Chronic sinusitis, which does not respond to persistent medicine treatment, may require surgery. Surgery can be carried on with endoscopic sinus surgery as well as balloon sinuplasty technique.

Sinusitis, which affects 15 million people in Turkey every year, decreases life quality as well with its symptoms that vary from person to person. Surgeon Dr. Yahya Demirdelen from Ekol Ear Nose Throat states there are many treatment methods applied for the treatment of this disease, which occurs when sinus cavities are inflamed due to blockage of sinuses. He remarked, “When blocked channels are opened and air enters sinuses, sinusitis heals. Chronic sinusitis, which does not respond to persistent medicine treatment, may require surgery. Surgery can be carried on with endoscopic sinus surgery as well as balloon sinuplasty technique.”

He said that in the sinuses where inflammation accrued due to contracted sinus channels; these channels are cleared with the help of balloon catheter. He continued his words by saying, “This operation, which can be conducted with local or general anesthesia, is a simpler operation compared to endoscopic sinus surgery. It usually does not require using plugs or staying at hospital.”

Demirdelen specified that every sinusitis cannot be treated with balloon sinuplasty, but balloon sinuplasty is a method that makes treatment of sinusitis easier for appropriate patients. Demirdelen said, “The tissue covering inside the nose has many tasks. It warms, moistens, and filters the inhaled air. These tissues might be damaged more or less during all surgeries performed inside the nose. Balloon sinuplasty was born out of the question how we could expand the sinus opening without damaging tissues. In this technique, a balloon is mounted on the opening of the problematic sinus with the help of a catheter. Then the balloon is filled with serum. Filled balloon expands the blocked sinus opening. Thus, no beneficial tissue inside the nose is harmed during the process. Since there is no incision in this operation, there is no bleeding as well. There is no need for plugs after the operation, and healing progresses very quickly. Sometimes, the patient may return to his/her normal life next day.”

Sinusitis Treatment and Endoscopic Sinus Surgery

Yes, even a newborn baby has sinuses though very small ones. These cavities, which initially have the size of peas, expand into the facial bones and the cranium bones. They continue expanding and growing during childhood and early adulthood. They are air bags. They are covered by the same membrane covering inside the nose and connected to the nasal cavity through the channels at the size of a pencil lead.

What are the functions of sinuses?

Sinuses are parts of the nasal system, which produces normal secretion (mucus). In normal times, the nose and the sinuses secrete half-liter mucus in a day. Resulting mucus, moving along the nasal cover (mucosa), clears bacteria, particles carried through air, and dust shreds. Then this mucus flows back into the throat and there it is swallowed. Particles and bacteria inside the mucus are decomposed by the stomach acid. Many people are unaware of this process since this is a normal body function.


What does the flow behind the nose mean?

Interior nose produces excessive mucus when it is irritated by air pollution, allergy making substances, smoke, and viruses. This is a transparent, water-like secretion produced in large amounts in order to clear and remove the  allergic substance inside the nasal membranes. A water-like secretion emerges behind the nose. This is the most important factor causing the flow behind the nose. In another type, mucus is sticky and viscous. This is seen when air channels are very dry and when membranes cannot secrete adequate fluid. Additionally, sticky and viscous mucus can also be observed in case of infections caused by bacteria. Due to purulence, color of the mucus can be yellow or green.

What is sinus?

The ‘-it’ appendix signifies infection or inflammation in medical language. Thus, sinusitis is the infection or inflammation of sinuses. A typical sinusitis case emerges when excessive mucus is secreted after having cold or being exposed to an allergic attack. Membranes can inflate so much that small openings of sinuses are blocked. If air and mucus cannot easily move between the nose and the sinuses, then mucus is gathered inside the sinuses and pressure increases. Depending on which sinus is affected, when pushed with a finger, pain emerges on the face or on the forehand, in between the eyes or behind them, on cheeks and upper teeth. A sinus, whose openings are blocked and filled with mucus, presents a suitable environment for bacteria reproduction. If having cold continues more than usual, if the color of the mucus turns into greenish yellow, or if there is a strange taste, there is possible bacterial infection. In acute sinusitis cases, pain in the face and the forehead might be unbearable. In the cases when the sinus opening is blocked for a long time, chronic sinusitis arises. Headache is rarely seen, but the flow and fetid smell remain. As a result of extreme inflammation, structures called polyps emerge. Some sinusitis cases are triggered by spreading of the inflammation in the upper teeth into the sinus.

Is sinusitis dangerous?

Most of the sinusitis cases respond to medical treatment and they are not dangerous. However, an infection inside the sinus is very close to both the eyes and the brain. Spreading of inflammation into the eyes or the brain occurs exceptionally seldom. The mucus coming out of infected sinuses are not healthy for the lungs. Thus, it initiates or exacerbates sinusitis, bronchitis, chronic coughing, or asthma.

What is sinusitis headache?

