SINUSITIS

What are sinuses?The sinuses are cavities, or air-filled pockets, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

• ethmoid sinuses - located inside the face, around the area of the bridge of the nose. These sinuses are present at birth, and continue to grow.
• maxillary sinuses - located inside the face, around the area of the cheeks. These sinuses are also present at birth, and continue to grow.
• frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.
• sphenoid sinuses - located deep in the face, behind the nose. These sinuses do not develop until adolescence.

What is sinusitis? Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are three types of sinusitis:

• acute sinusitis - occurs quickly and improves with the appropriate treatment.
• subacute sinusitis - does not improve with treatment initially, and lasts less than three months.
• chronic sinusitis - occurs with repeated acute infections or with previous infections that do not completely get better. The symptoms last longer than three months.

What causes sinusitis? Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses, and result in a sinus infection. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. There are other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis including the following:

• abnormalities in the structure of the nose
• enlarged adenoids
• infections from a tooth
• trauma to the nose
• foreign objects stuck in the nose
• cleft palate
• problems with the immune system
• cystic fibrosis

When the flow of secretions from the sinuses is blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis. The most common bacteria that cause sinusitis in children include the following:

• Streptococcus pneumonia
• Haemophilus influenzae
• Moraxella catarrhalis

What are the symptoms of sinusitis? The symptoms of sinusitis depend greatly on the age of the child. The following are the most common symptoms of sinusitis. However, each child may experience symptoms differently. Symptoms may include:

younger children:

• runny nose
  • lasts longer than seven to 10 days
  • discharge is usually thick green or yellow, but can be clear
• nighttime cough
• occasional daytime cough
• bad breath
• swelling around the eyes
• usually no headaches younger than 5 years of age

older children and adults:

• runny nose or cold symptoms lasting longer than seven to 10 days
• drip in the throat from the nose
• headaches
• facial discomfort
• bad breath
• cough
• fever
• sore throat
• swelling around the eye, often worse in the morning

The symptoms of sinusitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is sinusitis diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for sinusitis may include the following:

• sinus x-rays - diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)
• computerized tomography (Also called CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• cultures from the sinuses - laboratory tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.

Treatment for sinusitis: Specific treatment for sinusitis will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the infection
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the infection
• your opinion or preference

Treatment of sinusitis may include the following:

• antibiotics, as determined by your child's physician (antibiotics are usually given for at least 14 days)
• acetaminophen (for pain or discomfort)
• a decongestant (i.e., pseudoephedrine [Sudafed®]) and/or mucus thinner (i.e., guaifenesin [Robitussin®])
• cool humidifier in your child's room
• nasal spray to reduce inflammation

Antihistamines do not help the symptoms of sinusitis unless an allergy is involved.

In children with chronic sinus infections surgery may be needed. Surgical procedures for sinusitis include:

• adenoidectomy - the adenoids often contribute to sinus infection by blocking flow of secretions out of the nose and carrying bacteria that lead to sinusitis.
• sinus irrigation
• endoscopic sinus surgery

• What is sinus surgery?

  
  The following information is provided to help individuals prepare for sinus surgery and to help them understand more clearly the associated benefits, risks, and complications of sinus surgery. People are encouraged to ask their doctor any questions to help them better understand the the procedure.
  Sinus surgery involves the precise removal of diseased sinus tissue with the improvement in the natural drainage channels by the creation of a pathway for infected material to drain from the sinus cavities. In most situations, the surgeon will employ endoscopic techniques which allow better and more precise visualization without the need for external incisions. As a result, there is less swelling, bleeding, and discomfort, and a faster recovery from sinus surgery.
  Sinus surgery, unlike other types of surgery where a diseased part or organ is removed, involves the re-routing of existing sinus pathways in addition to removal of diseased tissue. It cannot be emphasized more strongly that post-operative care is as equally important as the surgery itself. One of the most common causes of failure of this procedure is poor post-operative care and follow-up. Your doctor can only do so much. It is up to the patient to share in the responsibility of caring for this chronic illness. The following instructions are designed to help patients recover from sinus surgery as easily as possible and to prevent complications. It is very important that patients read these instructions or those provided by their surgeon and follow them carefully.
  Picture of the anatomy of the sinuses
  
  
  
  

  What are the risks and complications of sinus surgery?

