Continuing our sojourn into the land of sinusitis, we will now explore treatment options. For ENT doctors, the primary goal of sinus treatment is to restore the normal sinus drainage patterns, allowing the sinus to clean itself.
The first step for treatment is medication and at-home supportive care, which may include antibiotics to kill bacterial infections. In many cases, once the nasal tissue is no longer in a cycle of infection and swelling, the sinuses naturally return to normal. In episodes of prolonged swelling, over the counter decongestants, such as Sudafed or Afrin, may increase the efficacy of the antibiotic. High fluid intake and humidifier usage reduces nasal tissue swelling and produces mucus that is not viscous. Saline solution, made by mixing a quarter teaspoon of salt in a cup of warm water, makes an excellent irrigator by moistening the nose and decreasing nasal congestion. You can also buy saline solution over the counter under the brand names of Ocean or Ayr.
When conservative therapies, such as the aforementioned measures, are insufficient and sinusitis symptoms last more than 4 weeks, there may be an obstruction in the sinuses that requires surgical intervention. To determine the appropriateness of surgery, an ENT will obtain perform a nasal endoscopy, in which a small telescope is inserted in the nostril to view the sinus openings. If the sinuses are occluded or unable to be visualized, a computerized tomography (CT) scan of the sinuses will be ordered, in which X-rays are used to produce a cross-sectional view of the affected area. If any abnormalities are seen, the patient may consider endoscopic sinus surgery or ESS.
Image Source: Dorling Kindersley
Under general anesthesia, surgeons use fiber-optic scopes to illuminate the internal anatomy of the the nasal cavity and sinuses. Probes of various sizes are introduced to widen and restore ventilation manually of the ostiomeatal complex, the opening between the sinus and larger nasal cavity. Cultures and biopsies may be performed to guide postoperative therapies such as identifying antibiotic resistance or illuminating alternate causes of the infection.
If your sinuses are causing you trouble, see your closest ENT!
Feature Image Source: Justin Chin
