What is acute sinusitis?
Acute sinusitis refers to an acute infection of the sinus and nasal passages. The term acute typically refers to the duration of the infection (usually lasting less than 6 weeks). Infections lasting between 6 and 12 weeks are referred to as “Subacute Sinusitis”, while infections lasting more than 12 weeks are referred to as “Chronic Sinusitis”. Symptoms of sinus infections result from inflammation and swelling of the nasal and sinus cavities.
Acute sinus infections oftentimes start off as a viral infection characterized by 1-3 days of nasal congestion, fatigue, and headaches. The infection usually progresses to more severe symptoms including:
- Difficulty breathing related to congestion
- Pain and pressure around the face, eyes, and sinuses
- Purulent, foul-smelling discharge
- Discharge with green or yellow discharge that is thick
- Postnasal drainage
- Reduced sense of smell
- Coughing
- Headaches
What Causes Acute Sinusitis?
Acute sinusitis, or the sudden onset of inflammation and infection in the sinus cavities, typically occurs when the outflow tracts—small channels that connect the sinuses to the nasal cavities—become blocked. This obstruction prevents mucus from draining properly, leading to a buildup that creates an environment conducive to infection. Several factors can contribute to this obstruction, including:
1. Allergies
One of the most prevalent causes of acute sinusitis is allergic rhinitis, commonly known as hay fever. Allergens like pollen, dust mites, pet dander, and mold can trigger inflammation and swelling in the nasal passages, leading to blockage of the sinus outflow tracts. This blockage traps mucus inside the sinuses, increasing the risk of bacterial or viral infections.
2. Viral Infections
Viral upper respiratory infections, such as the common cold or flu, are a leading cause of acute sinusitis. The viruses cause the mucous membranes lining the nose and sinuses to swell, obstructing the sinus drainage pathways. While these infections typically resolve on their own, they can sometimes lead to secondary bacterial infections, exacerbating the sinusitis.
3. Nasal Polyps
Nasal polyps are non-cancerous growths that develop in the lining of the nasal passages or sinuses. These soft, painless nodules can vary in size and, when large enough, can block the nasal passages and sinus outflow tracts, leading to recurrent or chronic sinusitis. Polyps are often associated with conditions like chronic rhinosinusitis, asthma, and aspirin sensitivity.
4. Deviated Nasal Septum
A deviated septum, where the thin wall between the nasal passages is displaced to one side, can significantly impact sinus drainage. The deviation can narrow one or both of the nasal airways, causing difficulty in proper airflow and increasing the likelihood of sinusitis by obstructing the outflow tracts and trapping mucus within the sinuses.
5. Autoimmune Conditions
Certain autoimmune diseases, such as Wegener’s granulomatosis (now known as granulomatosis with polyangiitis), can cause inflammation of the blood vessels in the sinuses, leading to severe obstruction and chronic sinusitis. These conditions can also affect other parts of the body, making their management complex and necessitating specialized medical care.
6. Nasal Tumors and Growths
Both benign and malignant tumors can develop in the nasal passages and sinuses. While benign growths like inverted papillomas may not be cancerous, they can still obstruct the sinus outflow tracts. Malignant tumors, though rare, can invade nearby structures, causing severe blockage and chronic inflammation that leads to sinusitis.
7. Congenital Narrowing or Structural Abnormalities
Some individuals are born with anatomical variations that predispose them to sinusitis. Congenital conditions like choanal atresia (a blockage of the nasal passage) or narrow sinus outflow tracts can hinder proper drainage from birth, leading to frequent or chronic sinus infections throughout life.
8. Environmental Factors
Exposure to environmental irritants such as smoke, pollution, or chemical fumes can irritate the nasal and sinus linings, causing inflammation and swelling. This can lead to acute sinusitis, especially in individuals with pre-existing nasal or sinus conditions.
9. Poor Immune Function
Individuals with weakened immune systems, whether due to chronic conditions, medications, or lifestyle factors, are more susceptible to infections, including acute sinusitis. The body’s reduced ability to fight off infections can result in more severe or prolonged sinus symptoms.
How are Acute Sinus Infections Treated?
Mediations are usually used first in treating acute sinus infections. There are two goals of medical therapy: to reduce the amount of bacteria and reduce the amount of inflammation. Antibacterial medications such as antibiotics will help in reducing bacterial load within the nose and sinuses. Anti inflammatory medications such as topical and oral steroids, antihistamines, and nasal irrigations, assist in reducing the inflammation.
