What are sinuses?
The sinuses are open air filled cavities that are located in four different areas within the facial bones and skull. They are almost always found in pairs and are named for their location in the different facial bones. They have nature openings that open into the nose. This area of natural opening is called the osteomeatus. Most people have four sets of sinuses.
Four Sets of Sinuses:
Maxillary Sinuses: located in the maxillary portion of the facial bones. These sinuses are located under the eyes and are usually the largest of all the sinuses. They are present at birth and grow in size with facial growth.
Ethmoid Sinuses: located in the ethmoid portion of the facial bones. These sinuses are located between the eyes. These sinuses have an anterior and posterior portion to them as well as many partitions that separate them into many partitions. Looking into these sinuses is much like looking into a honeycomb. Like the maxillary sinuses, these sinuses are present at birth.
Sphenoid Sinuses: located in the sphenoid bone. This bone is located midline in the skull, deep behind the nose. This sinus is usually divided in half by a midline septum. At birth it is usually filled with bone marrow, and starts to become air filled sometime later in life.
Frontal Sinuses: located in the frontal bone, which lies in the forehead area of the skull. These sinuses can grow to be quite large in the adolescent years, but are usually not present at birth. Most children begin to develop these sinuses around 10 to 14 years of age. They can remain quite small, or become very large, especially in males. About 10% of the population does not develop frontal sinuses.
What is sinusitis?
Sinusitis is an inflammation of the sinuses. This inflammation may be confined to one sinus cavity by itself, but more commonly involves all of the sinuses cavities.
Sinusitis usually implies infection of at least one of the sinuses and can be brought on by any condition that causes obstruction of the natural openings of the sinuses into the nasal cavity.
Conditions that may lead to or cause sinusitis include viral infections such as:
- common cold
- nasal allergies
- nasal polyps
- various fungi
- hay fever
- cystic fibrosis
- other anatomical variations of the nose and sinus cavities
Types of Sinusitis:
Sinusitis can be either acute or chronic.
In the acute form, the patient is usually ill with fever, facial pain, and many times a runny nose. The runny nose has usually been there for at least 7 to 10 days. This type of sinus infection usually occurs together with the common cold. It can be quite painful and requires antibiotics to help it resolve. Ten days of antibiotics is usually very effective for acute sinus problems.
The common cold probably causes the natural opening of the sinus cavities to become swollen and blocked shut, allowing the sinus secretions to become stagnated within the sinus cavities. When the flow of secretions from the sinuses is blocked, bacteria may begin to grow and this leads to a sinus infection, which leads to secondary pain and fever. Tender teeth can occur as well.
Common bacteria that can cause sinus infections include:
- Streptococcus pneumonia
- Haemophilus influenza
- Moraxella catarrhalis
Acute sinus infections usually respond well to antibiotics and rarely require surgery for resolution.
In chronic sinusitis there may be no pain or fever. In fact, fever is usually quite uncommon. These individuals usually have facial fullness.
Other common symptoms of chronic sinusitis include, but are not limited to:
- night time cough
- nasal stuffiness
- nasal fullness
- pain behind the eyes
- chronic post nasal drip
- chronic sore throat
- stomach ache
- chronic fatigue
Most cases of chronic sinus disease require a minimum of 4, and many times, 8 weeks of antibiotics to wipe out the disease process.
Unlike acute sinus disease which rarely requires surgery, chronic sinus problems may require surgery if they do not respond to antibiotics or the treatment of other causes such as nasal allergies.
Possible conditions that most often lead to chronic sinus conditions include:
- abnormalities in the structure of the nose
- enlarged adenoids
- diving and/or swimming
- dental infections
- nasal trauma
- cleft palate deformities
- nasal allergies
Many times there is no active infection that causes chronic sinus infections, but more commonly it is the ongoing blockage of the sinuses that causes the issues.
How is sinusitis diagnosed?
Sinusitis can be diagnosed based on signs and symptoms along with a physical examination. Patients with acute sinusitis usually look very sick, and have a fever, chills, headache, runny nose, upper respiratory infection, and facial pain.
These patients usually respond very well to oral antibiotics.
Chronic sinus problems can be tougher to diagnosis and evaluation nearly always requires some type of x-rays, usually a CT scan.
The CT scan has become the gold standard in the evaluation and work-up of patients with chronic sinus problems. The CT scan allows one to look at the anatomy of the sinus cavities. It is difficult to evaluate chronic sinus problems without the help of the CT scan.
Treatment for sinusitis:
The treatment of sinus problems usually involves the use of antibiotics, surgery, or both.
Acute sinus infections can almost always be managed with antibiotics. Usually 10 days of intense oral antibiotic treatment will cure most acute forms of the disease.
At times an abscess or puss-filled pocket can form with acute sinus disease and require surgical treatment, but these are not common. If the acute sinus attacks are secondary to environmental or nasal allergies, then aggressive treatment of the allergies is required to handle the acute sinus episodes.
Chronic sinus disease can be more challenging to manage and treat and can, at times, require multiple methods of treatment, depending on the cause. Nearly all cases of chronic sinus problems will require a CT scan to make the proper diagnosis.
Once the cause has been discovered, then a proper plan of treatment can be outlined. Sinus surgery along with antibiotics is more often necessary in treating chronic sinus conditions, but many of these problems can still be resolved with antibiotics alone, or in combination with other treatment modalities such as allergy skin testing and treatment.
Depending on the cause, one or more sinus operations might be required to bring the chronic sinus condition under control.
What is endoscopic sinus surgery?
Most sinus surgery today is preformed endoscopically. This involves using tiny telescopes to look up into the nose and into the sinus cavities. These small telescopes along with small microsurgical instruments can be used to actually open and go into the sinus cavities and clean the sinuses out.
Puss, polyps, and the like can be removed and sent to pathology for examination. This type of sinus surgery is usually reserved for cases that do not respond to conventional methods of treatment with antibiotics or allergy treatment.
The advantages of this type of surgery is that it enables the surgeon to look directly into the sinus passageways and remove any abnormal findings as well and to correct any bony or anatomical abnormalities.
This type of surgery causes little pain to the patient after the procedure, and there are no incisions or black or blue marks on the face or eyes.
How long does the surgery take?
This surgery can take as long at 4 hours, or be as short as 30 minutes, depending on the degree of sinus involvement.
What conditions might require endoscopic sinus surgery?
Conditions that might require endoscopic sinus surgery include:
- anatomical (bony) abnormalities of the nose or sinus cavities
- nasal polyps
- deviation of the nasal septum
- fungal infections
- cystic fibrosis
What are the risks of sinus surgery?
As with most surgical procedures, sinus surgery has some associated risks with it. Each patient should discuss the risks of the operation with his or her physician.
Depending on what sinuses are involved with sinus disease, each operation can have varying degrees of risk that go along with it.