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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:
The sinuses communicate with the nasal cavities through channels, our outflow tracts. Acute sinusitis is usually caused by conditions that narrow the outflow of secretions from the sinuses into the nasal cavities. Conditions that cause swelling or inflammation of the outflow tracts cause obstruction and infection in the sinuses. One of the most common causes of inflammation leading to infection is swelling related to allergies, as well as viral infections. Other inflammatory conditions include nasal polyps, and autoimmune conditions (such as Wegener’s Disease). Other causes of outflow tract obstructions include deviated nasal septums, benign and cancerous nasal growths, and congenital causes of narrowing.
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
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
The main ways to open your sinuses are Functional Endoscopic Sinus Surgery (FESS) and Balloon Sinuplasty. In revision surgery or if the sinuses next to your eyes or brain are involved then you may also need Image Guidance Functional Endoscopic Sinus Surgery (FESS)- This type of sinus surgery is performed using a high-powered camera on the end of an optically lighted tube. The surgeon can magnify the contents of your nose onto a large video monitor in great detail. Micro-instruments are used to open sinuses and remove infected bone and tissue. This is generally done under general anesthesia so you are completely comfortable and relaxed during the procedure. Balloon Sinuplasty- A wire guide is placed into the larger sinuses and a balloon is advanced into the sinus opening. The balloon is expanded with water and the sinus opening is enlarged. This can be used in 3 of the 4 sinuses but does not remove infected sinus tissue. Balloon sinuplasty is not appropriate for patients with nasal polyps or ethmoid sinus disease. Image Guidance Surgery- This is a 3-dimensional visualization system that uses your CAT scan to track instruments inside of your nose and sinuses. The guidance provides an additional tool to locate where you are inside of the nasal cavity. It can be used with Functional Endoscopic Sinus Surgery or some types of Balloon Sinuplasty. It is most appropriately used for revision surgeries or with the frontal, lateral ethmoid and sphenoid sinuses which are adjacent to the brain, eyes and major head nerves and vessels.