The paranasal sinuses are air-filled spaces within the bones of the face and skull that surround the nasal cavity and serve to lighten the head, protect deeper delicate structures such as the eyes and brain and create the mucus that protects the living lining tissues of the nasal cavity. Sinusitis refers to inflammation of this delicate lining, a common condition that happens to more than thirty one million Americans each year.
Sinusitis can manifest itself as a variety of symptoms that may include facial pain and pressure, headache, profuse nasal discharge, stuffy nose, loss of smell and malaise, fever and total body weakness. It is possible for the inflammation to extend into the eyes, facial bones or even the brain; in these severe cases, this can lead to blindness or even death.
Sinusitis is usually the result of a viral or bacterial infection, often after a common cold or flu. Less commonly, sinusitis is a result of severe allergies, facial injuries, medications, dental treatments or infections, immunologic disorders or surgery. Repeated infections can further damage the delicate lining tissues, causing blockage of breathing, nasal bleeding, yellow or green nasal discharge and pain.
Sinusitis that persists longer three months is considered to be chronic. This form of sinusitis causes persistent or, in some patients, intermittent episodes of infection. Some cases of chronic sinusitis begin with a severe acute infection, but not always. The persistent inflammation in this condition leads to injury to the delicate mucous membranes of the sinus, which disrupts the flow of mucus and encourages additional inflammation. Patients with abnormal immune systems, endocrine disorders such as diabetes, poor hygiene, dental disorders and cancer are more likely to have chronic sinusitis.
Certain forms of chronic sinusitis are associated with nasal polyps, which are severely swollen areas of the nasal and sinus lining. Polyps can become large enough to block the entrance from the nose into the sinuses and cause obstruction of breathing, excessive mucus production, loss of smell and facial pain and pressure. Polyps are thought to be caused by the excessive immune system inflammation present in some chronic sinus patients. This form of chronic sinusitis is more difficult to completely relieve. Continued use of medications can lessen the size of the polyps, but surgical removal is often required. Despite this, some patients will continue to develop polyps even after their complete removal during surgery.
When chronic sinusitis fails to respond to treatment with medications, such as corticosteroid sprays, antibiotics, irrigations and allergic management, surgery may be helpful. Surgery does two things: first, blockages of the nose and sinus passageways are removed, allowing free movement of the mucus and normal breathing. Secondly, good drainage of mucus is restored, lowering the ability of bacteria to cause inflammation and infection. Surgery is performed with the patient asleep; the removal of swollen lining tissues of the nose and sinuses is performed with the help of tiny endoscopes, which magnify and illuminate the small passages of the nose and sinuses. Dr. Volpi also makes use of image guided CT scan technology to safely avoid injury to the skull base and brain. After surgery, continued treatment with irrigations, topical corticosteroids and office cleaning of the operated tissues is necessary to allow the tissues to heal normally. In most cases, Dr. Volpi is able to devise a customized treatment to keep his patients healthy and comfortable.