While everyone will experience an acute sinus infection at some point in their lives, only a few will go on to develop chronic rhinosinusitis (CRS). There is great interest in figuring out why some people are prone to developing CRS while others are not. The fact is that there are probably multiple factors that work together to contribute to the formation of CRS. While many people think of CRS as an infection it is becoming increasingly more obvious that CRS is actually an inflammatory process and bacterial infections are a result. The presence of inflammation in the lining of the sinus, the mucosa, leads to increased mucus production, thickening of the mucus, blockage of the natural sinus drainage pathway. A healthy sinus is lined by tiny hair cells that sweep the mucus out through the natural opening. This keeps the sinus clean and prevents the buildup of bacteria. When there is a blockage of the drainage pathway and thickened mucus the bacteria is allowed to grow unchecked and eventually leads to an infection.
One of the single most important and readily treatable causes of CRS is nasal allergies. Patients with nasal allergies, also known as allergic rhinitis, have an increased sensitivity to substances in their environment. When these substances enter the nose during breathing they come in contact with inflammatory cells in the nasal mucosa. These cells, known as mast, cells have receptors on their surface for airborne allergens. When the allergen binds to the receptor the cell releases the inflammatory mediators that are stored inside and begins the inflammatory process. There are many different chemical or inflammatory mediators that are released during this process, the most well-known is histamine.
A small subset of patients with CRS will develop nasal polyps. Nasal polyps are small soft non-cancerous growths of the lining of the nose. Polyps are just the lining of the nose that has become severely inflamed from allergies or chronic infection. When they are very small polyps may go unnoticed by the patients. However as they get larger they can block the natural sinus drainage pathway and lead to infection. They can also block that air passages of the nose and lead to nasal obstruction.
CRS occurs when the sinuses cannot drain properly so it makes sense that treatment of CRS would involve improving the drainage of the sinuses. If medical treatment of allergic rhinitis and infection does not improve the symptoms a procedure may be required. There are two procedures available to treat CRS. The first is a Balloon Sinuplasty. This is a procedure that is done in the office under local anesthesia. There is little to no recovery and in the right patients the results are excellent. During the procedure a small flexible catheter is placed into the natural opening of the sinus. A balloon is than inflated to increase the size of the opening to 6mm. The balloon is removed and studies have shown that the results are long acting.
The second option is endoscopic sinus surgery also known as FESS. This is performed in an operating room under general anesthesia. The surgeon with remove the inflamed and damaged tissue and enlarge the natural sinus openings. The choice of the two procedures will depend on how severe your chronic sinusitis is, which sinuses are involved, and whether there are polyps. Don’t suffer with chronic sinusitis come in and see what can be done to relieve your symptoms.
