Sinusitis Treatments
By:
Timothy L. Smith, MD, MPH, FACS
Professor
and Director, Oregon
Sinus Center
Lindsay
Wyant, MS, PA-C
Instructor,
Oregon Sinus Center
| Treatment of Chronic Sinusitis |
No matter what the medical problem, surgery is almost always a last resort. Physicians favor trying less invasive treatments first, such as medication. Most chronic sinus problems are thought to occur as a result of ongoing inflammation in the nose and sinuses. In some cases, the cause of the inflammation is difficult to determine.
The treatment of chronic sinusitis revolves around re-establishing ventilation and drainage of the sinus air spaces. A majority of chronic sinusitis cases are managed medically. Non-surgical options are utilized extensively and may include topical steroids, systemic steroids, newer anti-inflammatory agents, decongestants, allergy remedies, and antibiotics. Many patients are often treated with antibiotics, although the symptoms will recur unless sinus drainage and ventilation is somehow accomplished and maintained. In most cases, surgical options are considered only if a patient has tried and failed maximum medical therapy.
Sinus surgery is performed using endoscopes (small telescopes) for visualization. Generally, no incisions are required. During surgery, the minimal amount of sinus tissue necessary is removed to re-establish ventilation and drainage of the sinus air spaces. This is done in a very precise manner so that healing is quicker and scarring is minimized. Nasal packing is generally not necessary.
Patients are instructed in the proper technique for irrigating the sinuses which promotes a quicker post-operative recovery. In addition, close endoscopic monitoring and cleaning of the sinus cavities is required to help prevent recurrent sinus problems.
Medical management such as topical steroids, systemic steroids, newer anti-inflammatories, and antibiotics may also be necessary post-operatively to aid in achieving a successful outcome.
Some sinus problems are not caused by an inflammatory disease. Victims of
a facial injury may incur damage to their sinuses. Additionally, sinus pain
can be caused by a benign or malignant tumor. In both circumstances, surgical
intervention is often necessary.
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