Common signs and symptoms include:
Many chronic sinusitis sufferers are treated with repeated courses of antibiotics, decongestants, steroids, antihistamines, nasal irrigation and various nasal sprays or other allergy treatments (such as allergy shots). Sometimes the infections are so chronic that these patients feel constant facial pressure and fatigue for such long periods of time they begin to feel “used” to it or forget what it is like to be without sinusitis.
Surgery is often the next step but they may feel afraid or unsure of its benefits. These patients have already maximized their treatment of allergies or control of environmental irritants and would like to feel better. Functional endoscopic sinus surgery (FESS) aims to relieve structural or mucosal obstruction of the sinuses with minimal damage to the rest of the nasal passages. The goal is to widen or open up the natural paths for sinus drainage.
In chronic sinusitis, the natural openings of the sinuses are often narrowed or completely closed due to the inflammation from repeated infections, allergies, nasal polyps, or other structural abnormalities. Antibiotics given in this situation will kill the bacteria but the sinuses are unable to drain the fluid - leaving the patient with persistent symptoms of pressure and fluid in the sinuses that can become easily re-infected. In this case, opening the sinus is the only way to improve the situation. Once the sinus is opened during surgery, the sinus can also be washed out to help clear the chronic infections.
Some new tools in FESS allow the surgeon to treat the sinuses with minimal damage to surrounding
tissues and organs. Image guidance during surgery allows the surgeon to bring an interactive computed tomography (CT) or magnetic resonance imaging (MRI) scan into surgery to help identify structures and steer clear of surrounding vital organs (such as the brain and the eye) to help make FESS safer (see article in July 2007 newsletter)
A device called Balloon Sinuplasty consists of a small guide wire that guides a small balloon to enlarge the sinus opening (see Figure 1)
Using the balloon to open the sinus rather than the traditional cutting instruments helps minimize trauma to the surrounding nasal tissue. The thin guide wire also aids in opening of some sinuses that can be harder to reach with traditional instruments such as the frontal sinus or sphenoid sinus (see Figure 2)
A new device called Stratus allows administration of medications such as steroids or topical antibiotics during sinus surgery directly into hard to reach sinuses. Both the Balloon Sinuplasty and Stratus devices may involve the use of fluoroscopy (an intraoperative real time x-ray) during surgery to confirm correct placement. With newer devices in the sinus surgeon’s armamentarium, sinus surgery is safer and more helpful to chronic sinus sufferers. Please discuss these devices with your surgeon to see if they are helpful in your individual case. All surgeons at CCENT are trained in image guided surgery, Balloon Sinuplasty, and Stratus.