Rhinosinusitis

Rhinosinusitis

Rhinosinusitis is defined as inflammation of the lining of the nose and the hollow sinuses near the nose. This causes at least two symptoms – one of which is nasal obstruction, blockage, or congestion; and the other is nasal discharge – with or without loss of smell or facial pain or pressure. The condition is very common, affecting up to 10% of the population and there are a number of different causes (see below). Rhinosinusitis is classified as mild, moderate, or severe and can either be acute (lasting less than 3 months) or chronic with symptoms lasting more than 3 months. Some patients with rhinosinusitis suffer with nasal polyps which is a severe swelling of the nasal lining that blocks the nasal cavity and fills the sinuses. This can be diagnosed when these are visible on examination of the nose or when viewing CT scan imaging of changes around the sinus openings or within the sinuses themselves. There may also be pus coming from the sinuses themselves.

Causes of Rhinosinusitis

There are numerous causes of rhinosinusitis that include infections which can be viral (such as the common cold), bacterial or fungal. Other causes include inflammatory conditions, allergy, degeneration of the nasal lining, vascular disease, medications, illicit drugs, neurological conditions, genetic conditions and altered anatomy.

Investigations and treatment of Rhinosinusitis

The red arrows point to the left maxillary sinus which is full of fluid and shows rhinosinusitis, this is grey compared to black (air) on the opposite side (right)

Treatment depends on whether this is acute or chronic, the severity of symptoms, the presence of nasal polyps or infection and the underlying cause. The main treatment is with steroids to reduce the inflammation. These can be topical via sprays into the nose, drops or even tablets. New topical intranasal steroids with sprays and drops are prescribed at relatively low doses and only get absorbed into the body in tiny amounts (less than 0.5%) so have no systemic side effects and are very safe. Other treatments include nasal douche (which is washing of the nose with salt water) to help clear mucous and reduce inflammation; antibiotics to treat infection; and surgery (functional endoscopic sinus surgery). Antihistamines and other allergy medication may be used if there is an underlying allergic component. Nasal decongestants can be used in the very short term but should not be continued for more than a maximum of around 10 to 12 days.

Following diagnosis and depending on the cause as well as the severity, a trial of medical therapy is usually initiated with treatment of the underlying cause (if it can be treated). A CT scan may be requested to assess disease severity as well as to look at your anatomy should you be suitable for surgery. Surgery is not a cure; but combined with medical therapy will aid in the treatment of the condition. Patients usually need to continue with medical therapy following surgery. Surgery should be performed if symptoms are ongoing despite medical therapy, or it is felt surgery will help with your symptoms.

Surgical treatment for Rhinosinusitis

Surgery for rhinosinusitis is called functional endoscopic sinus surgery. It is performed using endoscopes within the nose and there are no external scars. The sinuses are opened and if there are polyps these will be removed. Surgery allows for better drainage of the sinuses as well as improved dispersion of medications to the affected area helping to reduce symptoms. The procedure does sometimes have to be repeated. It is a day case procedure and most patients are able to go home the same day. Opening of the sinuses may also be combined with reducing the size of the turbinates which are bones within the nose lined with mucosa which can become very inflamed as part of chronic rhinosinusitis. Turbinoplasty helps reduce the symptoms of obstruction. If the septum (centre part of the nose) is also bent then this can be straightened with a procedure known as a septoplasty. A septoplasty helps relieve obstructive symptoms or may be required to access the sinuses if it is contributing to the blockage.

The procedure is straightforward with a low complication rate and patients should discuss the risks versus the benefits during their consultation. This is when everything will be fully explained and an informed decision on surgery will be taken. However, risks of surgery include:

  • Bleeding and infection
  • Visual disturbance (very rare)
  • Cerebrospinal fluid leak (very rare)
  • Black eye
  • Recurrence of symptoms and the need for further surgery

Post-operative information

The patient will usually be able to go home the same day, however in rare instances when bleeding is heavier than normal, nasal packs may be required and these can be removed the following morning before going home. A little bit of oozing is common after the operation for the first few weeks, this can be managed at home by pinching the nose, leaning forward and placing ice on your forehead or back of your neck. If bleeding is heavy or does not stop after 20 minutes, we would advise going to your local A&E Department.

There are no stitches to be removed, however you will be given some salt water washes to clean the nose. Depending on disease severity, it is likely you will also be prescribed some intranasal steroids to continue until you are seen again in clinic.

Patients are seen in clinic for a post-operative follow up appointment after around 6-8 weeks. A repeat nasal endoscopy will be performed in clinic to check everything has healed and the sinuses are open.

If a patient has any queries or concerns following their operation, they are welcome to contact Rebecca, our Practice Manager, and we will endeavour to help.