Mr Nigam ENT Treatments - Sinusitis
Why do we have sinuses?
The sinuses are air pockets located inside the bones in the skull. They are located to either side of the nose (maxillary), behind and in between the eyes (ethmoid), in the forehead (frontal), and there is one much further back in the head (sphenoid). (For a better understanding of this, please look at the CT scan page when you finish reading this page.) They are probably present to reduce the weight of the skull as well as to create resonance to the voice. The sinuses are lined with very fine hair-like projections called cilia. The function of the cilia is to move mucus (which is normally produced by the sinus) towards the tiny hole (the ostium) about the size of a pin hole which provides drainage for the sinus. Unfortunately, that hole is located at the top of the largest sinus, and consequently drainage may be poor.
What causes sinusitis?
Sinusitis starts as a result of blockage of the hole (actually a short hairpin shaped tube) into the sinuses, called an ostium. This blockage can occur as a result of an anatomical obstruction, swelling due to a cold or allergy, drying of the mucus, or a foreign body. When this occurs, mucus that normally is expelled from the sinus builds up in the sinus. This can cause pressure or pain. In addition the mucus is an excellent culture medium for bacteria. If the mucus is not cleared immediately, an abscess can develop in the sinus. An abscess is a pus-pocket inside a closed space. Ideally, treatment of an abscess involves opening the abscess up with a knife and allowing the abscess to drain to the outside. Unfortunately, this is obviously not feasible in the case of a sinus infection without doing extensive surgery.
How common is sinusitis?
Sinusitis is one of the most common medical problems affecting approximately 30% of the population at some point. Acute sinusitis commonly follows a cold and typically lasts for up to three weeks. After three weeks it becomes defined as a chronic sinusitis and may become much more difficult to treat.
Why is sinusitis increasing?
Since the Spring of 1990, we have noticed a significant increase in the number of people who have sinus infections. The reason for this is not clear at the present, but it is most likely due to increasing amounts of pollution and ozone. There have been similar increases in other major cities in the United States.
How is sinusitis diagnosed?
It may be extremely difficult to diagnose a sinus infection early in the course of the disease. After taking a careful history, which is extremely valuable in helping diagnose sinusitis, and doing a physical exam, the diagnosis is typically made by looking inside the nose with a flexible rubber or rigid steel tube called an endoscope.
Depending on what is found at the time of the endoscopy, an x-ray (CT scan) of your sinuses may need to be done. Previously, x-rays of the sinuses were done. Now CT scans are ordinarily done because a much greater amount of information can be gleaned from the CT scan, and at a very slight increase in the cost. If you need to have surgery, a CT scan will ordinarily be done prior to surgery. The CT scan is often performed in a special way ( called coronal views) so that certain portions of the sinuses are better seen. Endoscopy and CT scans are now done very commonly for sinus infections. Many doctors and all sinusitis specialists can look inside your nose with the endoscope. It's not painful but might be a little uncomfortable. Don't worry - your nose is sprayed first with a local anaesthetic.
Although antibiotics are important to use in treatment of sinus infections, it is extremely important to allow the mucus in the sinuses to drain adequately. The way this is done is to use nasal sprays containing small amounts of steroid to reduce the inflammation inside the nose and around the ostia (the opening from the sinuses into the nose). (There is minimal absorption of any of the cortisone nasal sprays into the body and so they are very safe).
Many patients will report that breathing in eucalyptus oils will help open the nose. Steam rooms are also often helpful. Patients often report that after a hot shower their nose seems to open up and they are more comfortable. Irrigation with saline nasal sprays can be helpful, but remember if you choose to use these non drug treatments.
Why do I have to keep my nose clear? I can breathe through my mouth.
Believe it or not, your nose is not just a decorative object found on your face, it really has a purpose. It is extremely important to keep the nose clear so it is possible to breath through the nose. It has been found that air exchange into the sinuses occurs twice as rapidly with nasal breathing. The air exchange will reduce the likelihood of bacteria growing in the sinuses.