  
  The following complications of sinus surgery have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for patient information only - not to make patients overly concerned - but to make them aware and more knowledgeable concerning potential aspects of sinus surgery. The surgeon will review the risks and benefits of the surgery when obtaining consent for the operation, and will be able to discuss the chance of these complications with respect to an individual's potential risks of surgery at that time.
  
  • Failure to resolve the sinus infections or recurrence of sinus problems and/or polyps.
    
  • Bleeding. In very rare situations, a need for blood products or a blood transfusion may be required. Patients have the right, should they choose, to have autologous (using their own stored blood) or designated donor blood prepared in advance in case an emergency transfusion is necessary. Patients are encouraged to consult with their doctor regarding these issues if they are interested.
    
  • Chronic nasal drainage or excessive dryness or crusting of the nose.
    
  • Need for further and more aggressive surgery.
    
  • Need for allergy evaluation, treatments, or environmental controls. Surgery is not a cure for or a substitute for good allergy control or treatment.
    
  • Failure to improve or resolve concurrent respiratory illness such as, but not limited to, asthma, bronchitis, or cough.
    
  • Failure to resolve associated "sinus or nasal" headaches. The exact cause of headaches can be difficult to determine or have many different causes.
    
  • The patient or physician may require consultation with another specialist such as a neurologist.
    
  • Damage to the eye and its associated structures.
    
  • Damage to the skull base with resultant meningitis, brain abscess, or leakage of spinal fluid.
    
  • Permanent numbness of the upper teeth, palate, or face.
    
  • Nasal obstruction due to failure to control infection or polyps.
    
  • Prolonged pain, impaired healing, and the need for hospitalization.
    
  • Failure to restore or worsening of the sense of smell or taste.

  • What happens before sinus surgery?

    
    In most situations, the surgery is performed as an outpatient at either the hospital or a surgical center (surgicenter). In both facilities quality care can be provided without the inconvenience of an overnight stay. An anesthesiologist will review the patient's medical history before surgery, and will monitor the patient throughout the procedure. If the doctor has ordered pre-operative laboratory studies, the patient should arrange to have these done several days in advance, and bring all lab results to the hospital the day of surgery for review.
    Arrange for someone to spend the first night after surgery with the patient, if possible.
    After surgery, the doctor will usually advise the patient to start using saline irrigation. There are many different ways to irrigate the sinuses; depending on the surgery that was performed, the surgeon will advise the patient on the best method for this to be done.
    In general, patients that have sinus surgery should not take aspirin, or any product containing aspirin, within 10 days prior to the date of surgery. Nonsteroidal anti-inflammatory medications (such as Advil) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or Advil-like drugs. Therefore, it is important to check all medications carefully. If there is any question please call the doctors that prescribe medications (surgeon, primary care physician, cardiologist or other specialists) or consult your pharmacist. Depending on the planned surgery, the surgeon may have you abstain from such medications for a longer period of time. Acetaminophen (Tylenol) is an acceptable pain reliever. Usually the surgeon will give prescriptions for post-surgery pain medications at the preoperative visit. It is best to have these filled prior to the date of surgery.
    In most pre-operative preparations, patients must not eat or drink anything 8 hours prior to the time of surgery; the surgeon or hospital/surgicenter will let the patient know the specific details regarding what time to stop eating and drinking. This includes even water, candy, or chewing gum. Smokers should make every effort to stop smoking, or at least reduce the number of cigarettes as much in advance of surgery as possible. This will help to reduce postoperative coughing and bleeding.
    If a person is sick or has a fever the day before surgery, they should inform the surgeon. If a patient wakes up sick the day of surgery, still proceed to the surgical facility as planned. The surgeon and the anesthesiologist will decide if it is safe to proceed with surgery.
    
    

  What takes place the day of sinus surgery?

