SINUSITIS DISEASE

Sinus disease is very common in industrialized countries. It contributes to significant respiratory disease, which is one of the largest causes of work loss in the United States.  It causes significant illness, including congestion, headaches, post-nasal drainage, and nasal polyps. Complications of sinus disease include face, eye, and brain abscesses, nerve injury to any of the cranial nerves(nerves to the face and head) near the sinuses, local bone destruction, spinal fluid leaks, and sometimes even death.

Proper treatment of sinus infections is necessary to prevent complications and decrease morbidity. Your otolaryngologist is the best trained physician/surgeon to diagnose and treat sinus problems. Early consultation with an otolaryngologist will help prevent the irreversible changes in the sinus mucosa and bone that occur when infection has been present for a long period of time.

Sinus disease is integrally related to multiple disease processes and environmental factors that affect the head and neck. Anatomical problems that interfere with a normal air flow and proper sinus drainage cause and aggravate sinus disease. Nasal septal deviation and anatomical abnormalities from old facial fractures are only two of these causes. Allergies, especially dust mite, mold, and animal allergy cause nasal swelling that interferes with normal air flow, obstructs sinus openings, and causes excessive mucous production that aggravates infection. GERD, gastrointestinal reflux disease, may also aggravate sinus disease. Sinus disease associated with nasal polyp formation is aggravated by the use of aspirin or aspirin-containing products, including the tartrazine dyes (yellow dye #5). Smoking also aggravates sinus disease.

Sinus disease occurs in several forms, but all are related to a combination of infection and the inability of air to get into sinus cavities from the nose. Similar to the ear and mastoid , the sinuses are air-filled spaces surrounded by thin bone and lined by mucosa. When the air is absorbed by the mucosa faster than air can get through the sinus openings (ostia) into the sinuses, a relative vacuum develops and fluid is pulled from the lining tissues of the sinuses into the sinus cavities.  This fluid easily becomes infected.  Allergy causes mucous glands to release thicker fluids (mucous), which can also become infected and which are harder to clean from the sinuses. Besides the toxic effect on the nasal tissues from the carcinogens in cigarette smoke, cigarette smoke paralyzes the hairs of the cilia of the nasal and sinus mucosa that move the mucous your nose normally produces into your throat. When normal mucous does not flow from your nose into your throat, it becomes infected more easily and adds to a "downward spiral" of problems that causes full-blown sinus disease.

Sinus surgery, opening the sinus cavities so air can reach the mucosa in a "functional" way, allows reversal of the disease process as long as the mucosal and bone of the sinuses has not been too badly damaged by the infections. FESS (Functional Endoscopic Sinus Surgery) has revolutionized sinus surgery. It has increased the completeness of disease removal at the same time as it has allowed simpler and less invasive procedures to eliminate the sinus infections/disease. Short endoscopes pass light into the nose and sinuses and magnify the field for the surgeon, allowing state of the art instruments to open the small sinus cavities and remove disease with the least surgical trauma to the remaining bone and mucosa. Less packing is needed with this kind of sinus surgery and there is less postoperative pain and drainage.

Control of allergic disease is imperative if sinus disease is to be cured and if reinfection is to be prevented. Allergy shots (desensitization) for dust mites, molds, and cat are often indicated if sinus disease is to be well controlled. Nasal steroid sprays help decrease nasal edema and open up sinus ostia, as well.

Chronic sinus disease may cause or aggravate nasal congestiion problems that can make sleep apnea worse. It can also cause problems that limit a patients ability to use CPAP on a consistent basis.

Gastrointestinal reflux (GERD) can irritate the lining of the throat, mouth, voice box, upper trachea (windpipe) as well as the back of the nose, the adjacent sinuse, and the openings ofthe eustacian tubes to the ears.. Reflux often occurs during the night when a person lies flat, but it can also occur during the day. It is a MAJOR factor causing and aggravating ear, nose, and throat diseases. Control of GERD is imperative.

Control of fungus infection in the nose and sinuses is often necessary to clear sinus infections and prevent their recurrence. Ask your otolaryngologist about this.