Jordan S. Josephson

A. Sinusitis is an inflammation of the membrane lining of any of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants, this usually clears in two weeks or less; chronic sinusitis is characterized by persistent sinus infection or recurring sinusitis. Either medication or surgery is a possible treatment.

A. Sinusitis is caused by inflammation secondary to the following four etiologies: the environment, allergy, infection (bacteria, fungus (otherwise known as mold), or virus) and may be exacerbated or precipitated by narrow sinus passageways. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics. In New York and the surrounding areas 9-11 worsened the air quality and caused significant sinus and lung problems for patients. For patients that have bad mold in their environment, some of these patients have developed severe sinus infections.

A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough.Acute sinusitis can last for up to four weeks. However, if it lasts longer than you should consider that the infection is not just acute but that you may be suffering from a chronic condition or worse. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

A. Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms. It is important that care be used with topical decongestants.

A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, yellow green mucus, pus in the nasal cavity, hoarseness, cough, snoring and at times, fever. They may also have headache, bad breath, and fatigue.

A. Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat) (PATIENTS NEED TO BE CAREFUL THAT THEY DO NOT BURN THEMSELVES). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops, sprays and irrigations are also helpful in moisturizing nasal passages.

A. Use of nonprescription drops or sprays might help control symptoms. However, extended use of non-prescription decongestant nasal sprays could aggravate symptoms and should not be used beyond their label recommendation. These products can very often be very harmful and should be used with caution. Saline nasal sprays, drops or irrigation is safe for continuous use. Over the counter products will resolve minor acute sinus infections and will aid in maintanence care but for any problem that is chronic patients are advised to seek care from a sinus swpecialist.

Q. How does a physician determine the best treatment for acute or chronic sinusitis?

A. To obtain the best treatment option, the physician needs to properly assess the patient' s history and symptoms and then progress through a structured physical examination. After that he needs to order and evaluate appropriate tests such as a CT scan. The physician should always read the films himself and should not rely on the report.

Q. What is fungal sinusitis and what is the best treatment for fungal sinusitis?

A. Fungal sinusitis is caused when the sinuses are infected with mold. Like the mold on bread or around your shower tiles. There are various tests that your physician may perform to reveal fungal infection. Cultures for fungus are still far from perfect and there are many false negatives. Therefore the physician must be very familiar with fungal sinusitis and be a good diagnostician to properly diagnose fungal sinusitis. Very often sinus infections can be a mixed infection with both bacteria and fungus causing the disease., Therefore the problem and it’s solution becomes more complex. When the sinuses are infected with fungus, it is important for the sinuses to be drained. Continued and appropriate medical regiments must accompany the drainage procedures that need to be performed to remove the fungus from the sinuses. Environmental control and diet play an important role in the treatment.

Q. What should one expect during the physical examination for sinusitis?

A. At a specialist' s office, the patient will be asked questions about the history of his problem as well as past medical history. No matter how irrelevant you may think something is you should always mention it during the history taking process. The patient should receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exist. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus. The physician should evaluate the ears, nose, throat and neck as they are all related.

A. Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

A. An endoscope is a special fiber optic instrument for the examination of the interior of the nose and the sinuses. The endoscope may also be used to evaluate the ears, and throat.. It allows a visual examination of the nose and sinus drainage areas.

A. Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient' s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that may cause recurrent sinusitis.

Q. Why may a physician perform a flexible fiberoptic laryngoscopy?

A. Flexible fiberoptic nasopharyngolaryngoscopy is performed to evaluate a patients nasopharynx (the area above the soft palate) and larynx(voice box). The nasopharynx is the area behind the nose where the sinuses drain. The eustachian tubes connect the ears to outside world for pressure equalization in the nasopharynx. The larynx (voice box) is visualized for manifestations of post-nasal drip, GE reflux disease (GERD) and tumors including polyps and cancer. Snoring may be evaluated as well. Symptoms such as hoarseness, fullness or foreign bodies in the throat or GERD should be evaluated by flexible fiberoptic laryngoscopy. Nasal Obstruction, nasal bleeding and eustachian tube dysfunction are some of the symptoms that should be evaluated by nasopharyngoscopy.

A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies. If this initial course does not provide relief than the physician may do further testing and prescribe other medicines and combinations of the above and other medicines.

A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus. Chicken soup will help with viral infections.

A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy or the environment causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If the passageways are narrow then they are more likely to have obstruction when inflammmed. If medicines are not effective, sinus surgery can correct the problem of obstruction of the passageways. When these pathways are widened with surgery than they are more likely to drain properly.

Q. What does the surgical procedure entail?

A. The basic endoscopic surgical procedure is usually performed under local anesthesia with sedation. The patient is in a twilight sleep. Packing is rarely required. The patient rarely has any black and blues and usually notes that there is less facial swelling than prior to surgery. The patient may return to work the next working day. It is advised that the patient refrain from doing anything that will raise their blood pressure because this may cause internal bleeding in their sinuses causing them to heal more slowly. The patient should not blow their nose for a few weeks after the surgery but may clear their nose by sniffing in saline solution. Recover takes about four weeks at which time the patient may return to full activity. Full healing takes about three months. And the patient will notice further healing over the next three years.

A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist--head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

A. Not seeking treatment for sinusitis can result in continuation of the patients sinus infections. This can result in continuous nasal obstruction, post-nasal drip, hoarseness, difficulty sleeping, snoring and/or fatigue. In other instances the patient may continue with headaches, unnecessary pain and discomfort. In rare circumstances, eye abscess, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Q. Where should sinus pain sufferers seek treatment?

A. If you suffer from severe sinus pain, you should seek treatment from an otolaryngologist--head and neck surgeon, a sinus specialist who can treat your condition with medical and/or surgical remedies.

Q. If I have had previous sinus surgery that has failed than can surgery correct my problem?

A. If you had sinus surgery in the past there are newer techniques available that offer sufferers new hope for relief of their symptoms. It is important for the patient to pick a physician that specializes in revision surgery. The highest level of training available in the United States to find a Board Certified Otolarngologist-Head and Neck (Ear Nose and Throat-ENT) Surgeon that is fellowship trained in Functional Endoscopic Sinus Surgery.