Sinusitus

The natural history of acute sinusitis is that it develops around a week to 10 days after starting a cold. Pain in the cheeks, forehead and upper teeth are common as well as congestion and a blocked nose. There may be a fever.

Unless there are complications, a sinusitis can be treated with nasal saline irrigation, decongestants and anti-inflammatories. Antibiotics can be used if the sinusitis is not resolving or is getting worse with increasing pain. Most acute sinusitis will resolve without antibiotics. Surgery is usually used for complications, such as the development of orbital or brain abscesses or meningitis, or to flush out the sinuses if it doesn’t resolve as expected.

Chronic sinusitis is defined as symptoms of nasal congestion, blockage and excess mucous for more than 3 months. It is due to longstanding inflammation and there may be pus, polyps and swelling on examining the nose with a scope. It is usually caused by repeated infection and is self-perpetuating because the sinus ventilation and drainage is blocked by swelling, which in turn causes more blockage.

Treatment is initially medical, with the use of saline irrigation, antibiotics and nasal steroid drops or sprays. Should this fail to resolve the symptoms, or if there is significant polyposis, the treatment focus shifts to a surgical option.

A CT scan is done to determine the extent of the chronic sinusitis as well as the degree and direct anatomical cause of the obstruction.

With endoscopic sinus surgery, the specific surgery is tailored to what is seen on the CT scan, with the usual approach being to widen the openings of the maxillary sinuses (the ones in the cheeks) and to remove the honeycomb of blocked ethmoid sinuses between the eyes.

Polyps are removed, if present, and the septum can be straightened if it is skew. In addition, frontal sinuses and sphenoid sinuses can be opened and cleaned if they are also a problem.

Endoscopic sinus surgery is done with a minimal access approach using a scope in the nose and working off a high definition monitor, so there are no external cuts.

It is a safe and well established technique which usually results in a significant improvement of complete resolution of symptoms, improving the quality of life.

It is done as a day case under general anaesthetic.

Post-operatively patients are advised to continue rinsing with saline and using a steroid spray for at least 3 months.