Chronic sinusitis

Close to 10% of the Danish population suffers from chronic sinusitis. If medical treatment does not help, sinus surgery may be the solution.

What is chronic sinusitis?

Sinusitis is inflammation of the cavities in the skull that have an opening to the nose. It can occur in one or more of the sinuses when the drainage channel is blocked. The disease most often occurs in adults and occasionally in older children, but very rarely in younger children. Blockage can occur due to swollen mucous membrane around the drainage from the sinuses caused by infection in the upper airways with, for example, cold viruses or bacteria. The mucous membrane may also be swollen in advance if the person suffers from allergy. There may also be a mechanical obstruction of the drainage due to deviation of cartilage or bone following a fracture of the nasal septum. When the drainage to the sinus is blocked, the mucous membrane in the sinus is damaged. The mucus from the sinuses is stopped, after which bacteria can penetrate and the inflammation occurs. Sinusitis can also occur in connection with root inflammation in a tooth with breakthrough of the inflammation to the maxillary sinus. The sinusitis will then usually only be on one side.

A sinusitis is termed chronic when it has lasted for a minimum of 3 months.

Symptoms of chronic sinusitis

The diagnosis >> chronic sinusitis << can be difficult to make, as there is a gradual transition from the milder infection with cold virus, where there is a blocked nose and mucus from the nose, to throbbing pain in the cheek and teeth, in the forehead or between the eyes. More persistent pain, high fever and affected general condition may occur. The pain can be difficult to distinguish from pain in the teeth and nerve pain in the face. Our consultants can, by looking in the nose, determine whether the mucous membrane is swollen, whether inflammation is coming from the sinuses, whether there is a deviation of the nasal septum or other changes. If necessary, a CT scan of the sinuses is performed. This allows one to see whether the drainage is sufficient and whether there is accumulation of mucus in the sinuses.

Normally, a sinusitis lasts around one to two weeks. A sinusitis is called chronic if it has lasted for more than 3 months.

You may experience several different symptoms if you have chronic sinusitis, such as:

• Chronic or frequently blocked nose
• Heavy and pressing sensation in the head
• Toothache
• Pain in cheeks and forehead
• Dizziness
• Periods with fever and mucus in the nose

Typical causes of sinusitis

• Inflammation in the sinuses often occurs either due to a virus or a bacterium.
• Problems with sinus drainage due to persistent swelling in the nose on the basis of allergy
• Poor sinus drainage due to chronic swelling in the nose on the basis of frequent infections
• Problems with sinus drainage due to deviation of the cartilage in the nose
• Chronic inflammation in a tooth root, which can cause persistent inflammation in the maxillary sinus

Examination of the sinuses

If you are in doubt whether you suffer from chronic sinusitis, you should have an examination by an ear, nose and throat specialist. At CPH Privathospital we ask you about your symptoms and examine you with an endoscopic examination in the nose and with a CT scan of the sinuses.

Treatment

There are two treatment options: medical or surgical treatment. In most cases, one will initially attempt to treat the sinusitis medically.

Medical treatment

The medical treatment consists of medicine that causes the mucous membrane to contract, and thereby opens up to the sinuses, so the inflammation can drain freely. It will usually be prescription nasal spray with corticosteroid for a period. Furthermore, before the nasal spray, one should rinse the nose with saline. If there is no effect of this, and drainage has not been achieved, and the consultant believes that bacteria are involved, antibiotics can be used. In severe cases, antibiotics are given immediately. With a correct examination and assessment, you can quickly have your problems diagnosed and subsequently start the right treatment.

If you notice no improvement in your sinus problems with the medical treatment, surgery of the sinuses may be the right solution.

Surgical treatment

A number of patients have the drainage widened by an endoscopic operation through the nose, where the consultant widens the natural drainage to the affected sinuses, so the drainage becomes wider and does not close so easily. This concerns persons with repeated acute sinusitis or persistent problems despite medical treatment and rinsing. In individual cases, the operation is performed in connection with complications of sinusitis.

• Traditional operation: If you are narrowly built in the sinus system’s drainage sites, one chooses to operate traditionally. Hereby the consultant performs an endoscopic operation, where bone and mucous membrane are removed from the narrow areas in the nose-sinus system via the nose. In certain cases it will be necessary at the same time to straighten the nasal septum if it is deviated in order to be able to reach with the sinus instruments.

• Shaving of polyps: If you have polyps, we remove the polyps with a gentle shaver technique. That is, the polyps are dissolved, sucked away and thereby removed.
  
• Navigation surgery: Navigation surgery is a new method with a camera that provides extra thorough overview of the sinuses during the operation. This method is developed for cases where there are extensive amounts of polyp tissue and deeper changes in the sinus system, and for patients who have previously been operated on in the sinuses. We offer navigation surgery as extra safety for virtually all our surgical patients.

Before the decision about an operation, you come for a preliminary examination with one of our consultants in ear, nose and throat surgery. Our consultant listens to your symptoms and examines you. CT scanning may be necessary, and it is assessed in each individual case whether this is necessary. If we agree that an operation is the best solution, the consultant reviews the course as well as possible side effects and complications with you. We also talk about what you can expect from the operation.

Read more about sinus surgery here

Same doctor and rapid treatment

Regardless of whether the symptoms have occurred acutely or are of longer duration, you should be seen by a consultant in ear, nose and throat. Our consultants are ready to help you, so you can quickly have the right diagnosis made, regardless of whether you are a private payer, have health insurance or come through the public waiting time guarantee.

All examinations can take place at CPH Privathospital, and you therefore have the same experienced consultant throughout the entire course.