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The para-nasal sinuses are four pairs of cavities in the skull that are connected to the nasal passage. A thin respiratory lining known as mucosa covers the sinus walls. Infections, allergies, and autoimmune problems can lead to inflammation of the sinuses. Sinus infections are one of the most common maladies in the US, affecting 40 million Americans each year. Sinus infections can be categorized into: acute (lasting less than 4 weeks), sub-acute (lasting 4 to 8 weeks), chronic (lasting more than 8 weeks), and recurrent acute (greater than three or more episodes a year, each lasting less than 2 weeks).
Acute sinus infections cause nasal stuffiness, facial pain, mucous drainage, post-nasal discharge, loss of smell and taste, and upper tooth pain. Viruses are the most common cause of sinus infections. Viral sinus infections are self-limiting and typically resolve within two weeks. When acute sinus infections persist beyond two weeks one should suspect a bacterial sinus infection. Antibiotics are usually necessary in treating bacterial sinus infections. Cultures obtained form the sinuses can guide the best choice of antibiotic therapy.
Chronic sinus infections cause dull headaches, nasal stuffiness, postnasal discharge, heaviness of the eyes, and loss of smell and taste. Compared to acute sinus infections, chronic infections don’t cause fluid buildup in the sinus cavities. Instead, there is a change in the thickness of the sinus membranes leading to polyp formation, blockage of the sinus drainage pathways, and increased mucous discharge. Sinus obstruction causes further inflammation and exacerbation of the sinusitis. Definitive diagnosis of chronic sinusitis requires a CT scan.
In chronic sinus infections, when membrane thickening and polyp formation is minimal, patients may respond to a prolonged course of antibiotics combines with a short course of steroid tablets. However, when large polyps have formed, or when a patient fails to respond to medical therapy, sinus surgery can be curative. Sinus surgery can also alleviate chronic recurrent acute sinusitis.
Dr. Khosh is an expert in performing sinus surgery. Sinus surgery is performed with endoscopic cameras and small instruments that fit through the nose. During endoscopic sinus surgery, correction of a deviated septum may be necessary to gain access to the posterior part of the nose and relieve nasal blockage. In revision sinus operations, Dr. Khosh uses intra operative CT guidance to increase the safety and effectiveness of the surgery. Sinus surgery is an outpatient operation. Patients should expect mild to moderate pain for about three days, and scant oozing of blood for two days.
More recently, a new technique, balloon dilatation sinuplasty has become an accepted choice in surgical management of sinuses. Balloon dilatation sinus surgery is a less invasive method of treating sinus obstruction. In appropriate cases, balloon dilatation sinus surgery can be performed under local anesthesia, as an office procedure. The recovery from balloon dilatation sinus surgery is less prolonged.
