Chronic sinusitis, more than just a blocked nose.

Dr. Gerard de BruynENT Specialist

MBChB(US) / MMED (ORL) / FCORL

What is Chronic sinusitis?

Chronic sinusitis is an inflammatory condition involving the inner lining (mucosa) of the nasal cavity and the paranasal sinuses.  It is a condition that has a very complex pathophysiology but in essence occurs when a susceptible individual is exposed to an environmental trigger.  This trigger then sets in motion an inflammatory reaction in the body that effects the nasal cavity and paranasal sinus mucosa leading to symptoms of a blocked nose, purulent nasal discharge, decreased sense of smell and mid-facial pressure or pain.  These symptoms can be unbearable and really affect the patient’s quality of life.  Some authors state that the effect on quality of life can be similar to that of Parkinson’s disease.

How do I know if I have Chronic sinusitis?

If you suffer from a blocked nose, a purulent nasal discharge, decreased sense of smell and pressure like headaches for longer than 3 months, you might be suffering from Chronic sinusitis.  The best course of action would be to consult an ENT specialist.  During the consultation the ENT specialist will first determine the severity of your symptoms.  Then they will examine the nasal cavity with an endoscope (special flexible nasal camera) to look for signs of chronic sinusitis which can be: swelling (edema), nasal polyps or pus draining from the paranasal sinuses.  In some instances the ENT specialist will also request you to have a CT scan to look for radiological signs of sinus disease.  

How is Chronic sinusitis treated?

The aim of Chronic sinusitis treatment is symptom control by decreasing the nasal and paranasal sinus mucosal inflammation.  This is achieved by steroid therapy (to block the inflammatory reaction and decrease mucosal edema), a nasal douche (to rinse out the inflammatory fluid from the sinuses), a broad-spectrum antibiotic (when a recent sinus infection is suspected) and surgery (Endoscopic Sinus Surgery).

What is ESS, what does it entail and when is it indicated for Chronic sinusitis?

ESS is an acronym that stands for Endoscopic Sinus Surgery.  It is the procedure an ENT specialist performs to assist in treating Chronic sinusitis.  ESS is done with an endoscope and specialized nasal instruments.  These are introduced through the nose into the nasal cavity where the surgeon then operates on the paranasal sinuses.  Because they work through the nose there are no cuts or scars on the patient’s face.  It is a relatively painless procedure but patients do experience a blocked nose feeling afterwards that quickly goes away as the post-operative swelling settles.  ESS is normally indicated for patients that suffer severe symptoms or in cases that the medical treatment is not controlling the disease.

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