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What is a sinus?
The sinuses are air-filled bony cavities located in the face and skull adjacent to the nose. There are four pairs of sinuses. The right and left frontal sinuses are found in the forehead region, the maxillary sinuses are in the cheek area, the ethmoid sinuses are between the eyes, and the sphenoid sinuses lie deep in the center of the skull. Each sinus is connected to the nose by a small opening called an ostium. All except the frontal sinuses begin growing before birth as small pockets approximately the size of a pea. They increase in size through childhood until they are about as large as a walnut.

What is sinusitis?

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires a physician’s diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.

When Acute Becomes Chronic Sinusitis

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.

Tests to confirm the diagnosis

If the diagnosis is not entirely clear, if an acute infection recurs, or if your symptoms have been ongoing (chronic), then additional tests that your doctor may consider include an xray, CT scan, or magnetic resonance imaging (MRI). Sometimes, a referral to a specialist (known as an Ear Nose and Throat (ENT) doctor [also called an otolaryngologist]) is necessary. This specialist may perform a rhinoscopy (also called nasal endoscopy) using a fiber optic scope to look at your sinuses or a sinus puncture to test for different organisms that may be causing your sinusitis

Treating Sinusitis

Bacterial sinusitis:
Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis (see chart), be sure to see your doctor for diagnosis. In addition to an antibiotic, an oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid prolonged use of nonprescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help relieve sinus discomfort.

Antibiotic Resistance
Antibiotic resistance means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. You can help prevent antibiotic resistance. If the doctor prescribes an antibiotic, it is important that you take all of the medication just as your doctor instructs, even if your symptoms are gone before the medicine runs out.

Chronic Sinusitis
If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.

Sinus Surgery
Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease. Surgery can be performed under the upper lip, behind the eyebrow, next to the nose or scalp, or inside the nose itself.
Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on your individual circumstances.

Endoscopic sinus surgery

Why It Is Done
Endoscopic surgery may be needed when medication treatment has failed to improve or cure chronic sinusitis. It is the preferred method of surgery for most cases of chronic sinusitis that require surgery.

How Well It Works
Endoscopic surgery improves symptoms in about 85% of people.
However, surgery does not always completely eliminate sinusitis. Up to 20% may need a second operation.1
Surgery is most successful when used along with medication and home treatment to prevent future sinus infections. A second surgery and future sinus infections may be avoided if antibiotics are taken to prevent reinfection.

As with any surgery, there are always some risks involved. However, endoscopic sinus surgery is very safe when performed by an experienced surgeon who has special training with endoscopic surgical techniques.
Minor complications (such as scar tissue attaching to nearby tissue, or bruising and swelling around the eyes) occur in a small number of people who have the surgery. Major complications (such as heavy bleeding) occur in fewer than 1% of cases.2 Most complications of endoscopic sinus surgery can be managed or prevented.

What To Think About
Sinus surgery may involve the use of scalpels, lasers, or small rotating burrs that scrape away tissue. No one method is necessarily any better or safer than another; techniques vary depending on the surgeon’s experience and preferences. The rotating burr is becoming the preferred device for sinus surgery.

Endoscopic sinus surgery is less invasive than traditional sinus surgery. It does not require a visible incision, so there is no visible scarring. It is also less expensive than traditional surgery because it involves a shorter hospital stay, if any, and a shorter recovery.

Surgery Overview
In endoscopic sinus surgery, an endoscope is inserted into the nose, providing the doctor with an inside view of the sinuses.

Surgical instruments are inserted alongside the endoscope. This allows the doctor to remove small amounts of bone or other material blocking the sinus openings and remove growths (polyps) of the mucous membrane. In some cases a laser is used to burn away tissue blocking the sinus opening. A small rotating burr that scrapes away tissue may also be used.

The surgery may be done in a hospital (inpatient) or in a doctor’s office or clinic (outpatient). Either local or general anesthesia may be used. The procedure takes 30 to 90 minutes.

What To Expect After Surgery

Minor discomfort and bleeding are common during the first 2 weeks after surgery. Weekly visits to the surgeon may be necessary for about 3 weeks after the surgery to have dried blood and mucus removed.
Recovery also may involve:

  • > Packing the nose with gauze to absorb bloody drainage.
    > Taking antibiotics.
    > Using a nasal spray containing a steroid for 6 months or longer to reduce inflammation.
    > Using saltwater washes (saline nasal lavage or irrigation) to keep the nasal passages moist.
    > Avoiding activities such as blowing the nose, exercising strenuously, and bending forward for a few days.
    > Using a humidifier to keep room air moist, especially in the bedroom.

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