Sinusitis is one of the most common health problems in New Zealand presently. It affects both adults and children and has been reported worldwide to affect well over 30 million people every year.
Causes of sinusitis
Symptoms can significantly affect your health both physically, functionally and emotionally. Though sinusitis is a common problem, it is caused by a complex array of different factors occurring within the nose, such as allergy and nasal polyps, including:
- Bacterial changes
- Viral changes
- Fungal changes
- Immune changes.
These conditions lead to inflammation plus or minus infection of the lining of the sinuses. The sinuses themselves are small air-filled pockets in the areas around the nose (see diagram below).
Types of sinusitis
The drainage pathways from these sinuses into the nose are relatively small, and inflammation from any of the above factors or even environmental factors can lead to a sinus obstruction.
1. Simple sinusitis
2. Chronic sinusitis
A cold, caused by a virus, is a classic example of simple sinusitis. However, if symptoms persist for several days, bacterial infection or acute sinusitis may be diagnosed. If the problem lasts 3 months by definition “chronic sinusitis” is said to exist.
Symptoms of sinusitis
Common symptoms of sinusitis:
- Facial pain
- Pressure or fullness of the face.
People often complain that their face feels heavy or that they feel like they have a cold they just can’t get rid of. Nasal obstruction or blockage is common. Discharge of discoloured mucus can come forward, requiring the use of tissues or hankies throughout the day, or even discoloured post nasal drainage may be the only symptom. Loss of sense of smell is possible, as well as headaches and general tiredness. Clinical examination at my rooms, combined with CT scanning of the paranasal sinuses, can often aid in the diagnosis.
Treatments for sinusitis
Treatment for chronic sinusitis often involves either multiple medical therapy (including sprays, antibiotics and oral steroids) or sinus surgery.
Sinus surgery has rapidly evolved in recent years with the advent of fibre optic telescopes connected to high definition 4K cameras, real-time suction irrigation microdebriders and computer assisted surgical navigation.
I have been at the forefront of using surgical navigation and image guided surgery for sinusitis in Christchurch. This is an aid to assist safety and confirm landmarks as well as facilitating complete removal of diseased obstructive tissue in complex surgical cases.
Endoscopic sinus surgery is performed through the nose, usually with the patient asleep under general anaesthesia. A minimally invasive technique is utilised removing diseased or swollen tissue and removing small bony partitions to create improved ventilation of the sinuses.
The goals of surgery are:
1. Restore ventilation of the sinuses
2. Restore homeostasis and self-cleaning of the sinuses
3. Allow medication to reach the diseased lining of the sinuses such as steroids, antibiotics and more.
For complex cases such as those with nasal polyps or other immune issues, or in the setting of someone who has had failed previous surgery, other techniques may be required using advanced endoscopic techniques such as endoscopic lothrop surgery.