Sinus problems

1. h2. SINUSITIS AND NASAL POLYPS

How it develops

The paranasal sinuses are air filled cavities situated in the face. It is thought that they act as a buffer zone protecting important facial structures from trauma plus they also give the voice resonance and a certain timbre.

Lining the sinuses is a mucosal lining which has a lot of mucus glands, to lubricate the nose, and “cillia” that act to transport this mucus to the back of the nose and into the throat.

There are some conditions that temporarily paralyse the nasal cillia such as bugs, pollution, allergies and cigarette smoke. If unchecked, this can result in infected secretions damming up in the sinuses which can cause acute sinusitis which is typified by pain, headaches and blockage. Accompanying these symptoms is a feeling of malaise and fever.

If this process continues it can cause the nasal lining to become permanently swollen and scarred. This too requires the same treatment as for acute sinusitis but often will require surgery to help the sinuses to drain properly and to “breathe”.

Persistent, low grade infection and allergies are two of the main causes of benign swellings in the nose called nasal polyps. Predictably they can block up the nose over a long period of time and, if they do not respond to the medications below, will ultimately need to be removed to improve sinus drainage and aeration.

Conservative Treatment

Acute / Chronic Sinusitis

Analgesics. Paracetamol and anti-inflammatories (Brufen / Voltarol)
Decongestants. Short term use of Otrivine or Vicks helps to improve the drainage of the sinuses.

Moisture. This is provided by regular steaming and use of salty water douches. Douches can be home made (cup of tepid water, ½ tsp salt, ½ tsp bicarbonate of soda) or purchased over the counter (Neilmed).

Antibiotics. These will be provided by me or your GP for a week.

Surgical Treatment

Resistant Nasal Polyps / Resistant Acute or Chronic Sinusitis

Before surgery on the paranasal sinuses can be safely carried out, a pre-operative CT Scan (Computer Tomography Scan) is performed to show the anatomy accurately thus acting as a “road map” through the sinuses. Once the CT Scan has been performed, I then go through it carefully with the patient demonstrating the source of the sinus problem and how it will be resolved.

This procedure is almost always carried out under a general anaesthetic but very occasionally local anaesthesia with sedation can be used to remove 1 or 2 large polyps.

In order to perform sinus surgery accurately, I use a small telescope (endoscope) to navigate through the paranasal sinus complex. This is called FESS: Functional Endoscopic Sinus Surgery and it is divided into different components:

Polypectomy. Removes the nasal polyps while leaving behind the normal nasal tissues.
Middle Meatal Antrostomy. Drains the large maxillary sinuses which lie under the cheeks.
Ethmoidectomies. Drains the “honey comb” ethmoid sinuses that run along almost the full length of the nasal cavity at the level of the eye sockets.
If the sphenoid or frontal sinuses are blocked, these too can be carefully opened up.

I also deliver advanced applications for endoscopic nasal surgery such as tear duct surgery (Dacrocystorhinostomy), nasal tumour removal and anterior skull base surgery / pituitary surgery. This is usually in conjunction with my ophthalmological and neurosurgical colleagues respectively.

Post operative care

• Keeping the head elevated along with cold compresses over the nasal bridge and neck helps to reduce nose bleeds as does avoidance of hot food and drink. It also helps to suck on ice cubes as the roof of the mouth also forms the floor of the nose, thereby cooling the nasal cavity as well.
Sometimes spongy packs are inserted to stop oozing and these are removed later the same day or the following day.

• Bathing, showering and hair washing is acceptable after 48 hours but the water should be kept on the tepid side for the first week.
Pain and headaches can occur and are best treated with paracetamol.

• BetnesolR steroid drops will be supplied to moisten the nasal cavity plus reduce internal swelling in the first week. If the polyps are large, a short (5 day) course of oral steroids will be supplied as well.

• External bruising and swelling are very uncommon.

• The paranasal sinuses lie close to the brain and the eye sockets. It is possible to involve these areas causing damage but this is an extreme rarity and is mentioned to make sure that patients undergoing this surgery are fully informed.

• FESS can be performed as a day case procedure or may require an overnight stay. This really depends on the individual concerned and the potential for bleeding or further complications.