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For other articles and previous issues click here. January 12, 2004 The
Sinuses: Unplugged Each year, chronic sinusitis afflicts 37 million Americans—more than 15% of the population. It claims more victims than arthritis or hypertension and results in millions of physician office visits and an equal number of dollars spent on medications to relieve symptoms. Sinusitis—the inflammation of the sinuses—may be acute, generally lasting for fewer than three weeks and often caused by viruses; chronic, spanning a period of three weeks to years and often caused by allergies; or recurrent, characterized by the occurrence of several acute episodes within a year’s time. Although the condition sounds as run-of-the-mill as the common cold (with which it’s often confused), it can result in significant pain, loss of productivity, and social dysfunction for chronic sufferers. The first line of treatment for chronic sinus disease generally involves treatment of any underlying disorder and administration of a variety of medications or the use of irrigation procedures, or a combination of the two. When these approaches fail or sinusitis is recurrent, some patients may get relief from surgery that improves sinus drainage. THE SINUSES Properly functioning sinuses drain through the openings or ducts, releasing their secretions into the nose. Any one or more of the eight sinuses may be affected by sinusitis. When air or secretions are prevented from flowing freely and the sinus becomes swollen and blocked—which may occur as a result of allergies, cold, flu, bacteria, or fungus—pressure may build along the sinus wall, causing pain. The condition becomes chronic when the sinuses remain occluded and their lining swells. A consequence of chronic sinus blockage is the development of polyps in the nose, which in turn often leads to relentless postnasal drip. SYMPTOMS Inflammation of the sinuses is caused when ventilation and drainage are occluded. This blockage may occur as a result of a cold virus, bacteria, fungal infections, nasal allergies, polyps, lesions, or an anatomical anomaly such as a deviated septum. Researchers have established a link between allergic rhinitis and chronic sinusitis—sometimes called rhinosinusitis. Some studies have noted that as many as 80% of individuals with chronic sinusitis also suffer from allergic rhinitis. Studies have also demonstrated that as much as 75% of people with asthma experience sinusitis. Also at greater risk are individuals with immune deficiency disease or disorders of mucus flow such as cystic fibrosis. Researchers from the National Institute of Allergy and Infectious Diseases and other organizations are exploring a possible genetic basis for chronic sinusitis. DIAGNOSIS CONSERVATIVE TREATMENT OF CHRONIC
OR RECURRENT SINUSITIS Medical treatment might involve antibiotics to conquer infection, antihistamines to combat allergies if they have been identified as a source of sinus difficulty, topical and systemic decongestants, nasal steroid sprays to reduce congestion and swelling, and painkillers. In severe cases, doctors may prescribe oral steroids, such as prednisone, to fight inflammation. Another conservative tactic stresses nutrition as a weapon against inflammation. Patients are advised to drink large quantities of water, decrease caffeine consumption, limit intake of fatty and sweet foods, and increase their intake of green vegetables, foods high in fatty acids, and tea. Relief may also be found in home remedies, including over-the-counter saline nasal sprays, vaporizers, and the application of heat to the affected areas. Most patients with sinusitis improve with conservative management. When they fail to respond, if the infection keeps recurring, or when complications occur, surgery may be considered. SURGERY Generally, the goal of surgery is to enlarge the openings that allow the sinuses to drain, but for individuals who have developed polyps as a result of allergies or infections, and for those with structural abnormalities such as a deviated septum, surgeons also want to eliminate or repair the underlying condition. Functional endoscopic sinus surgery
To perform FESS, surgeons advance the endoscope into the nose to visually explore the entrances to the sinuses. Using microsurgical techniques and aided by the telescopes, they can remove diseased tissues directly through the nostrils. Increased drainage and airflow will decrease the inflammation of affected tissues and facilitate a return to a healthy state. Image-Guided Surgery This technology produces a three-dimensional (3-D) triplanal view of an individual’s CT scan and delivers real-time mapping information that relies upon infrared signals, which allow surgeons to more accurately pinpoint problem areas and advance instruments through dense or otherwise difficult-to-navigate sinus passages, particularly in patients with severe disease, those who previously had anatomy-altering sinus surgery, and those with structural abnormalities. In preparation for the procedure, patients are outfitted with a framed plastic helmet (inside of which are small magnets) and given a CT scan. The images from the scan are saved in the computer, where a 3-D model of the patients’ sinuses is developed. This technology, which is based upon military tracking and guidance principles, has vastly improved surgeons’ ability to eradicate sinus disease and bring comfort and relief to patients who have not responded to more conservative approaches. During surgery, the patients wear the same helmet that is now attached to a probe that generates a magnetic field. As the probe moves through the magnetic field, the 3-D CT scan images change to match each new area probed. Small arrows appear on the computer display to indicate the location of the instruments so that the surgeons know precisely how they’re advancing through the complex terrain of the sinuses. Recovery is swift—from three to five days—and the surgery results in no external swelling or bruising. Caldwell-Luc operation Recovery
Sinusitis leads to considerable suffering and reduced quality of life as it places a drain on the healthcare economy. Because it can affect all ages and tends to be recurrent, it interferes with productivity at work and achievement at school. However, early and accurate diagnosis of symptoms and prompt and appropriate treatment by a specialist can relieve sinus misery and greatly improve the quality of life for millions of Americans. — Kate Jackson is a staff writer at For the Record. For more information about sinusitis, visit: American Academy of Allergy, Asthma and Immunology
American Academy of Otolaryngology-Head and Neck
Surgery, Inc. |
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