Rashmi Hospital

Centre for Minimally Invasive Surgery & Maternity

190, Double Road, Indiranagar Bangalore 38

Tel: 25253311, 25251573, 25251139, 25200447

For Maternity, Gynaecology & ENT: 9880108844/9980015424

Keyhole surgeries performed

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What are sinuses? ] What is sinusitis? ] How is sinusitis diiagnosed? ] [ How is sinusitis treated? ] Functional Endoscopic Sinus Surgery ]

How is sinusitis treated?

The goal in treating sinusitis is to re-open the narrow communication between the sinuses and the nasal cavity (See "What are sinuses?"). This in turn promotes movement of mucus out of the sinus and re-establishes normal oxygen levels within the sinuses. In chronic sinusitis, the principal way to accomplish this goal remains medications. In some patients, medical therapy fails to provide relief of their symptoms. These patients may be considered for surgery (See "What is Endoscopic Sinus Surgery?").

Often the treatment of chronic sinusitis involves combining a number of medications. Each class of drugs is summarized below.

STEROID NASAL SPRAYS    This class of medications works to diminish the nasal lining's inflammatory response, resulting in less swelling and better mucus transport. These sprays form the first in the treatment of a number of inflammatory conditions within the nose. They are typically sprayed into both sides of the nose and work directly on the lining they come into contact with. Their onset of action is relatively slow and patients may not feel their effect for days or weeks. For this reason, often patients give up on this method of treatment too soon.

Steroid nasal sprays are generally well tolerated. Side effects from these medications include irritation within the nose and nasal bleeding. This bleeding can be avoided by pointing the spray bottle away from the nasal septum (the bone and cartilage that runs down the middle of the nasal cavity). Because the sprays are minimally absorbed throughout the rest of the body, side effects seen with taking steroid pills (see below) are extremely rare.

ANTIBIOTICS    The vast majority of cases of chronic sinusitis are due to bacteria. For this reason, antibiotics are another mainstay of treatment. Most patients who see a specialist regarding their sinuses have previously been on many courses of numerous antibiotics. In many cases, these courses are for only seven to ten days, usually insufficient to stamp out the bacteria in a chronic infection. Most experts now believe that antibiotics for chronic sinus infections should be maintained for a minimum of three to four weeks. Ideally, the antibiotic should be chosen based on the results of a culture, where a sample of the bacteria is sent to the laboratory for identification and other testing. Because the openings of the sinuses cannot be seen without an endoscope (See "How is sinusitis diagnosed?"), blind sampling of the nasal cavity using conventional equipment is nearly useless. Nevertheless, endoscopically directed cultures have proven quite useful and specific.

Antibiotics have a number of side effects, many of which are specific to each different type of drug. Nevertheless, some are common including rash and diarrhea. If these occur, the drug should be discontinued and the symptoms immediately reported to your physician. While most reactions are mild, some can be serious and may require additional medical attention.

ANTIHISTAMINES    Antihistamines combat the allergic response within the nose. Many patients with chronic sinusitis have symptoms of allergies including itchy nose or eyes, sneezing, watery eyes, and nasal congestion. Patients with chronic allergies may not experience the typical itching and sneezing symptoms, but may have chronic congestion, runny nose, and fatigue. The allergic response to an irritant (commonly dust mites, pet fur, or pollen) results in inflammation within the nose, precipitating or worsening the sinus condition. Blocking this response can improve sinus function and reduce symptoms of sinusitis.

One problem with many older antihistamines is the fact that they can cause sedation as well as drying and thickening of nasal secretions. Many new antihistamines have little or no sedative side effects and don't cause problems with secretions. Some are also combined with a decongestant to further reduce swelling within the nose and sinuses. While most antihistamines come in the form of pills taken once or twice a day, others can be sprayed into the nose or come as eye drops to control specific symptoms.

DECONGESTANTS    Decongestants act specifically to decrease swelling within the nose. They work directly on the blood vessels within the nose that control the thickness of the lining. They may also affect blood vessels throughout the body and should be used with caution (if at all) in individuals with certain disorders, particularly difficult to control hypertension or high blood pressure. Most decongestants are available "over the counter" and they are often combined with antihistamines. They can cause jitteriness or difficulty sleeping for some patients and should not be used in men with prostate problems.

Decongestant nasal sprays merit a special word of caution. They are particularly useful in diminishing swelling within the nose for a short period of time. If used for more than three days in a row, they can lead to a "rebound effect" and actually worsen nasal swelling. Often patients will then increase the dosage or the frequency with which they use the sprays in order to diminish the rebound swelling. This leads to a vicious cycle of decongestion followed by rebound swelling, a condition known as "rhinitis medicamentosa"

MUCOLYTICS    These drugs, also known as expectorants, are common ingredients in cough syrups to loosen and thin mucus. Because mucus often becomes thick and stagnant in chronic sinusitis, many physicians believe these medications may be helpful in this condition as well. The mucolytics are usually well tolerated with almost no side effects. In higher doses they can cause nausea and, because these drugs act to thin mucus, they can increase fertility in women.

NASAL SALINE SPRAY    Like mucolytics, nasal saline (salt water) has been theorized to improve mucus transport. While there are no good studies to support this claim, saline sprays are relatively innocuous and inexpensive. They appear to be helpful in some patients, especially those with dryness or crusting as a major symptom. Other sprays, which have various herbal additives, have given some patients relief as well.

IRRIGATIONS    Some physicians advocate rinsing the nose with saline or other solutions. The fluid can be delivered using a rubber bulb or with an attachment to a Water Pik machine. Irrigations can assist in removing thick or dried mucus. Antibiotics are sometimes added to the solution to decrease infection as well. If irrigations are used within the nose, great care should be taken to keep all items as clean as possible. This will prevent introducing new bacteria from the irrigation system into the nose, which can perpetuate an infection.

ORAL STEROIDS   In severe cases of chronic sinusitis, oral steroids (steroid pills taken by mouth) may be used. These drugs augment the action of the nasal steroid sprays in decreasing the inflammatory response within the nose and sinuses. While they are quite effective, because these drugs are taken in pill form the medication spreads throughout the body and may have significant side effects. These include osteoporosis, liver abnormalities, cataracts, glaucoma, weight gain, emotional changes, and joint problems. With the exception of emotional changes and weight gain, most of the side effects are rarely seen unless the drug is used for a prolonged period of time. Oral steroids are often given to patients with nasal polyps or asthma in preparation for surgery. They may be continued for a few weeks following the procedure to diminish the inflammatory response during healing.

Go to next page: "What is Endoscopic Sinus Surgery?"