Sinusitis refers to an inflammation or infection in the sinus cavities that is most often caused by bacteria. Other causes of sinus infections include viruses and fungus. By the time we are approximately 20 years old, adults have a total of eight fully-developed sinus cavities (4 paired sets).
In children, factors that contribute to sinusitis include:
- Exposure in daycare or school to other children with contagious upper respiratory diseases
- Exposure to smoke in the environment
Symptoms of sinusitis can include:
- Extensive and/or discolored nasal discharge
- Nasal stuffiness
- Facial pain and/or pressure
- Eye pain
- Toothache-like pain in the cheek region
- Worsening asthma
One of the most common causes of difficulty breathing through the nose is a deviated nasal septum. The nasal septum is a midline structure made up of cartilage (front) and bone (top and back) that divides the nose into right and left passages. It can be seen by looking into the nostril. If it is deviated (crooked) from birth or from trauma, it can block airflow into the nose. This obstruction may contribute to difficulty breathing through the nose, snoring and obstructive sleep apnea.
A deviated nasal septum that causes difficulty breathing at rest, during exercise or sleep can be straightened with a surgery called septoplasty. This procedure involves removal of the deflecting cartilage and bone and can be performed under sedation or general anesthesia in an outpatient setting. Typically, this surgery takes 45 minutes and has a two to three day recovery period. Septum repair is commonly combined with a reduction in the nasal tissues called turbinates that can swell abnormally and worsen the airway obstruction. Septoplasty is sometimes combined with a rhinoplasty to correct external nasal deformities that will improve the outward appearance of the nose and face.
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive sinus procedure that widens the natural sinus openings. It is designed to restore normal function to the sinus cavities, which require drainage and ventilation to prevent infection and inflammation called sinusitis. Common signs and symptoms of sinusitis include: thick nasal mucous, nasal congestion, fever, facial pain, headache, dental-like pain in the cheek region, post nasal drip, cough, and loss of taste and smell. FESS promotes better mucous clearance and ventilation of the sinuses, minimizes bleeding and scarring, and preserves healthy tissue. The procedure is performed through the nostril with an endoscope under general anesthesia and takes one to two hours with a four to five day recovery. Instruments used during surgery may include balloonplasty devices that use a guide wire and balloon under high PSI pressure to open boney ostia (openings). Image-guided surgery combines the use of a CT scan of the sinus with a 3-D mapping system of the anatomy that can acquire data during the procedure and allow the surgeon to navigate the region more accurately. FESS usually has a good outcome, with most studies showing an 80-90% success rate.