Sinusitis is one of the most common ailments in the U.S. and causes significant suffering for over 31 million adults a year. Sinusistis manifests as an inflammation on the lining of the sinuses. The sinuses are essentially air filled extensions of the nasal cavity into the bones of the face and skull which serve to lighten the head, provide extra mucus for the nose and protect the deeper structures of the head from injury. Air is free to enter the sinus cavities through through tiny openings that connect with the nose. The mucus produced by the nose and sinuses protect and sustain the living tissues that make up the lining of the nose and sinuses. The mucus itself contains immune system cells and other defensive substances to maintain function of this vital organ.
When this lining tissue becomes inflamed, explains Dr. Volpi, who sees many sinusitis patients in his NYC office, the result is a collection of distressing symptoms, such as facial pain, pressure and headache, profuse nasal discharge, blockage of breathing, loss of smell and fever. More severe cases can lead to spread of the inflammation to the brain, eyes and teeth, occasionally causing neurological injury, blindness or death. Sinusitis and nasal problems have become major causes of medical expenditures .
Getting to the Root of the Problem – What Causes Sinusitis
Sinusitis can be the result of a common cold that is not quelled by the immune system. In chronic cases the appears to be malfunction of the immune system itself. When this happens, the inflammation becomes a sourse of continued injury to the sinus and nasal membranes which is difficult to control with medicines and surgery. The most common local factors believed to be responsible for chronic sinusitis are fungal infections, contamination, bacterial infections and allergies. If local factors are ruled out, other possibilities include:
- Deformities of the sinuses and nose
- Chemical irritations on the nasal lining
- Previous surgeries
- Effects of medications
- Reduced immunity malfunctions in the mucus flow
- Endocrine disorders such as diabetes and thyroid problems
Though allergies and infections play a major role in this condition, they are not the considered the direct cause. They do increase the severity of the inflammation. ENT Doctor Volpi stressses that most cases of chronic sinusitis cannot be treated just by using antibiotics or undergoing immunotherapy for allergies.
Chronic sinusitis can also be worsened by the presence of nasal polyps. Polyps in chronic sinusitis develop from swollen and inflammed lining tissue in the nasal lining and sinuses and can lead to breathing difficulties and obstructed drainage. If sinus cavities do not drain well, mucus is trapped and infection can develop in the nose and sinues. The presence of polyps makes these recurring infections difficult to treat. Polyps tend to persist in severe cases due to malfunctioning of immune system control mechanisms.
Treatment of Sinusitis
In more severe cases, where over-the-counter and prescription medicine cannot provide patients with a permanent relief, Dr. Volpi may recommend surgical procedures. The goal is to allow air to freely enter the sinuses and allow mucus to easily exit into the nose. Procedures to accomplish the restoration of sinus and nasal function are known as functional endoscopic sinus surgery, which employs sophisticated medical equipment and computer aided imaging. Dr. Volpi and other experts have shown that endoscopic sinus surgery can cure and relieve many forms of chronic rhinosinusitis, especially when the underlying problems are deformities of the face and nose, fungal accretions, dental disorders, congenital malformations and injuries. However, there is no guarantee for complete recovery when the cause is related to systematic factors and immunodeficiency issues.
The primary goal in curing sinusitis is to suppress the inflammation. When the problem stems from a fungal or bacterial infection, autoimmune disease or allergy, the inflammation cannot be treated until the underlying problem is resolved.
Because there are so many factors to be considered in treating this condition, and so many possibilities, an effective treatment and cure that will eradicate all causes of sinusitis is difficult to find. Many FDA approved drugs are only effective in certain situations, and most pharmaceutical companies are hesitant to market a drug they cannot claim will work for every individual. Doctors are developing other regimens for patients to help alleviate their suffering; because the inflammation is caused by several factors, there are different methods to target the source. The most commonly used anti-inflammatory drugs are nasal corticosteriods, which are used through a topical inhaler or orally. Irrigating the nose with salt water also helps remove thick or mucus secretions that may be contaminated by microorganisms. Antihistamines are helpful for drying up allergies, but in the long run can be more damaging. The dried and thickened secretions can attract bacteria, leading to severe inflammation. Inhibitors of inflammation, such as Singulair, may assist in the control the inflammatory mediators, but cannot cure the chronic rhinosinusitis completely. Dr. Volpi will assess your condition and design a customized regimen to treat the underlying causes of your sinusitis.
Why is it Difficult to Treat Chronic Sinusitis?
Persistent or recurrent sinusitis are sometimes the result of hard to eliminate microorganisms create a biofilm which surrounds the mucus, making it difficult for antibiotics and the immune system of the body to completely eliminate these microorganisms. Biofilm formation is the characteristic feature of bacteria in which a starch-like covering protects the organism by encasing it. This protective covering slows down the metabolic activities and growth of the microorganism. The majority of inflammation in sinusitis is related to the formation of biofilm. Prevention of biofilm formation is possible using materials such as xylitol. Hopefully, more sophisticated medications will become available to stop the chemical signaling among the microorganisms and reduce biofilm formation. Bacterial super-antigens, which are strong stimulants for inflammation, may also cause intense immune reactions resulting in polyp formation and sinus obstruction.