HOW IS CHRONIC SINUSITIS TREATED?
Sinusitis is initially treated with medicines to decrease inflammation and resolve infection. If sinus symptoms fail to respond to appropriate medical treatment, then surgical options are available which can be extremely effective.
Non-Surgical Treatment Options:
- Antibiotics, usually for 10-14 days
- Steroid Pills and/or Steroid Nasal Sprays
- Salt Water Irrigation of the Nose (Neti Pot for example)
- Antihistamine sprays or pills if nasal allergies are part of the problem
- Over the counter pain relievers (Motrin/Aleve/Tylenol)
Surgical Treatment Options:
Surgical treatment for sinusitis is reserved for cases in which appropriate treatment with medicines is not effective. Many patients continue to have recurrent or chronic sinusitis symptoms despite appropriate non-surgical treatment. Some patients cannot tolerate antibiotics or the other medications prescribed to treat sinusitis. For patients who fail to respond to appropriate non-surgical treatment, surgery can be the difference between a lifetime of continued suffering and freedom from debilitating symptoms.
Most of the patients who fail to respond to non-surgical treatment have a narrowing or blockage of the drainage pathways that should allow mucus from the sinuses to drain into the nasal cavity. Impaired drainage leads to a backup of secretions which is likely a root cause for infections. These narrowed or blocked passageways also lead to a lack of air exchange between the nose and sinuses. This lack of air flow may play a role in continuing sinus problems, in the sense that the sinuses are unable to “dry out” without an exchange of fresh air from the nose. Lack of airflow can also cause sinus pain and pressure from barometric changes such as during weather changes, diving, flying, etc.
Surgeons have treated chronic or recurrent sinusitis for many years by locating the narrowed sinus passageways within the nose and using special cutting instruments to make the passageways much larger. Because this procedure requires special instruments called endoscopes that allow a magnified view of the nasal cavity, this procedure is called FESS for “functional endoscopic sinus surgery.” (Some surgeons just say “ESS” because a “non-functional” surgery would be pretty pointless, right?) FESS often requires general anesthesia in an operating room and a recovery time of 1-2 weeks off work.
About 10 years ago, a minimally invasive sinus procedure became available using special balloons to gently and permanently dilate (rather than cut open) the narrowed sinus openings. This is called Balloon Sinuplasty. The balloon is inserted into the narrowed passageway and then expanded. This essentially “snowplows” open the sinus passageway (ostium), breaking eggshell-thin bone surrounding the ostium in the process. The balloon is then withdrawn from the nose. The new procedure has been shown to be equally as effective as the traditional FESS for sinusitis symptom relief and has several advantages over the old procedure:
- Safer with a much lower rate of potential complications
- Less Bleeding
- Faster Recovery Time (return to work in 1-2 days vs 1-2 weeks)
- Performed in the office with no need for operating room, hospital, or anesthesiologist
- Much less expensive because operating room and anesthesia costs are eliminated
At the San Diego Sinus Center, balloon sinuplasty is our preferred procedure for treating chronic or recurrent sinusitis for the above reasons. Dr. Scheurer has successfully performed hundreds of balloon sinus dilations over the last few years with excellent results.