  
  It is important that patients know precisely what time they are to check-in with the surgical facility, and that they allow sufficient preparation time. Bring all papers and forms, including any preoperative orders and history sheets.
  Patients should wear comfortable loose fitting clothes which do not have to be pulled over their head. Leave all jewelry and valuables at home, including ear rings, watches, rings, etc. Remove all make-up with a cleansing cream. Patients should thoroughly wash their face with soap and water. Do not apply make-up or cream to the face. If possible, avoid using hair clips or other materials to hold up hair.
  Do not take any medication unless instructed by the doctor or the anesthesiologist. Usually, in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and the patient may be given a medication to help them relax.
  
  

  What happens during sinus surgery?

  
  In the operating room, the anesthesiologist will usually use a mixture of a gas and an intravenous medication to put the patient to sleep and to maintain anesthesia at a safe and comfortable level. During the procedure, the patient will be continuously monitored. The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room. The whole procedure usually takes several hours. The surgeon will come to the waiting room to talk with any family or friends once the patient is safely in the recovery room.
  
  

  What happens after sinus surgery?

  
  After surgery, the patient will be taken to the recovery room where a nurse will monitor the patients vital signs. Usually, patients will be able to go home the same day as the surgery once they have fully recovered from the anesthetic. This usually takes several hours. Patients will need a friend or family member to pick them up from the surgical facility. Someone (a responsible adult) should spend the first night after surgery with the patient in case any post-surgical problems develop.
  On arrival at home from the surgical facility, the patient should go to bed and rest with their head elevated on two to three pillows. By keeping the head elevated above the heart, edema and swelling from the sinus surgery can be minimized. Patients may get out of bed with assistance to use the bathroom but should avoid straining with bowel movements because this may cause some surgical site bleeding. If the person is constipated, they should take a stool softener or a gentle laxative.
  Some patients may have noticeable swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling is normal and will gradually go away. People can help reduce it by putting an ice-pack on the face, bridge of the nose, and eyes as much as tolerated. This will also help with postoperative edema and pain. Some patients have found frozen vegetables in packages (for example bags of frozen peas) to be a convenient ice pack which nicely conforms to the face. The frozen material should be separated from the skin by a towel or similar barrier to avoid any skin damage. Many clinicians suggest periods of 15 minutes of such ice-pack treatment followed by 15 minutes of removal to not damage the skin.
  Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changed as needed. It is not unusual to change these dressings every hour during the first 24 hours after surgery. It is recommended to purchase gauze pads prior to surgery so that the patient will have enough for dressing changes. After a few days the patient will probably not need to use the dressing any longer. Do not take aspirin, aspirin-containing medications, or nonsteroidal anti-inflammatory medications (such as ibuprofen/Advil, Naprosyn, and others) for as long as your surgeon has instructed following surgery, because such medicine may increase bleeding and slow clotting at the surgical site.
  It is best to eat a light, soft, and cool diet as tolerated once the patient has recovered fully from the anesthetic. Avoid hot liquids for several days. Even though people may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit one or two times immediately after surgery. If vomiting persists, please contact the surgeon; the doctor may prescribe medication to reduce or eliminate vomiting. It is important to remember that a good overall diet with ample rest promotes healing.
  Patients may be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic may also be prescribed and is to be taken as needed for pain. If the patient requires narcotics, they should not drive and should consider having a responsible person stay with them. In some situations the doctor may give steroids to be taken either preoperatively and/or postoperatively. It is very important that the take this medication as prescribed, and not discontinue it prematurely. The steroids are instrumental in facilitating proper healing. If patients have any questions or they feel that they are developing a reaction to any of these medications he or she should consult their doctor immediately. Patients should not take any other medication, either prescribed or over-the-counter, unless they have discussed it with the doctor
  
  

  What takes place the day of sinus surgery?

