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General information about sinusitis
Simple overview of nose and sinuses
Symptoms of nose and sinus problems
Sinusitis and allergies
Sinusitis and asthma
Sinuses and acid reflux or gerd
Diagnosing nose and sinus problems
Medical Treatment of sinus problems
Sinus surgery information
Anatomy of the nose and sinuses
Treating sinus polyps
The sinuses and snoring problems
Special topics regarding sinuses
Powered Instrumentation sinus procedures
Sinus image guidance information
Sinus problems and quality of life
Effect of fungus on sinuses and sinusitis
FESS and rhinoplasty
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Diagnosis of Sinus Problems

Question: What are the sinuses?
The sinuses are chambers in the bones of the face and skull that are normally lined with a thin mucus-producing membrane (called mucosa). They communicate with the nasal cavity via narrow openings. Air and mucus enter and exit to and from the sinuses through these openings.

Question: What is sinusitis, and what causes it?
Sinusitis literally means "inflammation of the sinus cavities." This inflammation is what happens when your nose and sinuses are exposed to anything that might irritate the membranous linings. These irritants may include dust and pollution, cigarette smoke, and other irritants. Allergic reaction to mold, pollen and so forth may also irritate the nasal linings. Furthermore, infection with a virus or bacteria may irritate the nasal linings. All of these factors may cause the narrow openings in the nose and sinus cavities to narrow even further or even to shut entirely.

The "grand central station" of the sinuses is the osteomeatal complex -- the most important sinus opening. Any process that causes blockage in this sensitive area can occlude the other sinuses that drain into the osteomeatal complex. When obstruction occurs, the mucus is retained in the sinus cavity. These stagnant secretions thicken and provide a medium for bacterial growth. These changes lead to damage and dysfunction of the cilia (microhairs) that line the sinuses. The retained secretions and infection lead to further tissue inflammation, which in turn leads to further blockage. These events demonstrate a vicious cycle that leads to chronic sinusitis.

Question: What is the basic principle underlying treatments that restore normal sinus function?
We now know that sinus disease can often be resolved or controlled by controlling the sinus problems at the main sinus opening, or osteomeatal complex (OMC). This allows for restoration of normal sinus aeration and mucus clearance.

In general, the OMC can be blocked by mucosal congestion or anatomic obstruction. The causes are commonly reversible with appropriate medical and, at times, surgical management.

Question: What are the symptoms of sinusitis?
The symptoms of sinusitis include nasal blockage (the #1 symptom), facial pressure or pain, snoring, postnasal drainage, bad breath, fatigue, recurrent infections, tooth pain, loss of sense of smell, and others.

Question: Is there a relationship between sinusitis and asthma?
Sinusitis can actually exacerbate asthma. Many patients who have successful treatment of their sinuses find that their asthma also improves. The post-nasal drainage of diseased sinuses can irritate the reactive airways of asthmatics.

A significant number of asthma/sinusitis patients -- nearly 2/3 -- find they can decrease or, in some cases, come off of asthma medication after sinus surgery.

Question: What is the appropriate medical therapy for sinusitis?
Once the diagnosis of sinusitis is made, medical therapy is instituted. The exact therapy chosen by your doctor will depend upon the underlying cause. Therapy is aimed at relieving obstruction of the nose and sinuses, particularly at the osteomeatal complex. In addition, therapy is targeted in such a way as to treat any infection that may be present.

In general, medical management of sinusitis may include one or more of the following: Antibiotics, topical and systemic decongestants, topical nasal lavage, nasal saline sprays, humidification, mucolytics, decongestants, and steroids.

Medical therapy must be undertaken under a doctor's care. Some medications for sinusitis must not be taken if a patient has other medical conditions. For example, if a patient has high blood pressure, or if a patient is pregnant, certain medications must not be taken.

Most cases of chronic sinusitis treated by otolaryngologists are successfully treated with medical therapy. When medical therapy fails, the surgical alternative is a consideration.

