WHATS UP YOUR NOSE?
The presence of long-standing (more than 3 months duration) nasal symptoms such as nasal congestion or blockage, drainage sensation at the back of throat, runny nose, reduced smell, and particularly facial pain, does not necessarily mean that sinus disease is causing those symptoms. Such symptoms may occur due to nasal allergies, inflammation of adenoids, facial pain and migraine syndromes, reflux, dry eye/nose/mouth (sicca) syndromes and problems with the tear duct. A thorough ENT assessment can help identify objective signs of sinus disease. This generally involves an endoscopic examination of the entire nasal cavity, including drainage areas of the sinuses and tear duct within the nose, allergy tests and sinus CT imaging. If follow-up sinus imaging is needed, we usually request low-radiation sinus CT scans.
When inflammatory sinus disease is confirmed, the best approach is to manage the problem medically first, and in the majority of patients such treatment is sufficient. In most situations antibiotics are not needed to treat chronic sinonasal symptoms. Antibiotic treatment alone does not cure chronic sinusitis. However there may be findings during your clinical assessment that would indicate whether antibiotics are required for you. One of the keys to successful medical treatment is ensuring that nasal medications are applied correctly and diligently.
A personalised, step-by-step approach to rational medical therapy is instituted and an assessment of general health, immune function, vitamin deficiency, and optimisation of co-existing conditions such as asthma may be necessary to achieve the best outcome for your sinuses. This may include a visit to your dentist, immunologist/allergist, respiratory physician, nutritionist, and other healthcare specialists. Exposure to cigarette smoke (including passive smoking), chemicals, dusty environments and allergens are also important to address.
Where medical treatment fails, an operation may be indicated, especially if it appears that blocked sinus drainage pathways may be contributing to your chronic sinus inflammation. In the majority of patients, an operation is likely to improve symptoms due to sinus inflammation once the sinuses are healed. However, as mentioned earlier that, if some of the “sinus symptoms” were due to other causes, such as allergies, facial pain syndromes or reflux, these would not be expected to improve with a sinus operation and will need to be addressed separately. In a small proportion of patients, the goals for surgery are slightly different because there is an underlying tendency for chronic sinus inflammation. Patients with nasal polyps, cystic fibrosis and Wegener’s granulomatosis may fall in this category. In this situation, generally surgery is not expected to cure sinusitis but to help control sinusitis together with medical treatment to achieve “remission.”
The indications for sinus surgery and the likely outcomes will be discussed prior to an operation. The importance of optimising sinus health in the weeks before and after your surgery cannot be emphasised enough to ensure that the best possible outcome from an operation is achieved.
ABOUT THE AUTHOR, DR HARSHITA PANT:
Dr Pant undertook post graduate fellowship training at the University of Pittsburgh Medical Centre in the USA as a fellow and clinical instructor in minimally invasive skull base surgery, rhinology and allergy. She has a unique understanding of the influence of microbes (bacteria, fungi and viruses) and the patient’s immune system in chronic sinusitis and has extensive training in the medical and surgical treatment of nose and sinus problems. Dr Pant specialises in advanced endoscopic sinus surgery and skull base surgery in both adult and paediatric patients, using minimally invasive endonasal (through the nose) approaches. Dr Pant is a staff specialist consultant at the Queen Elizabeth Hospital and a senior lecturer at the University of Adelaide. She has an active teaching and research career at the University of Adelaide.