Sinusitis – Current state-of-the-art treatment

The treatment of sinusitis depends upon if it is an acute sudden or chronic longstanding infection.  With the acute infection, there is facial pain and swelling with endoscopic evidence of pus at the openings of the sinuses. The treatment consists of antibiotics, decongestant, nasal saline douching and pain relief. Often this is sufficient although sometimes a sinus washout with a maxillary sinus needle may be required. Uncommonly in severe acute cases, the sinus infection can spread to involve the neighboring vital structures like the eye and brain. This can be easily diagnosed and seen on a CT scan of the sinus. Under these circumstances, the sinus is unable to drain itself effectively enough and the infection finds other routes to spread. Treatment here will include endoscopic surgery to drain the affected sinuses in addition to intravenous antibiotics.

Chronic sinusitis, on the other hand, is not usually painful. Here the sinus openings are blocked and narrowed, and the pus within the sinus cannot effectively escape. However the body is unable to completely clear the sinuses of the infection. Sinusitis can be best diagnosed here with a CT scan of the sinus which shows the anatomy of the sinuses and the infection contained within. Based on this CT scan, the ENT Surgeon has a roadmap to surgically operate on the natural sinus openings with an endoscope through keyhole surgery without having to use his knife. Studies have long shown that sinuses must be drained through their own natural openings for the sinus to re-establish its own function again. Drainage openings made into the same sinus at other places other than their natural openings to drain the pus are ineffective. Here the body’s natural clearance pathway will still direct the remaining pus to the “blocked “ natural sinus opening even when a big drainage opening has been made nearby.

More recently in sinus management, there is a trend to offer balloon dilatation of the sinus openings, very much like the balloon expansion of the heart vessels. These balloon tubes are directed through the narrowed bony sinus openings and then expanded to 12 atmospheres of pressure. This expansive pressure pushes open the bony sinus air cells that surround the opening, and immediately the sinus openings are “widened” allowing them to drain and re-ventilate again with air.

Today sinus surgery is minimally invasive and all the surgical wounds are inside the nose. The concept of the surgery is to widen the natural opening of the affected sinus with endoscopic techniques, and therefore to re-establish the natural function of the sinus. This philosophy directs the way we now term modern sinus surgery as FESS (functional endoscopic sinus surgery).

The Chinese version of this article was published in Hong Kong Economic Journal on July 22, 2013.