  
  It is important that patients know precisely what time they are to check-in with the surgical facility, and that they allow sufficient preparation time. Bring all papers and forms, including any preoperative orders and history sheets.
  Patients should wear comfortable loose fitting clothes which do not have to be pulled over their head. Leave all jewelry and valuables at home, including ear rings, watches, rings, etc. Remove all make-up with a cleansing cream. Patients should thoroughly wash their face with soap and water. Do not apply make-up or cream to the face. If possible, avoid using hair clips or other materials to hold up hair.
  Do not take any medication unless instructed by the doctor or the anesthesiologist. Usually, in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and the patient may be given a medication to help them relax.
  
  

  What happens during sinus surgery?

  
  In the operating room, the anesthesiologist will usually use a mixture of a gas and an intravenous medication to put the patient to sleep and to maintain anesthesia at a safe and comfortable level. During the procedure, the patient will be continuously monitored. The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room. The whole procedure usually takes several hours. The surgeon will come to the waiting room to talk with any family or friends once the patient is safely in the recovery room.
  
  

  What happens after sinus surgery?

  
  After surgery, the patient will be taken to the recovery room where a nurse will monitor the patients vital signs. Usually, patients will be able to go home the same day as the surgery once they have fully recovered from the anesthetic. This usually takes several hours. Patients will need a friend or family member to pick them up from the surgical facility. Someone (a responsible adult) should spend the first night after surgery with the patient in case any post-surgical problems develop.
  On arrival at home from the surgical facility, the patient should go to bed and rest with their head elevated on two to three pillows. By keeping the head elevated above the heart, edema and swelling from the sinus surgery can be minimized. Patients may get out of bed with assistance to use the bathroom but should avoid straining with bowel movements because this may cause some surgical site bleeding. If the person is constipated, they should take a stool softener or a gentle laxative.
  Some patients may have noticeable swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling is normal and will gradually go away. People can help reduce it by putting an ice-pack on the face, bridge of the nose, and eyes as much as tolerated. This will also help with postoperative edema and pain. Some patients have found frozen vegetables in packages (for example bags of frozen peas) to be a convenient ice pack which nicely conforms to the face. The frozen material should be separated from the skin by a towel or similar barrier to avoid any skin damage. Many clinicians suggest periods of 15 minutes of such ice-pack treatment followed by 15 minutes of removal to not damage the skin.
  Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changed as needed. It is not unusual to change these dressings every hour during the first 24 hours after surgery. It is recommended to purchase gauze pads prior to surgery so that the patient will have enough for dressing changes. After a few days the patient will probably not need to use the dressing any longer. Do not take aspirin, aspirin-containing medications, or nonsteroidal anti-inflammatory medications (such as ibuprofen/Advil, Naprosyn, and others) for as long as your surgeon has instructed following surgery, because such medicine may increase bleeding and slow clotting at the surgical site.
  It is best to eat a light, soft, and cool diet as tolerated once the patient has recovered fully from the anesthetic. Avoid hot liquids for several days. Even though people may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit one or two times immediately after surgery. If vomiting persists, please contact the surgeon; the doctor may prescribe medication to reduce or eliminate vomiting. It is important to remember that a good overall diet with ample rest promotes healing.
  Patients may be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic may also be prescribed and is to be taken as needed for pain. If the patient requires narcotics, they should not drive and should consider having a responsible person stay with them. In some situations the doctor may give steroids to be taken either preoperatively and/or postoperatively. It is very important that the take this medication as prescribed, and not discontinue it prematurely. The steroids are instrumental in facilitating proper healing. If patients have any questions or they feel that they are developing a reaction to any of these medications he or she should consult their doctor immediately. Patients should not take any other medication, either prescribed or over-the-counter, unless they have discussed it with the doctor
  
  

  How long will it take to recover from sinus surgery?

  
  Depending on the extent of the surgery, recovery may take a few days. It may take up to 3 to 5 days to feel completely back to normal. Patients should refrain from activities that increase heart rate or blood pressure such as running, exercising, weight lifting, or other similar activities. It is imperative to obtain guidance from the surgeon as to when they may resume all normal activities. Until this time, patients should rest and limit physical exertion.
  