In cases of having cold, swollen nasal cover, nasal draining, filling up of the nose with mucus, the pain occurring in the face, in the cheeks, in the forehead, or around the eyes are probably sinusitis pain. This is caused by sinusitis infection. Another type of headache emerges when the plane descends before landing. This pain becomes particularly severe if you have cold or active allergy (This is called “Vacuum Headache”). Unfortunately, there are many other diseases that might be mistakenly diagnosed as sinus headache. For instance, migraine and other vessel-related headaches or the headache caused by stress might be confused with sinusitis since they all generate pain in the forehead and around the eyes and cause nasal flow. However, these types of headaches heal automatically in short time without the intervention of a doctor. They are different than sinusitis, which lasts for a long time if it is not treated by a doctor and which can be cured only with antibiotic treatments. Additionally, the randomly occurring headache, which causes nausea and vomiting, is generally migraine. A doctor should definitely be consulted for the diagnosis of severe, frequently happening, and long lasting headaches.

Who is affected by sinus problems?

In fact, everyone can have sinus infection, but some groups are more sensitive. Those who have allergy: Just like having a cold, an allergy attack might cause swelling of the mucosa, blockage of sinus channels, inhibition of mucus flow, and bacterial infections. Those who have structural nasal disorders which prevent healthy breathing and mucus flow: For instance a broken nose, or septum deviation (septum is a cartilage structure that divides the nasal cavity into two as the left and the right. When septum leans toward one side, this is called a deviation). Those who have infections frequently: Teachers and medical personnel are sensitive. Those who smoke cigarettes: Tobacco smoke and nicotine disrupt natural resistance mechanisms.

What will the doctor do about my sinuses?

Your ENT doctor will ask you question about your respiration, the color and smell of your nasal flow, and the events (at which hour of the day, in which season) that trigger these particular findings. Get ready to describe your headache: When and in what frequency it happens, how long it takes, whether or not it is related to nausea, vision disorder, or nasal blockage. Ear Nose Throat specialist initially examines you ears, nose, mouth, teeth, and throat while paying careful attention to the appearance of the mucosa and the quality of the secretion. The specialist then checks sensitivity of your nose. In some cases, x-ray of your sinuses might be required. Treatment for sinusitis would be connected to the diagnosis made by your doctor. Infections may require antibiotic treatment, surgical operation, and sometimes both. While acute sinusitis usually responds to antibiotic treatment, chronic sinusitis often necessitates surgery. Functional Endoscopic Sinus Surgery (FESS) performed in recent years is a simple technique for treatment of these diseases. Results have been quite successful. If findings are due to a factor that indicates allergy, migraine, or sinusitis, your doctor applies an alternative treatment plan.

What can I do for my sinuses?

Use a steam humidifier when you have cold. Check your allergy if you have one. Sleep on a higher pillow. You can use decongestants, but these substances may be dangerous for people with hypertension since their chemical ingredients may affect similar to adrenaline. These decongestants are also stimuli that may bring about sleeplessness. Consult your doctor before taking them. Avoid contaminants that may irritate your nose, and stay away from cigarette smoke. Have a regular diet and exercise consistently. Try to limit your relationships with people who have infections. If this is unviable take some precautions (washing your hands, and avoiding using the same towel or aprons with them). There are many non-prescriptive sinus medicines available, but it is not safe to take them before having an appropriate diagnosis.

The best option would be to take the medicines prescribed by your doctor who examines you and knows about your complaints.

Sinusitis in children

In children, a great majority of problems regarding ear nose throat diseases is directly or indirectly related to allergy. It is estimated that 10% of children have allergic catarrh.

It should be considered that an allergic disease might be the underlying reason for childhood sinusitis.

Specific findings that are obtained when acute infection attacks are absent, might give us crucial information about the allergic disease. The symptoms we interrogate at the first place are nasal flow, eczema, frequently happening infections of the upper respiratory tract, irregularity in sleeping, uneasy and wheezy sleep or snoring, often encountered middle ear infections, allergy stories of family members. Allergic catarrh might be seen in various ways such as seasonal or continuing throughout a year.

Certainly, sinusitis might develop more easily in a nose, which is frequently blocked and which has an inadequate air circulation. Especially in winter months or in periods when flue infections occur recurrently, a simple catarrh might easily transform into sinusitis attack in this type of patients.

Sinusitis heals within at most 6-8 weeks under normal conditions. If symptoms continue more than 12 weeks and emerge in the form of acute attacks, we identify the disease as chronic sinusitis. The patients’ medical background from a previous immunity problem to experiences with other systemic diseases should be closely examined. For instance, especially in children, sticking a foreign object (toy parts, foods, beads etc.) in the nose may cause fetid smelling flow or sinusitis. These should be researched in detail and treatment should be organized accordingly. Although, antibiotics and other supportive treatments can be performed according to condition of the infection, if there are obstruction factors that cause nasal blockage such as adenoids, advanced and large tonsils, or nasal polyps, outgrowths of mucosa, a surgical operation might be necessary for opening the respiration tract especially in childhood sinusitis. We perform endoscopic sinus surgery on the patients who are diagnosed with sinusitis, even when they are in the pediatric group.

With widespread utilization of endoscopes in medical field, a new era in nasal surgery has begun. We departed from many surgical techniques we have once performed. In the case, medical treatment cannot heal sinusitis and x-rays confirm the need for a surgery, endoscopic sinus surgery can be successfully performed on children and adult patients as well.

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