07 April 2019
SINUSITIS : FREQUENTLY ASKED QUESTIONS
Q. What is sinusitis?
A. Sinusitis is an inflammation of the membrane lining of the sinus cavity. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants. Chronic sinusitis is characterized by recurrences of acute sinusitis and persistent sinus symptoms such as nasal congestion and postnasal drip that does not respond well to medical therapy. Surgical intervention may be recommended.
Q. How does an ENT specialist determine the best treatment for sinusitis?
A. To obtain the best treatment, patient’s history and symptoms are properly assessed and a thorough examination will be performed. This will include nasal endoscopy under LA in the clinic. Other diagnostic tests may include culture studies of pus / mucous from the sinuses, allergy test or CT scan of the sinuses.
Q. What is nasal endoscopy and why is it an essential examination?
A. A nasal endoscope is a special fibreoptic instrument that is used for the examination of the nasal and sinus passages. It offers the ENT specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. The procedure is used to look for signs and cause of obstruction such as thick mucous or pus as well as nasal polyp, nasal tumour, hypertrophied turbinates, scarring and structural abnormalities. At the same sitting, nasal toilet can be performed, swab for culture can be taken and abnormal nasal mass can be biopsied.
Q. What course of treatment will be recommended?
A. To reduce nasal congestion, nasal sprays, nose drops or oral decongestants may be prescribed. Antibiotics will be prescribed for any bacterial infection. Antihistamines may be recommended for the treatment of allergies. If these measures do not improve symptoms, surgery may then be recommended.
Q. When is sinus surgery necessary?
A. Our bodies naturally produce mucous. It acts as a lubricant in the nasal passages. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by cilia. When inflammation causes the sinus opening to narrow, the movement of mucous is then blocked. It often then becomes infected. If medical treatment failed, sinus surgery can correct the problem.
Q. What does the surgical procedure entail?
A. The basic endoscopic surgical procedure is performed under general anaesthesia. It is a safe, effective surgical option. The patient returns to normal activities within 4 days and full recovery takes about 2 weeks.
Q. What does sinus surgery accomplish?
A. The surgery enlarges the natural opening of the sinuses allowing mucous to drain properly. ENT surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucous.
Q. What is FESS ?
A. FESS stands for Functional Endoscopic Sinus Surgery. The procedure is as described above and the term ‘Functional’ means the aim of the surgery is to restore normal function of the sinuses ie. clear the obstruction / drainage of the sinuses, resulting in normal flow of mucous and eventually normal mucociliary clearance.
Q. What is Balloon Sinuplasty ?
A. Balloon Sinuplasty is a relatively new procedure in which a high pressure balloon is used to enlarge the ostium of obstructed sinuses without removing sinus mucosa. The aim of the procedure is the same as FESS, however it can only be used to enlarge ostium of frontal, maxillary and sphenoid sinuses. It cannot be used to clear ethmoidal disease because there is no ethmoidal ostium. Ethmoidal sinus consists of labyrinth of air cells which need to be cleared surgically if it is diseased.
Q. FESS or Balloon Sinuplasty ?
A. As I have been performing FESS for more than 15 years, in my opinion, FESS is the gold standard surgical treatment for Chronic Sinusitis. If performed well, good result and resolution of most sinus symptoms in majority of patients can be achieved. However, in very difficult frontal sinus disease, Balloon Sinuplasty is advantageous because surgery in frontal recess ( drainage area of frontal sinus ) can be very difficult.
Q. What are the consequences of not treating infected sinuses?
A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and spread of infection to the eye can occur.