Center for Sinus Surgery

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.

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

Acute Sinusitis
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.

Chronic Sinusitis
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
• headaches
• 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.

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.

Acute Sinusitis
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 Sinusitis
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.