Sinus disease
This section contains information on the following:
1. Sinuses- what are they?
2. Sinusitis
3. Nasal polyps
4. Fungal sinusitis
5. Complications of surgery
1. Sinuses- what are they?
Paranasal sinuses number 5 on each side and are air-filled bony pockets in the facial skeleton and skull bones. The maxillary sinus is the largest and is present inside the cheek bone between the eye and upper teeth. The anterior and posterior ethmoid sinuses are present between the eyes and are in the form of small, honey-comb cells. The sphenoid sinus is situated at the very back of the facial bones between the back portion of the eyes. The frontal sinus is located in the bone above the eye.
2. What is sinusitis, how does it present and what is the treatment?
Sinusitis is caused by blockage of sinus outflow and results in sinuses getting filled with thick secretions and inflammatory (swollen) tissue. It typically causes recurrent or constant pain over the cheek bones and between and behind the eyes, frontal or vertex (top of the head) headache, and nasal block. Nevertheless, many patients with the above symptoms may not have sinusitis. A complete clinical examination and out-patient nasal endoscopy under local anesthesia, supplemented by a CT scan if necessary, will establish the diagnosis.
If you are indeed suffering from sinusitis, a trial of medical therapy, consisting of nasal steroid spray and macrolide antibiotics is recommended. If there is no improvement, endoscopic sinus surgery is required and achieves excellent and long-lasting relief.
3. What are nasal polyps, how do they present and what is the treatment?
Nasal polyps are benign, fleshy growths arising from the sinuses that tend to fill up the nasal cavity. They cause nasal block and result in mouth breathing, and may also cause headache. They are often associated with allergy and hence patients may also have watery nasal discharge and recurrent sneezing. Nasal polyps are diagnosed on nasal endoscopy.
A trial of medical therapy, consisting of nasal steroid spray/drops and macrolide antibiotics is given initially. Some authors recommend tablet steroids as part of initial medical treatment. Usually, medical treatment does not result in lasting relief and most patients benefit from surgery. Surgery is done endoscopically (endoscopic sinus surgery). All visible polyps are removed using powered instruments (microdebrider) and the sinuses opened up using this minimally invasive approach. Following surgery, long-term nasal steroid spray and regular self-cleaning of the nasal passages with salt water is required. Click here to read about Dr. M. Dhiwakar’s research and journal articles on sinusitis and nasal polyps.
4. What is fungal sinusitis and what is its treatment?
It is sinusitis that is caused by fungus. It is of 2 types- non-invasive and invasive. The former is mainly caused by allergic fungal sinusitis. This is a recently described condition that is similar to nasal polyps, except that it causes more severe symptoms. The nasal polyps contain fungus, and this causes the sinus tissues to react more strongly, resulting in severe nasal polyps and symptoms. Considerable relief is achieved by Expanded Endoscopic Sinus Surgery (EESS), wherein all polyps and fungal material can be removed endoscopically up to the skull base and side of the eye in a safe manner. Following surgery, long-term nasal steroid spray and regular self-cleaning of the nasal passages with salt water is required. Invasive fungal sinusitis is a more serious condition caused by invasion of fungus into the sinus tissue with potential to spread beyond the confines of the sinuses. This is treated more aggressively. While EESS is adequate in most instances, an open approach may be required for advanced disease. Surgery is followed by anti-fungal drugs. Click here to read about Dr. M. Dhiwakar’s research and journal articles on fungal sinusitis.
5. What complications can occur with endoscopic sinus surgery?
ESS is a safe and effective procedure. While damage to the skull base and eye have been described in the medical literature, these risks are negligible in expert hands.