Answers to Your Sinus Questions
The paranasal sinuses are air-filled cavities within the skull, adjacent to the nasal cavity. There are four sinuses on each side, eight in total: 2 frontal, 2 ethmoid, 2 maxillary and 2 sphenoid. The sinuses are bony cavities lined with membrane called mucosa.
Sinusitis refers to a condition in which there exists an inflammation of the mucosa that lines one or more of the paranasal sinuses. The most common causes include viruses, bacteria and yes, even allergies. The inflamed and swollen mucosa of the nose and sinues leads to obstruction of the drainage outflow tract, called the sinus ostium. As a result of the obstruction there is loss of air in the sinus cavity and this is an ideal environment for bacterial growth.
Sinusitis is typically categorized into 4 types, according to the duration of symptoms:
ACUTE - symptoms presents for 4 weeks or less
CHRONIC - symptoms present for 12 weeks or more
RECURRENT ACUTE - 4+ acute episodes within one year, with resolution of symptoms between episodes
ACUTE EXACERBATION OF CHRONIC SINUSITUS - an acute episode occurring in a patient with chronic sinusitis, producing a sudden worsening of baseline symptoms
In the United States more than 30 million people are diagnosed with sinusitis each year.
Chronic sinusitis affects 15% of the US population and is one of the most common chronic illnesses in America.
- Nasal Obstruction or Nasal Congestion
- Thick and Discolored Drainage
- Facial Pain
- Facial Pressure or Fullness
- Bad Breath
- Loss of Smell
- Upper Tooth Pain
- Ear Pressure
The diagnosis of sinusitis, either acute or chronic is made primarily on the basis of the patient history and the physical exam. From time to time it may be necessary to perform on or more procedures to more definitely confirm the diagnosis.
A spray is topically applied into the nose to decongest and anesthetize the nasal cavity. The doctor then examines the nasal cavity and to evaluate the anatomy and presence/absence of infection. If warranted, both cultures and biopsies can be obtained.
X-Rays: while x-rays were used in the past to routinely image the sinuses, this is no longer the case. A CT (CAT) scan is the standard today.
CT Scan: This study is not routinely performed for the initial diagnosis of a sinus infection, but it may be needed in certain situations. If the patient’s symptoms fail to respond to medical treatment, if the presenting signs/symptoms are unclear, or if a complication of an infection is suspected, then a CT scan may be necessary. We at the have a CT scanner dedicated for this purpose. It emits 82% less radiation than those scanners typically found in a large hospital or imaging center. The scan is typically complete in 40 seconds.
MRI: MRI scans by their nature emphasize soft tissue. Since the sinuses are bony cavities this study is not typically employed in the evaluation of sinusitis.
- Antibiotics (this is the mainstay of treatment, with the duration typically lasting between 10-14 days)
- Nasal Salin Irrigation
- Mucus Thinning Agent (Mucinex)
- Over the Counter Pain Relievers (Motrin/Aleve/Tylenol)
- Balloon Sinusplasty
This procedure, now performed under a local anesthetic in the office is a state of the art procedure that effectively dilates the sinuses, thereby permanently opening the drainage outflow tract into the nose. The recovery process is negligible since the majority of patients return to work within 24 hours without any physical restrictions. For more information about Balloon Sinuplasty, click here.
- FESS (Functional Endoscopic Sinus Surgery)
This procedure is performed in the operating room under a general anesthetic, using powered instrumentation. The patient typically requires 5-7 days off from work. Given the advances in surgical treatment, this option is generally reserved for patients that are not candidates for the balloon sinuplasty.
The symptoms of allergies and sinusitis can overlap to some degree. In addition, some patients may have some combination of both. Some symptoms that are more isolated to allergies include sneezing, itchy eyes/nose, clear nasal secretions, itchy/scratchy throat. In addition, allergy symptoms tend to fluctuate with the seasons or environmental change. Many people with allergies will notice specific triggers for their symptoms, such as increases in the pollen count or coming into contact with a cat or dog.
ANTIHISTAMINES: In either oral or spray form, these act by preventing the release of histamine, a chemical that causes nasal congestion, itchy nose and nasal drainage.
NASAL STEROID SPRAYS: These act by reducing the inflammatory response of the allergic reaction; they are useful for targeting nasal congestion.
LEUKOTRIENE INHIBITORS: These act by reducing mucosal inflammation and are useful as an adjunctive treatment for nasal congeston.
NASAL IRRIGATION: Reduces mucosal inflammation by providing a moist environment for the nasal tissues.
ORAL DECONGESTANTS: In the oral form is useful to reduce nasal congestion. Must used with caution since they can easily elevate the blood pressure.
SUBCUTANEOUS IMMUNOTHERAPY (SCIT): A form of therapy that builds up “blocking antibodies.” These antibodies essentially create an immune barrier that prevents your body from eliciting the allergic reaction; this administered into the skin at home on a weekly basis.
SUBLINGUAL IMMUNOTHERAPY (SLIT): Essentially the same as SCIT except this is administered as drops under the tongue on a daily basis.
At the Ress ENT we offer a comprehensive approach to the evaluation and management of nasal/sinus disorders. A complete evaluation is often performed to test for environmental, and when necessary, food allergies. Allergy testing, in the form of both skin testing and blood testing, can be utilized in order to achieve the most accurate test results.
Facial pain/pressure in the absence of nasal congestion or discolored drainage is only rarely associated with true sinusitis. The are many causes of headaches and facial pain that may mimic sinusitis. These include migraine headaches, tension headaches, temporomandibular (TMJ or jaw joint) problems, dental problems and much less commonly tumors.
The nasal septum is located inside the nose. It is the wall that divides the nose into the left and right sides. It is composed of cartilage in the front and bone in the back. If a significant deviation occurs it may result in:
- Nasal airway obstruction
This condition is diagnosed on the physical exam, often in conjunction with both nasal endoscopy and a CT scan. Treatment is available for patients with a deviated septum. With a simple in-office procedure called a Septoplasty, we can realign the septum, and help you breathe clearly again.
Inferior Turbinate Hypertrophy:
The turbinates are bony structures in the nose that are lined with mucus membrane. There are three paired turbinates: the superior, middle and inferior. It is the inferior turbinates that help to filter and humidify the air we breathe. They easily become engorged in response to both allergy/irritants and infection. By reducing the size of the inferior turbinates, long-lasting improvement in nasal breathing can be achieved.
MEDICAL TREATMENT: Antihistamines (oral and nasal), nasal steroids and occasionally decongestants can be useful in reversing the turbinate congestion and improving nasal breathing.
SURGICAL TREATMENT: When medical treatment fails to control the turbinate swelling, surgical options can be considered. We offer an in-office procedure, akin to a liposuction, that shrinks the turbinate from the inside out. It takes less than 10 minutes to complete and avoids any nasal packing. In most instances, the patient is back to work with full activity and no restrictions the very next day.
ACID REFLUX: This condition is associated with acid coming up from the throat. It may present with symptoms such as post-nasal drip or a feeling of thick mucus in the throat, chronic throat clearing and occasional hoarseness. This condition is treated very differently from sinusitis, therefore making the correct diagnosis is of critical importance.
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Locations & Hours
7900 Glades Road Suite #340
Boca Raton FL 33434
Mon: 8:30am - 5:00pm
Tues: 8:30am - 5:00pm
Thur: 8:30am - 5:00pm
Fri: 8:30am - 5:00pm
Phone: 561-353- 7377