Dr. Davidson's Homepage

Nasal Disease Handbook

Anatomy & Physiology

Bloody Noses

Common Cold

Cystic Fibrosis

Endoscopic Sinus Surgery

Environmental Control for Allergy

HIV

Nasal Irrigation

Nasal Steroids

Nasal Surgery

Nasal Tip Infection

Rhinitis - Allergic

Rhinitis - Cold-Induced

Rhinitis - Irritative

Rhinitis - Vasomotor

Rhinoplasty

Sinusitis

Sinusitis - Chronic

The Aging Nose

The Crusty Nose

Tobramycin

Tonsillitis with Halitosis

CHRONIC SINUSITIS

Chronic sinusitis is a condition in which the sinuses become inflamed, which means the mucosa is swollen and the entire mucociliary transport system is impaired. As a result, bacteria within the sinus grow continuously. People suffer from facial pains, pressure, nasal congestion, nasal discharge, post nasal drip, cough, fatigue and just generally not feeling well. Normally, sinusitis is treated with antibiotics. Some add a course of nasal steroids. If this corrects the problem, wonderful.  All to often this does not correct the prblem, because the small drainage ports (the sinus ostia) are just too small to keep the sinus aerated and the fluids properly drained. Once you realize that medical treatment is not going to improve or relieve the chronic sinusitis, it is my practice to perform a complete nasal workup looking for anatomic deviations, allergies, irritations, tumors, foreign bodies left in the nose or anything else which might predispose to the sinus disease. Any illness identified is then treated. If illness is not identified or if medical treatment does not correct the chronic sinus condition, surgery is indicated. The surgery performed today is called endoscopic sinus surgery (ESS). It is performed by ear, nose and throat physicians also called otolaryngology-head and neck surgeons. It can be performed under local or general anesthesia. The surgery is performed using small endoscopes (instruments for visual examination) and micro instruments all inserted through your nostrils. No external incisions are made. The surgery normally takes about an hour to perform. The surgery involves removing the inflamed ethmoid sinuses and then opening the natural sinus ostia to the maxillary and frontal sinuses. The surgery is normally performed on you as an outpatient, meaning that you go home the same day of the surgery. You normally have an uncomfortable stuffy nose for one, or at the most, two days. I usually recommend that patients take a week off of work, not so much that they really need the week, but if you rest, relax and take care of yourself, you will heal better. This surgery has been extremely effective and relieves or cures the chronic sinusitis in as many as 90% of patients.

It is interesting that my familiarity with nasal irrigation began with endoscopic sinus surgery. When the surgery was first described, it was the usual practice to see patients back in the office 3 times a week to clean the crusts from the operated sinuses. This seemed a nuisance both to the surgeon and the patient. We learned that with nasal irrigation, as prescribed in this handbook, the patient could flush the crusts and secretions out of the sinuses. No postoperative endoscopic cleaning was then necessary.

For more information, please review the sinusitis consultation .  In some cases of chronic rhinosinusitis, Amphotericin, an antifungal agent, is recommended.