The paranasal sinuses are the air filled spaces in the skull which have several functions. The sinuses improve the structural integrity of the skull, by providing a “crumple zone” which doesn’t allow the force of trauma to be transmitted directly through the bone of the skull, to protect vital areas such as the eyes and brain. In addition, the sinuses provide a resonant chamber for the sound vibrations of the voice to improve vocal quality. There are actually four pairs of sinuses within your skull. The bone of the sinuses is covered by a mucosa, which secretes mucus. These particles that are caught up in the mucous, are then expelled from the sinus via the rhythmic sweeping of cilia, small, microscopic hair-like fibers on the surface. This keeps the sinuses free of bacteria, dust, allergens and other particles. Sinuses that are in good health have a wide open drainage pathway, which also allows air to circulate within them. Mucus is able to pass from the sinuses into the back of the nose and then down the throat, to continuously keep the sinuses clear of any pathogens which could trigger inflammation.
Colds, allergies, infections or other obstructions of the sinuses (i.e. deviated septum) can cause blockage the drainage of mucus from the sinus cavities. If the sinuses become inflamed, and an acute sinusitis can occur. The mucus becomes thicker and cannot pass through the openings and accumulates in the sinuses. Symptoms including low-grade fever, headaches, fatigue and pain over and underneath the eyes soon develop. If the symptoms persist for more than three months, the infection is referred to as a chronic sinusitis.
Before surgery is recommended, a patient with sinusitis is first treated with a complete medical trial. This means selecting the appropriate antibiotic and anti-inflammatory medication, and prescribing it for an extended period, usually 3 to 4 weeks. A CT scan of the sinuses is performed following medical therapy to evaluate for the persistence of inflammation, and also to evaluate sinus drainage pathways.
During your initial evaluation, an extensive physical examination of the nasal passages will be performed. A fiberoptic endoscope will be used to examine the particular area of the nasal passage, which if blocked, is responsible for the development of sinusitis. If there is a question regarding the diagnosis, a high resolution CAT scan can be performed to see the sinuses in greater detail. Treatment is based upon the cause of your infection. Obstructions caused by allergies or sensitivity to non-allergic triggers can be minimized or eliminated with the appropriate medical therapy. Antibiotics will also be prescribed based upon bacterial prevalence data for this geographical area. Prior to your return visit to the office for evaluation, a CAT scan of the sinuses will be performed to evaluate response to therapy. A copy of this scan will be provided to you by the radiology center after your test, and will be reviewed with you personally at your office visit. Depending upon the results of the study, surgical alternatives will be discussed, or conversely, maintenance medical therapy will be outlined to prevent recurrence of symptoms. If medication fails to resolve the symptoms, your physician will review with you whether surgery would be helpful. Sinus surgery is almost always performed with the use of a fiberoptic telescope called an endoscope. This eliminates the need for any external incisions, and virtually eliminates bruising after surgery. If surgery is necessary, and involves one of the sinuses close to the eye or the brain, it is done with the help of a technology called stereotactic image guidance or FUSION. This technique utilizes a high resolution CAT scan of the sinuses to create a virtual, three-dimensional model of the surgical area. The instruments used in the procedure are then registered against this virtual model, so that the position of the instruments within the nose and sinuses, and most importantly their proximity to vital structures including the eye and the brain, can be continuously monitored with a high degree of precision. This is similar to a GPS system to navigate a car on the road.
The surgery is done under general anesthesia; and there is surprisingly little discomfort after surgery. In the past, sinus surgery was known to have a very uncomfortable post-operative course, due to the use of nasal packing. The packing produced pressure on the sensitive nasal lining and also obstructed breathing and made swallowing difficult.
More recent technological developments have made the routine use of nasal packing unnecessary, and thereby reduced post-operative pain to the point that narcotic pain medication is seldom required.
The surgery itself is almost always performed as an outpatient, so you are able to go home being able to breathe through the nose on the day of surgery. Usually, patients require only 4 to 5 days to feel well enough to return to work.