3555541Introduction
Each year approximately 37 million Americans suffer from sinus related diseases. What is more, Americans spend $5.8 billion each year on health care costs contributable to sinusitis, making this disease an enormous public health issue. Sinus disease is a complex and wide ranging topic that go well beyond the scope of this website, but here we seek to educate our patients and referring physicians about some of the basic concepts surrounding this disease entity.

Sinus function and anatomy
The sinuses are hollow, bone and mucus lined spaces that lie just to the side of the nose and extend up to the bottom of our skull. There are several different sinuses in the human head and include two large paired maxillary (sometimes referred to as cheek sinuses), two frontal and sphenoid sinuses and multiple ethmoid sinuses. Although the function of the sinuses is subject to some controversy, most agree that the sinuses serve to warm, filter and humidify inspired air. In addition, these structures lessen the weight of the skull, act as a brace to absorb energy to protect the brain from trauma and play a role in creating certain resonances for human speech. The sinus mucosa has millions of tiny hairs called cilia that serve to push fluid and foreign material towards fixed openings called ostia. If this mucosa swells this can lead to build up of fluid and potential colonization with viruses, fungi, bacteria or chronic inflammation.

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Inflammation of the sinuses (sinusitis) is at times a difficult diagnosis to make and is often confused with processes confined to the nose itself (allergic or infectious rhinitis) or those outside the nose (migraine headaches). According to the American Rhinologic Society, there are several major clinical criteria to diagnose sinusitis, these include facial pain or pressure, nasal obstruction, thick, discolored nasal discharge and significant alteration of taste and smell. There are also several more minor criteria and these include headache, tooth pain, foul smelling breath, ear pressure and cough. Often the diagnosis of sinusitis is corroborated by an endoscopic nasal examination (where we look in your nose with a very small lighted tube) and/or a sinus CT scan to look for objective signs of swelling and infection in the nose and sinuses. In order to allow our patients to get rapid diagnosis and treatment of their sinus issues, our office has our own CT scanner that takes high resolution images of the sinuses.

Types of sinus disease
Sinus disease is not just one entity but many. Overall infectious or inflammatory sinus disease can be broken up into acute (quick onset) or chronic (over a long period of time). Acute sinusitis is the most common form of sinusitis and is typically treated with a combination of antibiotics and agents to decrease inflammation in the nose. This type of infection typically resolves quickly over the course of a week or two. Surgery is typically not performed in this setting unless the patient has a complication of sinusitis (which can include spread to the eye, meninges or brain itself), or occasionally for patients that get multiple infections due to a structural abnormality.

Chronic sinusitis is more of a structural and inflammatory problem where the patient suffers over most of the year with sinus symptoms. Typically for this problem patients are given an aggressive long-term course of antibiotics combined with a nasal steroid and/or an oral steroid combined with other medications. Failure of symptoms and CT findings to resolve with this treatment strategy are an indication for endoscopic sinus surgery.

There are several other types of sinus issues, many of which are related to fungus. Fungus likes warm and moist environments, and when host defenses are damaged or working improperly, the sinuses make a very attractive setting. Fungal sinus disease has varied presentations and can range from an isolated fungus ball that is of little consequence to invasive fungus that in immuno-suppressed patients can be life threatening. Depending on the type of fungus and the severity of the infection treatment can range from medicines which reduce swelling to allow the fungus to be removed by the body, to endoscopic sinus surgery.

An additional kind of sinus disease occurs in conjunction with polyps. These polyps are typically related to allergy and inflammation and can fill the nose and block the sinuses. They may occasionally be associated with asthma and aspirin sensitivity (known as Samter’s triad). These polyps are typically sensitive to oral steroids, but this usually serves to debulk rather than cure the disease. Typically these patients require periodic endoscopic sinus surgery to keep these polyps and the resultant sinusitis at bay.

Sinus tumors, although relatively uncommon do occur as well. These can range from benign and low grade malignant lesions that can be removed via a minimally invasive endoscopic approach to tumors that are extremely aggressive and require removal of most or all of the entire cheek bone (maxilla) and occasionally the base of the skull and eye as well. These tumors typically present with symptoms similar to those of sinusitis but fail to respond to treatment. They are usually diagnosed with nasal endoscopy as well as CT scanning and magnetic resonance imaging (MRI).

Otolaryngologists from our group have extensive experience in treating both medical and surgical sinus issues and if you or one of your patients has sinus problems you wish to be evaluated please don’t hesitate to give us a call.