Sinus Infections and Sinus Surgery
What Is A Sinus Infection (Sinusitis)?
Inside your nose, there is a series of connected spaces that drain mucus into the nasal cavity. When these spaces swell they can become blocked and infected. Causes of a sinus infection include; the common cold, allergic rhinitis, or a deviated septum. Symptoms may include, facial pain and pressure, headaches, green or yellow nasal discharge, severe nasal congestion, and fatigue. Sinusitis will usually go away within a few days with rest, hydration and Vitamin C. However, when your symptoms last more than one week or suddenly worsen, chances are you have a bacterial sinus infection and it is time to see your doctor for antibiotics.
Is A Deviated Septum or Nasal Congestion The Same As Sinusitis?
No. But having a deviated nasal septum or nasal congestion can both cause your nose to become more congested and make you more likely to get sinus infections. Every nasal septum is a little crooked but when they are severely deviated enough to block your breathing or plug your sinuses then they are termed a “deviated nasal septum”. You can have nasal congestion from allergies, generalized swelling of your nasal tissue or a common cold.
If I Have A Headache, Do I Have A Sinus Infection?
Most headaches are unrelated to the sinuses. Although, sinus infections can cause headaches. Sinusitis headaches are usually accompanied by facial congestion, fatigue, and discolored nasal discharge. There are situations where the only sign of a sinus infection can be a headache. In these situations, a sinus CAT scan (detailed X-rays of the sinuses) may be needed to look for obstruction or inflammation of the sinuses.
How Do I Treat My Sinus Infection?
For the first few days you can hydrate, get plenty of rest, avoid caffeine and alcohol, rinse your nose with saline (Neti pot), and take Vitamin C. If your symptoms continue for greater than one week or suddenly your headaches worsen or your nasal discharge becomes thicker and more discolored, you most likely have a bacterial sinus infection requiring antibiotics. Your doctor can prescribe an antibiotic that targets the most likely causes of your sinusitis. Your physician may also prescribe a topical or oral steroid to help speed the decrease of inflammation inside your sinuses. An otolaryngologist has the highest amount of training inside the nose and has endoscopes to actually look inside your nose at the sinuses.
When Do I Need Surgery?
Acute sinusitis is when you have a sinus infection that lasts less than one month. Chronic sinusitis is when you are having a constant sinus infection that doesn’t go away with antibiotics and steroids. Either of these can significantly decrease your quality of life. Having multiple episodes of acute sinusitis per year or having chronic sinusitis that has failed medical treatment are both good reasons to consider sinus surgery. Decreased quality of life would include missing school or work, suffering frequently or through long periods with sinusitis symptoms, depression or constant fatigue.
Preparation For Sinus Surgery
You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.
Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.
What Is Sinus Surgery?
The spaces inside of your nose have tiny openings and channels that connect to each other and to both sides of the nose. Sinus surgery widens the channels and removes most of the walls of these spaces which prevents your sinuses from obstructing and allows them to drain more freely. Having more open spaces prevents the pressure from building up in your nose and decreases the frequency and severity of your sinus infections. Sinus surgery also allows saline rinses and topical medications to better access the open areas inside of your sinuses.
What Are The Types Of Sinus Surgery?
The main ways to open your sinuses are Functional Endoscopic Sinus Surgery (FESS) and Balloon Sinuplasty. In revisions surgery or if the sinuses next to your eyes or brain are involved then you may also need Image Guidance Functional Endoscopic Sinus Surgery (FESS)- This type of sinus surgery is performed using a high-powered camera on the end of an optically lighted tube. The surgeon can magnify the contents of your nose onto a large video monitor in great detail. Micro-instruments are used to open sinuses and remove infected bone and tissue. This is generally done under general anesthesia so you are completely comfortable and relaxed during the procedure. Balloon Sinuplasty- A wire guide is placed into the larger sinuses and a balloon is advanced into the sinus opening. The balloon is expanded with water and the sinus opening is enlarged. This can be used in 3 of the 4 sinuses but does not remove infected sinus tissue. Balloon sinuplasty is not appropriate for patients with nasal polyps or ethmoid sinus disease. Image Guidance Surgery- This is a 3-dimensional visualization system that uses your CAT scan to track instruments inside of your nose and sinuses. The guidance provides an additional tool to locate where you are inside of the nasal cavity. It can be used with Functional Endoscopic Sinus Surgery or some types of Balloon Sinuplasty. It is most appropriately used for revision surgeries or with the frontal, lateral ethmoid and sphenoid sinuses which are adjacent to the brain, eyes and major head nerves and vessels.
After Surgery and Recovery
Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting. If you wear glasses, you may require some alterations if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.
- Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
- Infection: In rare circumstances patients may develop an infection following sinus procedures. These are usually managed with intraoperative and postoperative antibiotics.
- Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
- Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
- Scarring (Synechia) and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
- Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
- Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
- Persistent or Recurrent Sinus Infections: Although the goal of surgery is to reduce the severity and number of sinus infections, patients may continue to experience some infections. This may be related to underlying medical issues (e.g. asthma, or nasal polyps). In rare circumstances, if the infections are similar in frequency and severity as prior to the surgery, a secondary surgery may be required.
- Persistent, New, or Recurrent Nasal Airway Obstruction: Altering the nose may result in changes to breathing. Sometimes patients may develop new, persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
- Continued need for medical therapies: If you have sinus complaints related to medical causes (e.g. allergies), then you may continue to require medical nasal therapies (e.g. nasal steroids and sprays). Oftentimes, medical therapies are used in conjunction with surgery to maximize the benefit of each therapy.
- Nasal Septal Perforation: A hole in the septum may develop. Oftentimes these do not cause any problems. Other times however, they may cause crusting, bleeding, and breathing difficulties. These require secondary surgeries for repair.
- CSF Leak: The sinuses are situated near the skull base. Sometimes this area may be injured or involved with disease causing leakage of cerebrospinal fluid (link to CSF leak article). This is rare, but if it occurs may lead to infections, and often require secondary surgeries for repair. The risk of CSF leaks is reduced by use of intraoperative navigation technology, to insure the safety of the patient.
- Orbital Complications: The sinuses are located near the eye. This area may be injured or involved with disease. This may lead to complications such as blurry vision, double vision, or loss of vision. This is exceedingly rare, and is usually rare. In the rarest of circumstances this may be permanent. However, the use of intraoperative navigation systems minimize the risk of this occurring.
Will Insurance Pay For My Sinus Surgery?
Almost all insurances will consider sinus and breathing disorders as functional surgery that is covered by insurance. Our office will check your benefits and let you know what they are before you come into the office so there are no surprises. We will submit your paperwork and obtain approvals for your procedure. Dr. Moustafa Mourad has highly trained in sinus surgery as well as rhinoplasty, broken noses and valve repair. If you have sinus problems please feel free to give us a call so we can help.