  

  General instructions and follow-up care for sinus surgery

  
  In many cases, packs or nasal packing is placed in the nose to control postoperative bleeding. The surgeon will tell the patient when to return to the office to have these packs removed. Patients may need to call the office to schedule this postoperative appointment. Please arrange for someone to drive the patient to and from the office for this first visit in case any complications (for example, additional bleeding) develop. Patients should eat a light meal before coming, and avoid taking excessive pain medications. In addition, most patients will also have several subsequent office visits scheduled to assess healing, remove crusts, and insure a speedy recovery. These visits are very important as the surgeon may use the endoscope (camera to look in the nose) to clean up the sinuses and perform further debridements. This post-operative surveillance by the surgeon is very crucial in the individual's long-term success with the surgery.
  After the packing has been removed, individuals may breathe through their nose, but should not blow or sneeze through it for 7 to 10 days to reduce the chance of bleeding. If a person must sneeze, they should try to sneeze through an open mouth. Many surgeons tell patients to expect some light blood-tinged drainage from the nose for several days. If bleeding becomes excessive, apply an ice-pack (described previously) and rest quietly with head elevated while applying mild to moderate pressure to the nose. If bleeding continues, call the doctor's office.
  One of the most important things patients can do after surgery is nasal irrigation. Immediately after the nasal packs are removed patients should use a saline nasal spray such as "Ocean Spray" several times per day to prevent crusts from forming in the nose. The surgeon will tell patients when to discontinue the nasal spray and will also let them know the best way to irrigate the sinuses.
  Patients should go back to work or school only when the doctor says you can and should plan on resting for several days following surgery. Avoid excessive talking, smiling, hard chewing, strenuous activities, and lifting heavy objects, bumping the nose, and bending over. Try not to rest eye glasses on the bridge of the nose until soreness and swelling subside. People may wear contact lenses once eye swelling and any eye irritation has resolved. Alcohol and tobacco should be avoided because they may prolong swelling and healing. Smoke, dust, and fumes may irritate the nose and cause an infection. In general, people may use usual make-up anytime after surgery, as long as the structures (for example, eyelids) with make-up are relatively normal and are not irritated by the application of make-up. Be gentle while brushing the upper teeth. They will often be tender for several weeks, and some people may have some numbness of the teeth and palate for several months.
  Patients should plan to remain in the general area where the surgery was performed for 3 weeks to allow for postoperative care and in case bleeding occurs, the patient can be seen by the surgeon that did the procedure and who should best be able to treat the patient.
  
  

  When should I notify the doctor (surgeon) of any postsurgery complications?

  
  
  • A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.
    
  • A fever greater than 101.5 F (38.6 C) that persists despite increasing the amount of fluid intake and acetaminophen (Tylenol) use.
    
  • Persistent sharp pain or headache which is not relieved by the prescribed pain medication.
    
  • Increased swelling or redness of the nose or eyes.
    
  • Drainage of a thin, clear fluid in large quantities from usually only one side of the nose. This would be different from the clear, thicker mucus drainage normally produced by the nose.
  
  

  Self-care and prevention following sinus surgery

  
  It is important for all patients with chronic sinus disease to understand that they have a chronic illness. Successful sinus surgery will only help control the complications and discomfort of chronic sinus disease. The following three areas of prevention should always be remembered:
  
  1. Maximize Moisture. Patients should always remember to maximize moisture in their nose. Keeping sinuses moist makes mucus thinner, allowing the sinuses to drain better. This drainage in turn helps prevent infection. Use a humidifier, drink plenty of water, avoid drying substances such as alcohol and caffeine, try to avoid smoke which dries out sinus linings, and use plenty of saline irrigation.
     
  2. Avoid Allergy Particles (Allergens). People may want to wear a mask when they clean or are exposed to dust. Sit in the non-smoking sections of restaurants. Avoid exposure to pollens during peak season, and keep an air-conditioner on during allergy season.
     
  3. Prevent Colds. Avoid exposure to colds and flu whenever possible; obtain a yearly flu vaccination.
  4. 
     
  
  
  
  
  
• SOURCE:chw.org website/medicinenet.com