The sinuses are air containing cavities situated in the cheeks, between the eyes and in the forehead. They produce mucus which drains into the nose and can be regarded as extensions of the nose. Rhinitis can be associated with blockage and inflammation of the sinuses (sinusitis).
Sinusitis can be ‘acute’, for example, when associated with a cold or flu or ‘chronic’ when the condition is ongoing.
(X-Ray of face showing opacification of the right cheek in a patient with acute sinusitis)
As well as allergy tests the patient will require imaging of the sinuses to confirm the diagnosis. This is usually a CT scan although sometimes an MRI is performed.
Treatment consists of:
- Treating associated rhinitis
- Decongestants (short term use only)
- Steroids (sprays and drops mainly but occasionally a course of tablets)
- Nasal douching (this involves passing salt water through the nose to remove secretions and allergic particles)
- Surgery (when medical treatment is not successful).
Surgery involves opening the drainage points from the sinuses to the nose and removing inflamed tissue. The aim of the surgery is to enable the sinuses to secrete mucus freely into the nose without obstruction and to allow the lining of the sinuses to become healthy.
Surgery is performed using small endoscopes that project an image of the inside of the nose and sinuses onto a television monitor allowing the surgeon to operate with fine instruments inside the nose using the monitor as a guide. This is called endoscopic sinus surgery or functional endoscopic sinus surgery (FESS). No cuts are made on the outside of the nose or face. Sometimes small balloons are used to dilate passages between the nose and sinuses in a procedure called balloon sinuplasty.
After the Operation
The surgery is not particularly painful but there is some discomfort with nasal congestion for the first 1-2 weeks. This is caused by inflammation and dry blood and mucus. The nose has a very good blood supply and usually bleeds a little after the operation. A nasal pack (sponge like material placed inside the nose at the end of the operation) is sometimes required and is removed before you leave hospital (non absorbable sponge type) or is left in the nose to fragment (fragmentable type). The bleeding gradually resolves although very rarely further treatment is required to stop the bleeding.
You will be seen in the clinic 1-2 weeks after the operation.