*** CHRONIC SINUSITIS ***   

Compiled By;  Dr. Hafiz Shahid Amin (MBBS, DCA, DLO)  ENT Surgeon,   drshahee@yahoo.com    Pakistan

Main Cause; It is due to inadequate sinus aeration and drainage.

 The main symptoms are post-nasal drip and mucus, blocked nose, loss of sense of smell.

Facial pressure often occurs, but pain is not a common symptom (except for acute flare-ups).

The sinuses are air containing cavities in the bone of the face, which have small drain holes (ostia) where they connect to the nasal cavity.  Air should move in and out of these ostia, and thin mucus that forms in the sinuses should drain freely out, down the back of the nose (800ml a day which we swallow with our 1500ml of saliva)  -  we are usually not aware of this drainage.  If anything interferes with mucus flow, it can thicken and stagnate, becoming contaminated.  This causes secondary swelling which blocks the sinuses further.

A cycle of problems occurs.   

Infection è swelling è obstruction è more infection, swelling  etc.

The ostia in humans are not favourably placed, nor shaped.  They used to be, when our “ancestors” walked on all fours with their nose on the ground – but due to evolution, the ostia are now at the top of the sinuses.

·         Because we walk erect, humans get flat feet, varicose veins, back problems and sinus problems.

 Some people have smaller ostia than others, aggravated by anatomical variations, deviation of the nasal septum, and swelling from allergy and infection.  These all add to sinus problems.

 Patients with severe polyps, massive swelling of the lining of the sinuses that actually bulge down into the nose (blocking it like a bunch of grapes), are less likely to respond to conservative measures and more likely to require surgery.   Patients with diffuse polyps are less likely to be cured surgically. 

The treatment of chronic sinusitis -

control infection, reduce swelling and help mucus clearance.  (PTO) 

·         Nasal decongestant sprays or drops (**do not use for more than 5 days due to nasal irritation**).

Spray each nostril (aiming for the back of the eye), wait 5 minutes

   then spray again, so that the spray can penetrate further.

·         Antihistamines should only be used if true allergy.  (Allergist referral might be needed)

(If not allergic - antihistamines dry the nose, thickening the mucus, interfering with drainage.)

·         Steroid sprays (Aldecin, Beconase, Rhinocort, Nasonex) reduce swelling, particularly in allergic.

·         Steam and Menthol inhalations do help (a good old-fashioned remedy) - Karvol, Vicks Vaporub.

·         Antibiotics – for at least 2 weeks, even 4-6 weeks

- Doxycycline, (100mg once or twice a day taken after meals) – sometimes causes nausea.

- Augmentin (or Rulide) with Flagyl is an alternative - requires up to 6 tablets a day.

·         Oral steroids (“Cortisone”, Prednisolone) shrink the swelling and help normal mucus clearance. 

Start with high doses, tapering off over 2 weeks.

·         Eccinachea, Garlic, Vitamin C, Horseradish, Milk reduction etc, is unproven, but might help.

 If all of the above fails, and the symptoms are bothersome enough, Functional Sinus Surgery will be required, to straighten the septum, clean out the sinuses, and make more efficient and larger ostia.

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