Sinus & Allergy Conditions, Nasal Obstruction

  O V E R V I E W     

The sinuses are small, hollow chambers inside the nose and head that reduce the weight of the facial bones, give the bones shape and support, assist in mucus drainage from the nose, and help the voice resonate. Healthy sinuses are filled with air. When their mucous membranes swell from allergies, the common cold, infection or other causes, the narrow sinus openings become blocked, the pressure inside them drops, and they can fill with fluid, which easily leads to bacterial infection (called sinusitis, or rhinosinusitis if the nasal tissues are also affected). Blocked, inflamed or infected sinuses can be very painful.

There are four groups of sinuses: maxillary, in the cheekbones; ethmoid, along the nose; frontal, above the eyes; and sphenoid, behind the ethmoids. Any or all of these may be involved in an allergy or sinus infection, so accordingly, discomfort may occur in many areas of the face and head, including the cheeks, eyes, forehead and teeth.


   S I N U S I T I S   

Sinusitis may be acute (short-term, as after a cold or flu) or chronic (more than 8-12 weeks). Acute sinusitis symptoms include thick yellow or green discharge from the nose, sharp pain, headache and fever. Symptoms of chronic sinusitis are less obvious and may include nasal blockage or congestion, post-nasal drip, reduced sense of smell, and malaise.

A diagnosis of sinusitis is made after a description of symptoms, a physical examination and potentially an imaging test such as a CT scan, or endoscopic examination under local anesthesia. Treatment varies for acute infections versus chronic sinusitis. In the acute state, decongestants, mucolytics and antibiotics are the main line treatments, while the treatment of chronic sinusitis is directed towards controlling the inciting factor that causes obstruction of sinuses and chronic inflammation.

The first mode of therapy, thus, includes nasal irrigation at home daily, nasal sprays, antihistamines etc. Once your physicians have utilized the various medical treatment options to their satisfaction, then surgery is considered if the symptoms continue to persist. The advent of modern surgical techniques and instruments as well as image guidance during the operation has made sinus surgery considerably more effective and safe.

Our doctors are experts in treatment of complex sinus conditions. Although surgery is considered only after thorough medical therapy, our team of experts use the latest in high tech surgical modalities to treat difficult sinus conditions, including frontal and sphenoid sinus disease as well as revision sinus surgery.

Nasal Obstruction

The nasal passages are separated by a dividing wall called the septum; on the sidewalls of the nasal cavity are mucosa-covered protrusions called turbinates. The turbinates are sponge-like structures that change size (enlarge & shrink) at regular intervals, alternatively on each side. They humidify the air we breath and, along with the septum direct the flow of air in a uniform fashion. Deviation of the septum and/or enlargement of turbinates are the main causes of nasal obstruction. Another cause includes the narrowing of the opening of the nose due to structural weakness of the supporting cartilages, often times caused by previous nasal esthetic surgery (rhinoplasty). Careful analysis of these problems is necessary to devise the correct surgical plan.


  A L L E R G I E S         

Allergies are a common cause of inflamed sinuses and headaches as well as runny or itchy nose, sneezing, itchy or watery eyes, blocked or itchy ears, rashes and wheezing. Allergies are in essence an overreaction by the body’s immune system to one or more objects in the environment, called allergens. Common allergens include dust, pollen, animal dander, mold and certain foods. Nasal endoscopy, blood tests or skin “scratch” tests are often all that is needed to determine the presence and cause of an allergy.


  T R E A T M E N T   

Treatment for inhalant allergies begins with avoidance whenever possible (such as not exposing yourself to cat or dog dander if you react to them). The use of mattress and pillow casements to minimize dust and dust mite exposure during the night may also be beneficial. Using air conditioning early in the season to as late in the season as possible allows de-pollination of the house to further reduce exposure. When this is not enough, medications such as antihistamines, decongestants, intranasal steroid sprays and anti-inflammatory agents can be used to suppress symptoms. When this fails, allergy shots may also help.


  A L L E R G Y   S H O T S   

Allergy shots contain small amounts of allergens. They are given on a regular schedule so that your body gets used to the allergens and no longer overreacts to them.

Allergy shots are only used when the allergens you're sensitive to can be identified and when you can't avoid them. It takes a few months to years to finish treatment, and you may need to have treatments throughout your life.

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David M. Alessi, MD, FACS  

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