Acute and Chronic Sinusitis

by Dr. Christopher Chang, last modified on 9/21/11
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Everybody knows what sinusitis is, right? Well, sometimes it is not so straightforward. This article will try to explain what sinusitis is in a common sense way, especially the different forms of it. We will also touch on what endoscopic sinus surgery and balloon sinuplasty attempts to accomplish. (See a normal CT scan of a person's sinuses below.) Feel free to play the YouTube video below to get some background information on this topic.

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Simply put, sinusitis is an infection of the sinus cavities creating pus. Symptoms include facial pain/pressure, purulent drainage from the nose, fevers, etc. When the sinuses are functioning well, the infection gets cleared rapidly with antibiotics and the pus gets cleared easily through the nose. In this scenario, the openings of the sinus cavities into the nose are not blocked so things flow easily. No difficult concepts in this particular scenario.

However, let's look at other sinusitis scenarios which are a bit more unclear...

What about the situation where one experiences pain/pressure in the face and head, but little or no drainage? In this case, infection as the cause of the discomfort may or may not be true.

So what is a person to do if they truly have bona fide sinus infections that keep persisting or recurring despite optimal use of antibiotics, steroids, saline sinus washes (Neilmed Sinus Rinse recommended; sinus irrigation devices also exist for greater ease), and other medications? That's when sinus surgery is considered.

The goal of sinus surgery whether it is performed endoscopically or via balloon sinuplasty is to make the small drainage openings of the sinuses into the nose larger. That's it! By making the sinus openings big enough, the sinuses can't get obstructed as easily and therefore allow for good sinus drainage no matter how much swelling or inflammation may be present. Good sinus drainage prevents/minimizes sinus infections. Paradoxically however, sinus surgery may make your allergy symptoms worse (easier for allergens to gain access into your nose and sinuses since things are opened up), so it's very important to get your allergies under good control before sinus surgery is performed. For those with asthma, having sinus surgery has been shown to markedly improve lung function resulting in decreased number of asthma attacks and use of inhalers overall.

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Watch Video on Image Guided Endoscopic Sinus Surgery or Ballooon Sinuplasty
Video on How to Perform Saline Sinus Flushes

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When investigating what may be causing a given person's sinus pressure/pain, a CT scan of the sinus is often ordered. The reason for the CT scan is to first of all, see if the symptoms are indeed truly coming from an infection as well as to see if there are any anatomic causes of sinus obstruction including a deviated septum or large adenoids that makes a person more prone to sinus infections.

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Normal CT Sinus: Note the air within the sinus cavities denoted by black (just like the black surrounding the head). White is bone. Grey is soft tissue.

Abnormal CT Sinus: Note the grey coloration within the sinus cavity, especially the right side. This person has right greater than left maxillary sinusitis along with severe bilateral ethmoid sinusitis. Entirely possible that nasal polyps are present in these same locations as well. This person also has a deviated septum.