By Samuel Becker, M.D.
On a good day, you probably don’t give your sinuses a lot of thought.
But when a severe cold, sinus infection or other nasal condition develops, these hollow cavities around your eyes and nose can feel bigger than your entire head and cause enough pain to send you crawling back under the covers.
Sinus trouble is not uncommon, but if you suffer from a cold for more than 10 days, or if your symptoms worsen, you should consider seeing a sinus specialist.
Too often, people live with sinus problems that can be resolved easily with medical treatment.
Understanding Sinusitis
The sinuses are air-filled spaces in the skull, located behind the forehead, nasal bones, cheeks, and eyes. When these spaces are clear, mucus is able to drain out and air is able to flow through.
Sinusitis – or technically rhinosinusitis – is a condition in which the lining of the nose and sinuses becomes swollen or inflamed causing blockages that can lead to congestion and infection.
There are many different things that can trigger sinusitis, including allergens, non-allergic pollutants, cigarette smoke, viruses, and anatomic abnormalities such as polyps or a deviated nasal septum.
Other factors that may contribute to sinus inflammation include hormonal reactions associated with pregnancy, aging, medication misuse, and medication reactions.
An estimated 31 million people in the United States have some form of sinusitis, according to the American College of Allergy, Asthma and Immunology.
Signs and Symptoms
Sinusitis can be acute or chronic.
Acute sinusitis can last up to four weeks, while chronic sinusitis is present for three months or longer.
In addition, people can suffer from repeated bouts of acute sinusitis. This is referred to as recurrent acute sinusitis and occurs when a patient has repeated acute sinus infections, but is relatively symptom-free between infections.
Symptoms of chronic sinusitis are largely the same as those of acute sinusitis though they may be milder and last longer than 12 weeks. Symptoms include facial pain or pressure, headaches, nasal stuffiness, diminished sense of smell, postnasal drip and sore throat, fatigue, fever, dental pain, bad breath, thick or green/yellow nasal discharge.
Diagnosis and Treatment
Sinusitis is typically diagnosed by a physical exam in which your doctor will look in your nose for signs of inflammation and infection or masses such as polyps.
Additionally, you may be referred to an otolaryngologist, a doctor who specializes in ear, nose and throat problems, for further evaluation. This evaluation often includes a focused head and neck examination, a nasal endoscopy to allow direct visualization of the sinus drainage areas, and imaging studies, if necessary. Other testing such as allergy and immunology, may be ordered as well.
Sinusitis can often be treated with over-the-counter medicines, including nasal sprays, allergy medications, saline rinses, and decongestants. In other cases, prescribed medications may be needed.
In cases of chronic conditions or recurrent acute infections that do not respond to medical treatment, and where it is believed that structural or anatomical problems contribute, patients may benefit from procedures and surgical interventions.
A Minimally Invasive Procedure
Candidates for surgery need to meet three criteria: their symptoms must be significant, have failed to improve with other extensive medical treatments, and there must be an anatomical contributing factor.
In other words, there needs to be something structural that can be corrected, with a goal of moving or removing whatever is blocking the nose and sinuses from functioning properly.
In most cases, surgery is minimally invasive and performed on an outpatient basis under endoscopic guidance. This lets the surgeon operate through the nostrils with small magnifying cameras which allow them to specifically target the areas that are causing the blockage.
Procedures are designed to increase the opening in the nasal passages to improve breathing and airflow, and in the sinuses to remove polyps or other anatomical structures which impede sinus drainage.
Recovery times vary from person to person, but for most people the discomfort will subside enough in a few days to where they are just using an over-the-counter pain reliever.
Overall, there will be some discomfort for a week or two, and you will have a stuffy nose until the sinus swelling goes down.
Thanks to advances in medicine, sinus surgery today is nothing like it was years ago when your nose needed to be packed after surgery. Today, patients can be back to normal life after just a brief down time.
While sinus problems are common, leaving them untreated typically means living with unnecessary discomfort and pain. With a correct diagnosis and a comprehensive treatment plan, nose and sinus problems can often be relieved, and your quality of life restored.
To find a primary care or ear, nose and throat (otolaryngology) physician affiliated with Penn Medicine Princeton Health, call 1-888-742-7496 or visit www.princetonhcs.org.
Samuel Becker, M.D., is board certified in otolaryngology and a member of the medical staff at Penn Medicine Princeton Health.
