Frustrated,Mr.
Messinger turned to Dr.
Arie Rosen, a board-certified otolaryngologist at
University Hospital and associate professor of surgery
at New Jersey Medical School. The ears, nose, and throat
(ENT) specialist ordered another CT scan, which confirmed
the presence of polyps. Dr. Rosen recommended surgery
for their removal. In Fall 2000, Mr. Messinger underwent
the same-day procedure, and after about one week, he
was back to work and breathing much easier.
"The
difference is like night and day," says the 58-year-old
Union County man, who realizes that, despite surgery,
his polyps may come back. "Some days I have more
congestion than others, but it's very minor--nothing
like before."
Sinusitis,
in the simplest terms, is an inflammation of the sinuses.
When a sinus is blocked due to inflammation, it cannot
drain properly. Incidentally, many people envision their
sinuses as the two triangular-shaped areas underneath
the cheekbones. These air-filled pockets are the maxillary
sinuses, but there are others: the ethmoid sinuses near
the bridge of the nose; the frontal sinuses in the brow
area; and the sphenoid sinuses located near the center
of the skull. Sinusitis can occur in any of these sinuses,
but is least likely to affect the sphenoid sinuses.
Sinusitis
impairs the quality of many people's lives-about 37
million Americans each year. The facial pain and pressure
of this sinus condition, along with the tiredness and
irritability it can bring, is not soon forgotten.
One
of the complexities of sinusitis is that other conditions
have overlapping symptoms. Facial pain and pressure,
nasal congestion, and headache can be due to allergies
to molds or pollens; chronic rhinitis, an inflammation
of the nasal lining; or even a common cold caused by
a viral infection. On occasion, fungal infection can
cause similar symptoms, as well.
"It
is not always easy to distinguish symptoms of sinusitis
from other conditions that may have similar symptoms
without further testing. What someone thinks is a lingering
cold might actually be sinusitis. For that reason many
patients can have sinusitis for a long duration before
being diagnosed accurately," says Dr. Rosen, named
one of New
York Magazine's "Best Doctors" this year.
"Sinusitis
can also be long in duration, lasting 10 days or more.
What someone thinks is a lingering cold might actually
be sinusitis."
Doctors
make a distinction between acute and chronic sinusitis.
While there are different definitions, Dr. Rosen describes
chronic sinusitis as recurrent bouts of acute sinusitis
that result in permanent changes to the sinus lining.
These changes can readily be detected by using a CT
scan.
Sinusitis,
as common as it is, can be difficult to diagnose. Often,
people turn to a specialist after trying a course of
treatment that doesn't make them feel better. "The
best treatment can't help if the diagnosis is not correct,"
says Dr. Rosen. "ENTs ENT specialists have a thorough
understanding of the physiology of the sinuses and capability
to examine them thoroughly, which can help detect any
structural or other underlying conditions that may predispose
patients to develop chronic sinusitis and have specific
training in the diagnosis and management of problems
involving the sinuses."
Sinusitis
and Children
Children
get a lot of upper respiratory infections (about 6 or
7 a year), which can make them susceptible to sinusitis.
The symptoms are generally the same as those found in
adults, but coughing is also common in youngsters with
chronic sinusitis. Dr.
Huma Quraishi, director of pediatric otolaryngology
at University Hospital and an assistant professor of
surgery at New Jersey Medical School, takes a "stepwise"
approach to treating these young patients.
"When
the sinusitis is chronic-there are three or four bouts
of acute sinusitis that don't respond to antibiotics-we
need to explore other causes. Allergies could be a factor,
or there could be an underlying ciliary disorder, where
the tiny hairs that move mucous along are not working
properly. We also need to rule out cystic fibrosis or
an immunoglobulin problem, which can make a child more
susceptible to infection ," she says.
The
next step typically isn't sinus surgery, but removal
of the child's adenoid tissue, which is located at the
back of the throat. Enlarged adenoids become reservoirs
for bacteria and a possible contributing factor to the
child's sinusitis. This same-day procedure, during which
the sinuses may also be irrigated and a culture taken,
is done under general anesthesia. There's a small risk
of bleeding and infection.
