Sinusitis (or a sinus infection) is a problem that affects millions of people every year. Most of the time, your doctor can prescribe an antibiotic for 7-10 days and the infection will get better. In some people, however, their symptoms will continue despite one or multiple rounds of antibiotics. A sinus infection that does not go away within 3 months is defined as chronic sinusitis.
Sinusitis occurs when the openings into the sinuses become blocked and mucus builds up inside the sinus and becomes infected. Allergies and colds can cause swelling inside the nose that causes the sinus openings to become blocked. The major symptoms associated with sinusitis are facial pain/pressure, nasal congestion, and thick discolored mucus. Other symptoms may include headache, cough, bad breath, ear pressure, dizziness, and tooth pain.
Many of the symptoms of sinusitis are the same as allergies, the common cold, or even migraine headaches- sometimes it is not obvious exactly what is causing the symptoms. In unclear cases, I will usually order a CT scan of the sinuses to see if there is sinusitis present.
In patients who clearly have chronic sinusitis, I recommend that they have the maximum therapy of medicines to try to clear the infection. This includes 3-4 weeks of antibiotics (usually either augmentin or levaquin), a nasal steroid spray used daily, and sinus irrigations with a Neti pot or other kit twice daily. At the end of the 4 weeks of antibiotics, the patient will get a CT scan of the sinuses. If the CT scan shows continued sinusitis, I recommend sinus surgery or balloon sinuplasty at that time, depending on the extent of disease.
Sinus surgery is performed using a telescope inserted into the nose. The goal of the surgery is to enlarge the natural openings into the sinuses so that they will drain better and infections will be less likely to occur. Remember that the surgery will not cure underlying allergies or other problems that contribute to sinus infections. It is not a guaranteed cure, though the large majority of patients will do much better after having sinus surgery.
In certain patients, a procedure called balloon sinuplasty can be used to open the sinuses. This can be done in the office with numbing medication inside the nose and is tolerated very well by most patients.
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