In focus: chronic sinusitis

If you have been complaining of a nasal block for more than 12 weeks, it could be the sinus acting up, warns Dr Sunil Narayan Dutt

Is your nose congested and is it hard to breathe? Does the thick mucus irritate the back of your throat? Does your face, head and teeth hurt from the pressure? Are you losing your sense of smell and taste? Are you incredibly tired and irritable?

You may think that it is yet another cold or allergy attack. But if the symptoms last longer than 12 weeks you might be suffering from chronic sinusitis. Chronic sinusitis is often more debilitating to a person’s quality of life than congestive heart failure and chronic back pain.

Chronic sinusitis is the most common reason for employee absenteeism and causes economic losses of up to $ 50 billion. According to a US study, direct healthcare expenditures due to sinusitis cost over $ 8 billion each year and chronic sinusitis (not including acute sinusitis) results annually in an estimated 18-22 million physician-office visits.

What is sinusitis

Sinusitis is an inflammation of the sinus lining caused by bacterial, viral and / or microbial infections; as well as structural issues like blockages of the sinus opening (ostium). If the sinus opening (ostium) is closed, normal mucus drainage may not occur, leading to infection and inflammation of the sinuses.

There are two main categories of sinusitis: acute and chronic. Sinusitis is usually preceded by a cold, allergy attack or irritation from environmental pollutants.
Often, the resulting symptoms, such as nasal pressure, nasal congestion, a “runny nose,” and fever, will run their course in a few days. However, if symptoms persist, a bacterial infection or acute sinusitis may develop. If sinusitis occurs frequently or lasts three months or longer, it may lead to chronic sinusitis.

When you have acute or chronic sinusitis, the mucous membranes in your nose, sinuses and throat become inflamed, possibly from pre-existing cold or allergies. Swelling obstructs the sinus openings and prevents normal mucus drainage, causing mucus and pressure to build up.

Symptoms include drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat; nasal obstruction or congestion; tenderness and swelling around the eyes, cheeks, nose and forehead; and/or a reduced sense of smell and taste. The impact of chronic sinusitis on a person’s quality of life could include: throbbing facial pain or headaches, congestion, bad breath, irritability, fatigue or nausea.

The situation in India

In India, chronic sinusitis affects nearly 134 million people, making it the country with the second largest number of sufferers in the world. Patients suffering from chronic sinusitis also often complain of lower workplace productivity and social embarrassment as well as an overall decline in self-confidence.

In spite of this, patients are often unwilling to undergo treatment because of fear of pain, poor patient knowledge about the procedure and the perception that the surgery will only provide a temporary solution.

The treatment

If chronic sinusitis is suspected, the ENT surgeon uses several methods to help screen for chronic sinusitis: visual inspection, nasal endoscopy, CT scan, or nasal and sinus cultures. After diagnosing chronic sinusitis and identifying a possible cause, the ENT surgeon will often begin with medical management.

Medical management of chronic sinusitis may include:
Decongestants
Nasal steroids
Antibiotics
Mucus thinning drugs
Oral steroids

Healthcare professionals often find it difficult to treat the majority of chronic sinusitis sufferers with medication. In fact, it is estimated that up to 60 per cent of chronic sinusitis sufferers are not successfully treated with medication.

A breakthrough by the US — FDA and Indian — DCGI led to the approval of a procedure called ‘Balloon Sinuplasty’. The treatment is now available as an option for treating chronic sinusitis. Ensuring minimal bleeding and without cutting the normal structure, this procedure opens blocked sinus by restructuring the walls of the sinus passage. The procedure helps to drain mucus from the blocked sinus and restore normal sinus functioning.

Unlike traditional sinus surgeries, the Balloon Sinuplasty procedure causes minimal bleeding, has a faster recovery time and provides longlasting results. Clinical data reveals that patients who underwent this new procedure reported significant improvements and relief from symptoms. Clinical studies also show that patients who were treated did not have any recurrence even after two years.

Additionally, patients who do not get relief from symptoms even after undergoing conventional surgical treatment are also indicated for Balloon Sinuplasty. The procedure is used by surgeons to safely and effectively treat chronic sinusitis patients who fail to respond to medications for more than 12 weeks.

(The contributor is a senior consultant in ENT and head-neck surgery, Apollo
Hospitals.)