After sinus infections are treated medically, your surgeon will monitor for a response. Oftentimes, in the setting of frequent sinus infections, additional procedures such as sinus surgery will assist in treating the sinus infection or preventing future sinus infections
What is Sinus Surgery?
The spaces inside of your nose have tiny openings and channels that connect to each other and to both sides of the nose. Sinus surgery widens the channels and removes most of the walls of these spaces which prevents your sinuses from obstructing and allows them to drain more freely. Having more open spaces prevents the pressure from building up in your nose and decreases the frequency and severity of your sinus infections. Sinus surgery also allows saline rinses and topical medications to better access the open areas inside of your sinuses
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What are the Types of Sinus Surgery?
Sinus surgery is often recommended for patients who suffer from chronic sinusitis or other sinus issues that do not respond to medical treatments. There are several types of sinus surgery, each tailored to address specific conditions and anatomical concerns. The main types include:
1. Functional Endoscopic Sinus Surgery (FESS)
Functional Endoscopic Sinus Surgery, commonly referred to as FESS, is the most common type of sinus surgery. It is a minimally invasive procedure used to restore normal drainage pathways in the sinuses. FESS involves the following steps:
- Procedure Overview:
- The surgeon inserts a small, high-powered endoscope (a thin, flexible tube with a camera and light) into the nostril to access the sinuses.
- Micro-instruments are used to remove obstructions such as inflamed tissue, bone spurs, or nasal polyps.
- The goal is to open the natural drainage pathways of the sinuses, allowing mucus to flow freely and reducing the risk of infection.
- Benefits:
- FESS is typically performed under general anesthesia, ensuring patient comfort.
- It is a precise procedure that minimizes damage to surrounding tissues.
- Recovery time is generally shorter compared to traditional sinus surgery.
- Indications:
- Chronic sinusitis unresponsive to medication.
- Recurrent sinus infections.
- Nasal polyps or other obstructions.
- Sinus issues due to structural problems, such as a deviated septum.
2. Balloon Sinuplasty
Balloon sinuplasty is a less invasive alternative to traditional sinus surgery, often used for patients with less severe sinus issues. It is similar to angioplasty used in heart procedures and involves the following:
- Procedure Overview:
- A guide wire is inserted into the affected sinus using a catheter.
- A small balloon is then advanced over the guide wire and positioned in the blocked sinus opening.
- The balloon is gently inflated with water, which widens the sinus opening, improving drainage.
- The balloon is then deflated and removed, leaving the sinus pathways open.
- Benefits:
- It is usually performed under local anesthesia, reducing the risks associated with general anesthesia.
- Recovery time is typically shorter, with most patients returning to normal activities within a couple of days.
- It is a safe option for patients who may not be candidates for more invasive surgery.
- Indications:
- Patients with chronic sinusitis affecting the maxillary, frontal, or sphenoid sinuses.
- Not suitable for patients with nasal polyps, extensive ethmoid sinus disease, or severe sinus infections.
3. Image-Guided Functional Endoscopic Sinus Surgery (IGS-FESS)
Image-Guided FESS is an advanced form of FESS that utilizes real-time imaging to navigate the complex sinus anatomy. It is particularly useful in complicated cases or revision surgeries.
- Procedure Overview:
- Before surgery, a detailed CT scan of the sinuses is taken.
- During the procedure, the surgeon uses a 3D navigation system that combines the CT scan images with live endoscopic images.
- This allows the surgeon to precisely track the location of surgical instruments within the sinuses, reducing the risk of complications.
- Benefits:
- Enhanced precision and safety, especially in areas close to critical structures like the brain, eyes, and major blood vessels.
- Ideal for patients with distorted sinus anatomy, such as those who have had previous sinus surgeries or who have congenital abnormalities.
- Indications:
- Revision sinus surgeries.
- Complex cases involving the frontal, sphenoid, or ethmoid sinuses.
- Conditions affecting sinuses adjacent to vital structures (e.g., the brain and eyes).
Choosing The Right Type of Sinus Surgery
The choice of sinus surgery depends on several factors, including the severity of the condition, the patient’s medical history, and the presence of any anatomical abnormalities. Consulting with an experienced ENT specialist is essential to determine the most appropriate surgical approach based on individual needs and conditions.
Each type of sinus surgery offers unique benefits and considerations. While some procedures like FESS and balloon sinuplasty are less invasive with quicker recovery times, more complex conditions may require advanced techniques like image-guided surgery. Understanding the options available can help patients make informed decisions about their sinus health.
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