Got Sinus Issues?
Often, people say their “sinuses” are acting up or they have a “sinus” headache. Referring to the “sinuses” seems to be a catch-all phrase for any issues involving the nose, nasal airway, inflammatory conditions (both viral upper respiratory infections or allergy exacerbations) and the paranasal sinuses.
Assessing the Problem
When assessing patients with “sinus” complaints, it’s important for your physician to assess the context in which the symptoms occur. For example, is there a seasonal component? Any recent exposures to possible infections? Is there a history of dental procedures or midface trauma? Is the complaint present all the time or does it vary throughout the day? A careful evaluation by your physician can help provide clues as to the specific cause of the condition.
Based on the history of the “sinus” issue, a provider can perform a thorough examination for evidence of external nasal deformity, septal deviation, swelling of the nasal turbinates, nasal polyps, masses or infections of the paranasal sinuses.
With a thorough understanding of both the history and the physical exam findings, your physician can make an appropriate diagnosis and treatment recommendations. Symptoms that present like a “sinus” problem may actually be allergic rhinitis causing mucus production and swelling of the nasal lining. Mucus and swelling can cause restricted airflow, and initiating the appropriate medications may alleviate the problem. Management of allergic rhinitis often includes a combination of nasal washes/irrigations of high volume and low-pressure solution, prescription nasal sprays, oral antihistamines and, for some patients, allergy testing and immunotherapy (allergy shots).
Diagnostic Test and Surgical Options
Failure to respond to the recommended medical treatment may indicate anatomic factors that prevent the delivery of nasal sprays and washes, or variations in anatomy that can predispose patients to recurrent infections. Often patients who fail to respond to medical treatments may need a CT scan of their sinuses or nasal endoscopy to gain more information regarding their nasal anatomy.
If necessary, the nasal and sinus anatomy can be corrected with various surgical procedures such as rhinoplasty, septoplasty, turbinate reduction, endoscopic sinus surgery and balloon sinuplasty. There have been many advances in the surgical techniques and instruments available to ENT surgeons managing nasal and sinus issues including the use of image guidance systems, sinus balloon systems and endoscopic techniques to avoid external scars/incisions.
Pediatric Issues
Pediatric patients can also struggle with “sinus” issues. Children are born with maxillary (cheek) and ethmoid (between the eyes) sinuses but, they develop their sphenoid (deep in the nose behind the ethmoids) and frontal (forehead) sinuses during their teenage years. Sinus infections in children are often preceded by a viral illness or allergy exacerbation that causes watery nasal drainage and nasal congestion that usually lasts from a few days to a week. After their viral illness starts there can be a “double worsening” of their symptoms. Changes in the quality of the mucus, foul breath, fever, facial pain or symptoms that have persisted more than 10 days indicate a bacterial sinus infection. Bacterial sinus infections are treated with a course of antibiotics.
Adenoids Role in Airway Symptoms
Drainage from the nose and nasal obstruction can also be seen in patients with adenoid hypertrophy (large adenoids) or adenoiditis (adenoid infection). The adenoids are lymphoid tissue, similar to tonsils. The adenoids are located where the back of the nose and throat meet. Like the tonsils, the adenoids can be quite large in some children and can cause nasal obstruction. Patients with adenoid hypertrophy may have difficulty breathing through their nose, persistent nasal drainage, hyponasal speech (speech sounds like the nose is pinched shut), snoring, recurrent ear infections and mouth breathing. Adenoid Hypertrophy cannot be seen on a routine physical exam. To assess the size and amount of obstruction that the adenoids are causing, a physician can place a small camera into the nose (nasal endoscopy) to look at the back of the nose and throat or send the patient for an x-ray.
Infected adenoids can be treated with antibiotics; however, chronically infected adenoids or hypertrophic adenoids that are problematic are usually removed. An adenoidectomy (removing the adenoids) is a common surgical procedure that can be done by itself or in combination with a tonsillectomy (removing the tonsils) or placement of ear tubes (myringotomy with tube placement). Children who are less than 3 years old, who have sleep apnea or other medical problems are often observed in the hospital overnight; otherwise, most patients go home the same day as surgery.
Foreign Bodies
Another special consideration in pediatric patients is the possibility of a nasal foreign body blocking off the nasal passage and causing obstruction and infection. One indication of a nasal foreign body is drainage from one nostril and a lack of other symptoms of illness. In these cases, the foreign body must be removed completely either in the office if the patient is cooperative or in the operating room.
“Sinus” issues are common and can represent a variety of distinct “true” sinus and nasal problems with differing treatment regimens including medical and surgical management. For persistent nasal and sinus issues see your healthcare provider or ear, nose and throat physician for evaluation.
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