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Cold, Allergies or...Chronic Sinusitis? We all know what to do for a cold (chicken soup, bed rest). But often, cold-like symptoms such as a scratchy throat, stuffy nose and cough, may indicate sinusitis, an inflammation of the sinuses (those hollow spaces in the bones surrounding the nose). The treatment for acute sinusitis, caused by bacterial infection, is antibiotics. But when sinusitis lasts for months and months, it can be a more serious and complex ailment that affects up to 35 million Americans and results in a half million surgical procedures every year, according to the American Academy of
Otolaryngologists. While the pain of chronic sinusitis can be debilitating, a prominent surgeon warns that surgery is only for very special cases. "Chronic sinusitis generally has an underlying cause such as allergies that can be treated through medications and lifestyle changes," said Steven D. Schaefer, M.D., chairman of Otolaryngology/ Head & Neck Surgery at The New York Eye and Ear Infirmary. "Sinus surgery is the treatment of last resort for chronic sinusitis. While effective, it is a very delicate procedure with risks -- the sinuses border the brain and optic nerve."
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Chronic Sinusitis: Different Causes, Different Cures
The sinuses help to moisturize and warm the air we breathe through our nose and, under normal conditions, the sinuses drain mucus imperceptibly into the nasal cavity. Sinusitis develops because a cold, allergies, polyps or a deviated septum obstructs the drainage. Chronic sinusitis, characterized by dull, mid-facial pain, nasal congestion and yellow to green nasal and post-nasal discharge, does not respond to antibiotics because it is not caused by bacteria. To determine the underlying cause of chronic sinusitis requires a thorough history, physical examination including endoscopy of the nose and CT imaging of the sinuses. Depending on the diagnosis, physicians may recommend a vaporizer, warm compresses, antihistamines, antibiotics, ibuprofen or nasal steroids. If symptoms persist despite these treatments, surgery may become an option.
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Modern Endoscopic Sinus Surgery
A CT scan can pinpoint the physical cause of chronic sinusitis. It may show the cause to be polyps, enlargements of certain areas of the sinus, a deviated septum, or chronically inflamed tissue. At The New York Eye and Ear Infirmary, a special "real time" imaging device, which displays a 3-D image of the patient's sinus cavity based on the CT scans, helps Dr. Schaefer and his colleagues to visualize and locate the surgical site during endoscopic sinus surgery. In most circumstances, surgery corrects these problems. Endoscopic sinus surgery is a procedure that takes place through the nose using microscopic instruments held adjacent to a long, pencil-thin tube, called an endoscope. In many cases, surgeons remove thickened and diseased tissue that blocks an area called the ostiomeatal complex, which, when obstructed, can lead to infection of the maxillary, ethmoid frontal and sphenoid sinuses. Surgery can restore the normal flow of mucus from the sinuses. Endoscopic surgery can also be utilized to remove polyps and to straighten the septum to restore normal flow from the sinuses.
If you are looking for an otolaryngologist to treat a possible case of sinusitis, please consult the Physician Finder on this web site or call The New York Eye and Ear Infirmary's Information & Referral Service at 1-800-449-HOPE.
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