually not before age 6
Irritability or fatigue
Swelling around the eyes

If these symptoms persist despite appropriate medical therapy care should be taken to seek an underlying cause. The role of allergy and frequent upper respiratory infections should be considered.