Nasal disorders can have a major impact on a person’s quality of life, and at CCHNS we treat the range of disorders to restore nasal function. These can include difficulty breathing, allergies, sinus infections, nasal polyps, and tumors.
Anatomy and Function: Each nasal cavity acts as a conduit for air movement from the nostril down to the lung. Having open and functional nasal cavities is important for comfortable breathing, the development of our teeth and skull during childhood, and our ability to smell. Lining the nasal passageways are aerated spaces of the facial bones, called sinuses. These consist of paired sinuses just behind the cheeks (the maxillary sinuses), between the eyes (ethmoid and sphenoid sinuses), and extending up into the forehead (frontal sinuses). Each sinus drains into the nose through one or more small openings. Normal sinuses act to resonate sound as well as protect the brain from injury.
Sinusitis is defined as inflammation of the paranasal sinus cavities and can be caused by infection with viruses, bacteria, or fungi, or chronic irritation from allergies. Sinusitis can be classified as acute (symptoms less than 4 weeks), subacute (symptoms between 4 and 8 weeks), or chronic (symptoms lasting more than 8 weeks). When inflammation is present, the openings of the sinuses can be blocked leading to trapped secretions in the sinuses. The secretions become infected, leading to pain, pressure, and feeling of malaise that accompanies sinusitis.
Chronic sinusitis: is estimated to affect 40 million Americans every year, making it one of the most common chronic diseases. Treatment is generally focused on fixing the underlying infectious, inflammatory, or allergic triggers. The mainstay of therapy for most patients with chronic sinusitis includes daily inhaled nasal steroid (Flonase, Nasonex, etc.), oral antihistamine (Allegra, Claritin, or Zyrtec), and nasal saline irrigation (Neti pot, Neil Med Rinse). Many patients will have significant relief of symptoms on these therapies. Occasionally antibiotics, decongestants, and/or oral steroids are required to overcome a flareup.
Controlling Allergy: Along with medications, some patients can be helped with allergy shots designed to desensitize the immune system to common environmental allergens such as pollen, mold, and dust. Keeping pets out of the bedroom or avoiding cigarette smoke can have a beneficial effect on sinusitis by decreasing airborne irritants. Addition of a HEPA filter to the bedroom can further improve air quality.
Sinus Surgery: Functional endoscopic sinus surgery (FESS) is an option for many patients who suffer from sinusitis and have had inadequate relief from medications. The goal of FESS is to remove diseased areas from the sinuses and create stable openings that allow better drainage. Medications may also work more effectively after the sinuses have been opened. In addition to a complete history and physical, a CT scan of the sinuses is performed to assess whether a patient is a candidate for FESS. The CT scan will show areas with disease and also serves as a roadmap for the surgeon. The surgery is most commonly performed in the outpatient setting under general anesthesia. It usually takes between one to three hours and patients typically go home afterwards. Depending on the extent of surgery, recovery can take several days to one week before returning to work or school. There are no incisions on the face, rather the surgery is performed through the nostrils with tiny cameras and instruments specially designed for FESS.
Balloon Sinuplasty: For some patients with sinusitis, a newer technology known as Balloon Sinuplasty may be an option. This is a minimally invasive procedure that is now commonly performed in the office setting with local anesthesia. Using a tiny camera in the nose, the surgeon is able to thread a balloon into the sinus opening. As the balloon is inflated with water, the sinus opening is dilated to allow for improved drainage and aeration. Studies have shown high levels of patient satisfaction with Balloon Sinuplasty, with the added benefit of minimal or no downtime.