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Sinus & Allergy - SINUSITIS and Treatment Options

Sinusitis is one of the most common problems presenting to an ear, nose and throat physician. More than 35 million Americans are diagnosed with sinusitis annually, resulting in an estimated 2-3 billion dollars medical cost. Many patients suffer from upper respiratory infections, especially during the winter months. When a cold is persistent, usually more than 5-7 days, sinusitis often has developed. sinusitis treatment cumming, ga

Sinusitis is an infection of the mucous membranes that line the inside of the nose and sinuses. The infection is most often caused by bacteria, however, fungi and viruses can also play a role. Sinusitis requires evaluation by a physician and treatment with antibiotics in order cure the infection and prevent further problems.

Patients with acute sinusitis present to the physician with nasal congestion, cough, colored nasal drainage, facial pressure and headache. Other symptoms include bad breath (halitosis), decreased taste or smell and upper tooth pain. The treating physician can often make the diagnosis based on the history and by performing an examination of the nasal cavity. However, if foul drainage is not seen and the diagnosis remains unclear, a screening CT scan of the sinuses can easily be performed to confirm the diagnosis.

Treatment for bacterial sinusitis includes antibiotics, decongestant, mucus thinners and nasal steroid sprays. Oral steroids (prednisone) are prescribed for difficult cases and when nasal polyps are present. Because sinus infections are difficult to clear, the duration of treatment usually lasts 2-3 weeks. Shorter coursed of antibiotics often result in recurrence of the sinus infection. Antihistamines, the mainstay treatment for allergies, can actually be detrimental in treating sinusitis. Antihistamines thicken the nasal discharge and consequently prevent proper drainage. It is very important for patients to complete the entire course of antibiotic even though they might feel significantly better midway through therapy.

When patients fail to clear the sinus infection, the physician must consider whether a resistant bacteria is responsible. Ear, Nose and Throat physicians will pass a nasal endoscope and obtain a deep culture in these difficult cases. With the specific bacteria identified on culture, the precise antibiotic can be chosen. In some cases, a highly resistant bacteria found on culture is treated with intravenous antibiotics. Most labs take 5-7 days to process a sinus culture.

For the chronic sinus patients, who experience several infections per year, further testing is warranted. These patents either have an anatomical obstruction causing the repeated problem, undiagnosed allergies or both. A CT scan of the sinuses is obtained to better delineate the sinus drainage passages. If the CT does show a blockage, sinus surgery can be extremely beneficial. It is extremely important to test all chronic sinus patients for underlying allergies. Aggressive treatment of allergies will significantly decrease the frequency and severity of chronic sinusitis.

Sinus Surgery

Sinus surgery has progressed significantly over the past several years. Many patients fear surgical intervention secondary to horror stories relayed by relatives and friends. In truth, sinus surgery is both highly effective and in the majority of cases, minimally invasive. All sinus surgery is performed by visualizing the sinus cavities with a rigid endoscope, avoiding an external incision. The blocked sinus passages can be carefully opened up with minimal tissue trauma. The two most common methods available are balloon sinuplasty and powered instrumentation (a Shaver).

Balloon Sinuplasty

Balloon sinuplasty was FDA approved in 2005. A non-latex miniature balloon is advanced into the blocked sinus passages and inflated which results in a dilated sinus drainage pathway. The procedure is safe, minimally invasive and significantly improves quality of life. Surgical time and bleeding tend to be lessened with balloon sinuplasty.
Many Ear, Nose and Throat surgeons favor this technique when dealing with the frontal (forehead) sinuses.

Powered instrumentation for sinus surgery utilizes an oscillating blade with attached suction that allows for precise opening of the sinus blockage under direct visualization. Shavers were adapted from arthroscopic orthopedic surgery in the early 1990’s. Originally used primarily for nasal polyps (benign growths in the sinus and nasal cavity), today, many ENT surgeons including myself favor the shaver for the majority of sinus cases.

Often the two techniques, balloon sinuplasty and powered instrumentation are complimentary. The balloon is utilized for the Maxillary (cheek) and Frontal (forehead) sinus and the shaver is favored for the Ethmoid (Eye) and Sphenoid (deep) sinus.


Gain Access to the Sinus. To gain initial sinus access, our sinus guide catheter is introduced into the nasal cavity to target the sinus ostia under endoscopic visualization. Our sinus guidewire or our sinus illumination system is introduced through the sinus guide catheter and gently advanced into the target sinus.	Inflate Balloon Across Ostium. The sinus balloon catheter is introduced over the sinus guidewire or sinus illumination system and positioned across the blocked ostium. The position of the sinus balloon catheter is confirmed and the balloon is gradually inflated to open and remodel the narrowed or blocked ostium.	Deflate and Remove Balloon. The sinus balloon catheter is then deflated and removed, leaving the ostium open allowing the return of sinus drainage. There is little to no disruption to mucosal lining.

When prior surgery has been performed, the anatomy is often distorted. In these cases, image guidance technology is available to help guide the sinus surgeon. A detailed CT sinus scan is obtained prior to surgery. A computer in the operating room performs a three dimensional reconstruction of the patients head. During the actual surgery, the sinus surgeon can view a computer monitor and localize instruments during surgery to within 2-3 millimeters. The accuracy of the surgery is enhanced greatly as well as the safety.

Maintaining an open sinus cavity after sinus surgery for chronic sinusitis has always been a challenge. Although the overall percentage of patients requiring revision surgery is low, patients with severe allergies and nasal polyps often develop problems. A recent development to prevent restenosis of the sinus passage or regrowth of polyps involves placing a drug eluting stent after sinus surgery. The company, Intersect, has developed an absorbable stent that is place in the sinus cavity at the end of sinus surgery. The stent slowly releases a low level of steroid to surrounding tissue to prevent swelling and scarring. Clinical studies to date have been very favorable.

Nasal packing is rarely required after modern day sinus surgery. Patients are able to return to work much quicker and rarely complain about significant pain afterwards. The nose is very congested during the healing phase. Patients are instructed to rinse the nasal cavity with saline beginning two days after surgery. Keeping the nose moist prevents excessive crusting and speeds up the healing process.

Balloon Sinuplasty Video Animation

Balloon Sinuplasty Patient Testimonial

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In my practice, I offer all the very latest techniques described in this article. With over 20 years’ experience in dealing with the most difficult sinus and nasal cases, North Atlanta Ear, Nose and Throat Associates can offer patients the confidence they need when undergoing treatment for chronic sinusitis.