Treatment of Sinusitis



Mohiemen Anwar

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Q. What is the treatment of sinusitis?

A. Sinusitis is the inflammation of the lining of the nose and sinuses. There are two main types of sinusitis: acute and chronic. Acute sinusitis is caused by bacterial infection of the sinuses and can last for up to 6 weeks. Symptoms commonly include headaches, congestion, nasal discharge, fever and occasionally swelling and redness around the eye (peri-orbital cellulitis). Tooth infections in some cases can spread into the sinuses in your cheek and would persist despite your dentist’s initial treatment with antibiotics and dental treatment. Radiological investigations either by simple x-ray images or CT scans of the sinuses can help with the diagnosis and I will discuss these options with my patients during the consultation. Treatment would include, pain control, prolonged course of specialised antibiotics and nasal rinsing with saline water.

Chronic sinusitis is inflammation of the lining of the sinuses that can last for several weeks and can come after a period of acute sinusitis or an upper respiratory tract infection. In order to arrive to this diagnosis, I will take detailed history, which usually include symptoms of nasal congestion, runny nose, change in sense of smell, chronic cough and facial pain. I will examine the nose with a specialised fibreoptic nasal endoscope to confirm the diagnosis. CT scan of the sinuses is essential in confirming the final diagnosis. Treatment can be divided into medical and surgical treatment. Medical treatment includes a prolonged course of specialised antibiotics, topical nasal steroids, nasal douching and irrigation with saline water. Surgical treatment can be spared for cases that fail to respond to medical treatment, or can be offered at the time of diagnosis, depending on discussion with the patient during the consultation. 

Endoscopic Sinus Surgery (ESS or FESS) is the gold standard surgical treatment for chronic sinusitis. I have a special interest in this particular area of ENT surgery and has vast experience in performing endoscopic sinus surgery with a high success rate and positive long-term outcomes for his patients. The surgery is commonly performed as day surgery (patients would expect to be discharged home on the same day), no external scars are visible (key-hole surgery), and with minimal expected side effects (usually confined to minor bleeding and post-operative infection).

Endoscopic Balloon Sinoplasty: In recent years, the use of a balloon catheter balloon dilatation of obstructed sinus openings has increased in popularity, as it is associated with fewer complications and quicker recovery. The operation is performed commonly under general anaesthesia, although in rare occasions can be performed under local anaesthetic. The approach is similar to endoscopic sinus surgery, but would include passing a small-cuffed catheter into the sinus opening and inflating the balloon to dilate the sinus opening and drain any retained mucus and secretions within the sinus cavity.