All of us have had the uncomfortable experience of a sinus infection. The symptoms of Chronic Sinusitis are facial pain and pressure, headache, congestion, cough, and fatigue are hallmark signs. Luckily, these events only occur 1 to 2 times a year on the average, and resolve in 5 to 7 days, most commonly with only over-the-counter medication and supportive care.
However, for some of us, the symptoms become more problematic. The episodes of sinus symptoms may occur several times a year. The duration of each attack may last weeks or even months, many times requiring more than one course of antibiotics. Finally, in some cases, the symptoms never truly resolved. One may even resign themselves to the fact that there really isn’t anything that can be done – that they just have chronic sinus or allergy problems.
Steps for Treating Chronic Sinusitis
The good news is that in most cases, these chronic conditions can be treated and either resolved or at least markedly improved.
The first step is to make certain the correct diagnosis has been made. Rhinitis is a common condition that can be mistaken for sinusitis. Rhinitis is typically an inflammatory condition that may be caused by allergies. However, many times allergy testing is negative or allergy treatment does not seem to provide relief. In these cases, the diagnosis likely is “nonallergic” rhinitis, which is also known as vasomotor or gustatory rhinitis. Typically treatment can be simple avoidance if the cause is identified or medical management with antihistamines, nasal steroids, or allergy shots. Recently, however, an office based treatment has become available to treat rhinitis. The treatment uses radiofrequency, (heat energy) to target the site in the nose that controls drainage and congestion. It takes less than 30 minutes to perform, allows the patient to return to normal activity immediately, and provides long term relief in over 90% of patients.
Sinusitis on the other hand, is most commonly an infectious process. It occurs when the normal flow of mucus in the nose and sinuses (a liter a day in adults!) is obstructed. Obstruction may be mild at first, but over time becomes worse due to inflammation and scarring. Treatment is aimed at improving mucus flow and reducing the obstruction. Daily nasal irrigations may be helpful along with decongestants and nasal steroids. Antibiotics are used for infectious exacerbations of this condition.
When medical management fails, or is inadequate, a thorough examination is necessary to identify the location and severity of the obstruction. An office examination by an otolaryngologist (ENT) is often followed by a CT scan. This information can then be used to formulate a treatment plan. Depending on the findings, a simple office procedure may be able to provide relief. Alternatively, a relatively short outpatient surgery requiring only a 24 to 36 hour recovery can typically result in long-term success.
Chronic nasal and sinus issues can cause significant impact to one’s quality of life. As a patient, you should not assume that you must be forced to just live with these changes. By defining the exact cause of the condition, relatively straightforward treatments are now available to provide relief.
Dr. Jerome Hester is a board-certified otolaryngologist, providing medical and surgical treatment of disorders of the head and neck. He has been in practice in Menlo Park for 30 years. He has received specialty training and has lectured and published internationally in the treatment of sleep apnea and sinus disorders.
In his practice, Dr. Hester believes in providing a comprehensive outline of all treatment options that are available to the patient for their disorder, and then assisting the patient in their path to better health.
His practice is located at 1300 University Ave., Suite 4 in Menlo Park. The office phone number is 650-268-5133. His website is doctorhesterent.com.
Jerome Hester, MD, May, 2023