When
the adenoidectomy doesn't prove beneficial, then it's
time to consider sinus surgery. Dr. Quraishi says the
procedure is reserved for the most severe cases because
the child's face is still developing, and it's not known
how overly aggressive sinus surgery affects mid-face
growth. That's why she takes a conservative approach
during surgery, removing only the minimal amount of
sinus lining. Still, says the board-certified otolaryngologist,
the results after surgery are usually quite good.
"Not
every child with a runny nose is going to get a CT scan
or have surgery," says Dr. Quraishi. "However,
there is definitely a role for sinus surgery in children,
and we at University Hospital have the expertise to
do it."
The
Simplest Can Be The Best
When
it comes to treating acute sinusitis, sometimes the
simplest remedies can be very beneficial. Humidifying
the air and using a saline nasal spray can keep passageways
moist. Cigarette smoke can irritate the sinus linings,
so stopping smoking can be helpful, too. Over-the-counter
(OTC) antihistamines and decongestants often relieve
the symptoms of sinusitis, but their long-term use isn't
recommended. Decongestant nasal sprays can lead to "rebound"
congestion, and antihistamines can dry out sensitive
tissue.
And
while OTCs can make the patient feel better temporarily,
they don't eliminate the cause of sinusitis. Usually,
it's a bacterial infection that requires a round of
an antibiotic, but sinusitis can also be triggered by
an allergy or, more rarely, a fungal infection. Once
the cause of their sinusitis is identified, the overwhelming
majority of sinusitis sufferers can be helped by the
appropriate medicine.
However,
a small percentage of people with chronic sinusitis
don't respond well to antibiotics or other medical therapies.
Surgery is considered for them only after a complete
medical history, a thorough physical exam, and imaging
studies have been conducted and all medical options
have been exhausted.
When
Surgery is Recommended
Thanks
to new surgical techniques and technology, sinus surgery
today is less invasive, carries fewer risks, and is
more precise than earlier procedures. Functional endoscopic
sinus surgery ( or FESS, as it is more commonly known)
uses a thin, telescope-like instrument to view the sinuses;
other instruments are manipulated by the surgeon to
"shave" away and remove diseased areas of
the sinuses.
That
may sound simple, but the surgeon is operating in a
very small and critical area near the brain and the
eyes. With the slightest misstep, there's potential
to cause a cerebral spinal fluid leak, which can lead
to meningitis, or serious visual impairment.
Specially
trained surgeons like Dr. Rosen and Dr. Quraishi incorporate
image-guided surgical technology when operating on the
sinuses. Image guidance uses a computer and three-dimensional
CT scans to precisely and accurately pinpoint areas
and provide a "road map" for the surgeon during
surgery. "Image guidance can help to reduce the
potential risks involved with endoscopic sinus surgery
in some cases, enabling us to directly treat the diseased
area," says Dr. Rosen.
Like
Dr. Quraishi, Dr. Rosen takes a conservative approach
to sinus surgery. "Removing too much of the sinus
lining can leave patients with a chronic problem that
can't be reversed by additional surgery," he says.
"There's a fine line between restoring the natural
function of the sinuses and removing excess lining."
FESS
is a same-day procedure that most patients easily tolerate.
There may be nasal crusting and headaches for a few
days following surgery, and usually nasal packing is
not needed. Patients with desk jobs can typically go
back to work a week after the procedure; those with
more physically demanding careers return in about three
weeks. In addition to the rare but serious risks of
damage to the brain or eyes, FESS also carries possible
post-operative risks of bleeding and infection.
FESS
can bring tremendous relief to patients with chronic
sinusitis and, for those people who also have asthma,
can reduce the frequency and severity of that condition.
However, it's often not always a one-time solution.
"The surgery resolves problems within the sinuses,
but it is not always a cure for the underlying causes
for chronic sinusitis and polyps. chronic sinusitis
itself or nasal polyps. As with other chronic conditions,
over time, patients may require revision surgery or
prolonged “maintenance” -- medical treatment
after surgery, ”can occasionally expect to have
additional revision surgery," explains Dr. Rosen,
who often performs these "repeat" procedures.
"In most cases one surgery can offer But even one
successful surgery can offer dramatic improvement and
add to the quality of a patient's life."
