The sinuses are air filled spaces around and behind the eyes. They are thought to reduce the weight of our skull and have a wet lining called mucosa. The mucosa produces mucus and up to 1.5 litres is produced by the sinus and nasal mucosa per day. The sinuses have drainage holes through which mucus passes into the nasal cavity. These holes can be easily blocked as they are quite small, sometimes the size of a pinhead.
A number of situations can result in blockage of these drainage holes. These include acute infections or sinusitis, allergy, structural blockage and foreign bodies. A problem can also occur with the mucosal lining itself whereby the mucus does not shift towards the exit pathway but stagnates and gets infected a number of events occur which include the backlog of mucus. This stagnant mucus gets easily infected and the effect is resulting inflammation or swelling of the mucosa and more mucus production. This mucus id often more thicker than usual and if infected has a yellow or green colour. The presence of infection causes the mucosal lining to swell further and more mucus producing glands are seen in the mucosa. This exacerbates the situation and sets up a vicious cycle. Symptoms includes facial pain around the eyes, headaches, feeling of congestion, mucus production, post nasal drip, loss of sense of smell, nasal blockage and possibly associated fever.
When the episode is 0 – 3 weeks we call it acute sinusitis, between 3 weeks and 3 months sub acute sinusitis and when the symptoms have been present for more than three months this is termed chronic rhinosinusitis.
The swollen lining of the sinus particularly of the ethmoid sinuses eventually protrudes out of its natural drainage hole and dangles into the nasal cavity. This is commonly referred to as nasal polyps. Nasal polyps are often confused with the end of the inferior turbinates to the untrained eye – see picture.
The nasal cavity is difficult to examine with the naked eye but with modern fibre optic technology nasal/sinus cavity can be examined easily in the outpatient setting following application of a local anaesthetic spray into the nose. This is done at the same time as the consultation.
In addition to clinical examination blood tests to assess inflammatory/allergy markers, skin allergy tests and a CT scan of the sinuses can be used to make a comprehensive assessment of the underlying problems. The management of chronic sinus disease has undergone a great deal of research and development with new non surgical treatment regimes. These are effective in the majority of patients. However in those where medical treatment fails, surgical procedures can be considered. These include endoscopic sinus surgery which opens up the natural drainage pathways and create an open plan arrangement of the sinuses. However surgery will not improve the patients immune/allergic response and some patients may need to have long term medical treatment after endoscopic sinus surgery.
A new micro invasive technique, balloon sinuplasty, is also available and indeed Mr Patel was one of the first Surgeons within the United Kingdom to include this new technology in his practice. This technique is particularly helpful in patients with frontal sinus disease. The procedure involves insertion of an illuminating guide wire into the frontal sinus over which a balloon. The sinus can then be flushed and because there is no cutting involved scar tissue formation is much reduced and this avoids the risk of post operative of scaring or stenosis.