Cara Cockerill, M.D.
Otorhinolaryngology (Ear, Nose & Throat)
It's that time of year when the weather warms up, flowers bloom and — boom — your nose clogs up, and you feel miserable. While the signs of nice weather are welcome for some, for others, they signal the start of sinus misery.
Here are some answers to common questions about sinusitis:
What is sinusitis?
Sinusitis occurs when the spaces inside your nose and head ― your sinuses ― are swollen and inflamed. This swelling interferes with the way mucus normally drains and makes your nose stuffy. Sinusitis can be brought on by an infection; growths in the sinuses, or nasal polyps; or swelling of the lining of your sinuses.
Common signs and symptoms of sinusitis include:
- Nasal inflammation
- Thick, discolored discharge from the nose
- Drainage down the back of the throat, which also is known as postnasal drip
- Nasal obstruction or congestion, causing difficulty breathing through your nose
- Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
- Reduced sense of smell and taste
What is chronic sinusitis?
Acute sinusitis can turn into a chronic condition if you have had sinusitis a number of times, sinus infections that don't respond to treatment, or you have sinusitis symptoms that last more than three months. Common causes of chronic sinusitis include nasal polyps; complications of conditions, such as cystic fibrosis, HIV and other immune system-related diseases; recurrent respiratory infections; or allergies.
When should you see an ear, nose and throat specialist?
If you suspect you're having chronic sinus problems, then your primary care provider is a good place to start. They may recommend nasal steroid sprays, saline rinses, antihistamines or antibiotics.
If your symptoms don't respond to these more conservative treatments, then it may be time to see an ear, nose and throat (ENT) specialist, also known as an otolaryngologist. ENTs provide consultation, diagnose and treat disorders of the ear, nose, head and neck. This includes sinuses, adenoids, tonsils and thyroid.
What can you expect during your ear, nose and throat visit?
During a first visit, the specialist likely will spend a good portion of time getting to know you. That includes learning more about your day-to-day life and how sinus symptoms are affecting it. Then the specialist will complete a head and neck exam, paying particular attention to the nose. Typically, a small scope is used. This scope goes in the nose to get a better look at the nasal passage and sinus openings.
What treatments are available for sinusitis?
Treatment typically starts as conservative as possible. If we’ve tried these medical treatments and your condition hasn't responded, a CT scan of your sinuses may be ordered to get a better look at the sinus anatomy. If this ends up showing signs of chronic inflammation or infection, then surgery may be a good option.
What does sinus surgery involve?
Sinus surgery is typically performed under general anesthesia in the operating room. Most ENT specialists use a minimally invasive endoscopic approach, which uses a small camera inside the nose. No external incisions are made. Your surgeon will use various instruments to open the natural sinus passages to allow better mucous drainage, and better penetration of nasal sprays and rinses.
Your surgeon also may use image guidance during surgery. This allows the surgeon to see the surrounding anatomy and location of instruments as the procedure is performed to avoid damaging critical structures, such as the eye; skull base; and major blood vessels, including the carotid artery. It uses the patient's pre-operative CT scan so the surgeon can tell in real time exactly where the instrument tip is.
Sinus surgery is typically an outpatient, same-day surgery. Most patients don't experience significant pain afterward and find relief from their chronic sinusitis symptoms.