1. What are the sinuses?
The sinuses are air-filled outpouchings of the nasal cavity, covered by the same type of mucus-secreting lining as the nasal cavity itself. They fill the bones of the face, ie, the frontal bone and maxillary bone, but also the ethmoid bone and sphenoid bone.
2. Why do we have sinuses?
There are many proposed theories. These include: to reduce the weight of the skull; a ‘crumple-zone’ to protect the brain from trauma; increase the surface area for smell receptors (more so in other animals); increasing the resonance of our voices.
3. Why do they cause problems?
Sinuses drain their mucus into the nasal cavity, and from there into the back of the throat. The openings of the sinuses are only a few millimetres in diameter, and swelling of the lining of these openings can cause obstruction to this drainage. The mucus gets stuck in the sinus, can stagnate and lead to changes within the sinus that predispose to infections.
4. What sorts of problems arise within the sinuses?
As a result of the obstruction to the sinus drainage pathways, infection/inflammation within the sinuses can occur, leading to sinusitis. Acute rhinosinusitis (ARS) occurs very quickly, eg a few days after a cold. If symptoms persist for longer than 3 months, we call this Chronic Rhinosinusitis (CRS). Although rare, tumours can also arise within the sinuses. Systemic diseases (conditions that can affect many different parts of the body), eg, Wegener’s granulomatosis and Sarcoidosis can also occur in the nasal cavity.
5.What symptoms could I get with sinus disease?
The main symptoms associated with sinus disorders are:
– Nasal congestion or nasal blockage
– Runny nose; sometimes watery, sometimes thick and discoloured
– Facial pain or headaches
– Changes in one’s sense of smell (hyposmia/anosmia).
– Unpleasant smell (cacosmia).
More uncommonly
– With complications of sinus disease, you may get problems with your vision
– Tumours may cause nose bleeds
– You may even get a watery eye because of tear duct blockage (epiphora)
6. What treatments are there for sinusitis?
The most effective sinus treatments are topical steroids. These usually come in the form of sprays, but higher strength drops can be used in some circumstances. Along with this, high volume salt-water irrigations are very useful. Rarely, oral steroids may be useful, particularly in patients with nasal polyps. Antibiotics are often prescribed for acute episodes of sinusitis, but it is unclear as to whether they benefit patients with CRS. Ultimately, patients with CRS who do not respond to the above measures may require surgery.
7. What is Functional Endoscopic Sinus Surgery (FESS)?
Sinus surgery has been carried for a long time, but it is only recently that physiological understanding of the function of the sinuses has been achieved. This was in large part due to the work of Professor Walter Messerklinger. Combined with the development of technology, specially designed endoscopes are used to look inside the nasal cavity and sinuses and perform surgery in a manner that maintains the normal function of the sinuses (FESS). This has led to much better outcomes for patients and fewer complications.
8. Are there any risks during FESS?
As with any surgical procedure, there is the possibility of adverse outcomes. Fortunately, these are extremely rare. Bleeding and infection are risks inherent to the vast majority of surgical procedures, and most patients will have a degree of blood spotting for the first 24-48 hours after surgery. More specifically to FESS, there is a risk of visual loss, and injury to the base of the skull. The likelihood of these latter complications is much less than 1% in all patients undergoing this procedure.
Last updated 14/9/13