Question: When is surgical intervention (FESS) considered?
Surgical intervention for chronic sinusitis is reserved for those patients in whom maximal medical therapy has failed. Functional endoscopic sinus surgery has become the most widely accepted approach for patients undergoing surgical intervention for chronic sinusitis. The goal is to return the sinuses to as near a normal anatomic state as possible. This surgery is intended to correct conditions that impede mucocilary clearance of the sinuses, especially through the osteomeatal complex. Respect of the normal drainage patterns of the sinuses and elimination or improvement of obstruction of these drainage pathways promotes the resolution of mucosal hypertrophy and infection and the return to a normal disease-free state.

Question: How many sinus surgical procedures are performed each year in the United States?
Some estimates suggest that more than 200,000 sinus surgical procedures are performed each year.

Question: When should I consider surgery?
When anatomic abnormalities exist and are contributing to your sinusitis, and when other therapies have failed, these abnormalities can be surgically corrected.

Endoscopic techniques allow otolaryngologists to diagnose and treat these problems more easily than in the past, allowing them to be more proactive in the management of anatomic nasal abnormalities.

Question: When is surgical management indicated?
Surgical management of sinusitis is considered when medical management fails to relieve the patient of the symptoms of sinusitis, when the patient's condition, unrelieved by medical therapy, is also associated with lower respiratory tract problems such as chronic bronchitis and asthma, and when complications of sinusitis are present or threatening.

In general, patients who fail maximum medical therapy are potential candidates for surgical management.

Question: What are the surgical options?
FESS (or functional endoscopic sinus surgery) has essentially replaced the traditional "old-fashioned" procedures for the conservative surgical management of sinus disease. Functional endoscopic sinus surgery (FESS) is aimed at restoring patency and normal mucociliary flow of the natural sinus openings.

With nasal endoscopes the narrow anatomical region of the sinus drainage pathways can be visualized and accurately approached surgically.

FESS has brought dramatic positive improvement in the surgical treatment of sinusitis.

Question: What is the key underlying concept behind minimally invasive, functional endoscopic sinus surgery (FESS)?
The osteomeatal complex, or OMC - the small compartment located in the region between the middle turbinate and the lateral nasal wall in the middle meatus - represents the key region for drainage of the anterior ethmoid, maxillary and frontal sinuses. Obstruction of the OMC causes a vicious cycle of events that lead to chronic sinusitis.

Functional endoscopic sinus surgery opens these natural sinus openings to restore normal sinus functioning.

Question: Tell me more about Functional Endoscopic Sinus Surgery.
In FESS, an endoscope is used in the nose to view the nasal and sinus cavities. This generally eliminates the need for an external incision. The endoscope allows for better visualization of diseased or problem areas. This endoscopic view, along with detailed X-ray studies, may reveal a problem that was not evident before.

FESS focuses on treating the underlying cause of the problem. The ethmoid area is usually opened, which allows for visualization of the maxillary, frontal and sphenoid sinuses. The sinuses can then be viewed directly and diseased or obstructive tissue removed if necessary. The surgery is commonly performed on an outpatient basis.

Careful postoperative care is essential to the success of this surgery. The patient will be provided postoperative care instructions. It is very important that the patient follow these instructions, as well as any other instructions given by the surgeon, to promote healing and decrease the chance of complications.

Question: Will endoscopic sinus surgery cure sinus problems?
Overall, the majority of patients have had significant improvement with the combination of surgery and continued medical management. FESS performed as a result of medical therapy failures in acute and chronic sinusitis is associated with a success rate of 75 to 95% according to sources in the literature.

Sinusitis is a chronic problem, and while your symptoms may improve or even disappear after surgery, the patients nose and sinuses still have the potential to be irritated by pollen, dust, pollution, etc It should be realized that some medical therapy is usually continued after surgery, especially if allergy or polyps play a role in the sinus disease. This is necessary to control or prevent recurrence of disease.

It is possible that the disease may not be cured by the operation, or that the disease may recur at a later time. If this should happen, subsequent surgical therapy may be required.

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This site is supported by Becker Nose & Sinus Center: Samuel S. Becker, MD and Daniel G. Becker, MD, FACS. Copyright© 2009. For more information visit the Becker Nose & Sinus Center and
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