SINUSES

Sinuses

For sinus treatments and other rhinology procedures in Harrow, London, contact Mr Joe Marais at Clementine Churchill Hospital.

Our treatment includes:

Sinusitis
Functional Endoscopic Sinus Surgery (“FESS”)

Functional Endoscopic Sinus Surgery (“FESS”)

Sinuses are cavities within the forehead and facial bones (around the eyes) Normally, they open into the nasal passages via small drainage pathways called ostia

Why Is sinus surgery necessary?

In cases in which antibiotics, nasal drops, sprays and decongestants have failed to clear the problem, it is likely that the sinuses are physically obstructed and blocked. In this event, it may be advisable to undergo surgery to unblock these passages, in the hope of restoring normal function by improving mucus drainage, (i.e. functional endoscopic sinus surgery or FESS).

Why are endoscopes used?

These fibreoptic instruments allow us to carry out much more precise surgery which addresses the individual problem, particular to that patient. We know which sinuses are diseased by looking at the CT scan, and so we can operate on those that are diseased and leave alone those that are not.

What is the outlook after the surgery?

FESS is highly successful at improving the symptoms of sufferers of chronic sinusitis, but it may not offer a permanent, complete cure because the mucus drainage mechanism has already been badly damaged by the infection. Artificially-created pathways never work as well as natural ones, but are better than none at all. For this reason, even after successful surgery, the patient will be more prone to bouts of sinus trouble than the average person, but usually this will still be better than if they had never had their sinus operation. Most often, even if sinusitis recurs in somebody who has had FESS, it can be brought under control medically (rather than surgically) using various antibiotics, sprays/drops, decongestants or anti-inflammatory steroids. Overall, most patients who undergo FESS, although not completely cured, are a lot better.

Sinusitis

The sinuses are small, hollow chambers inside the nose, cheeks and forehead that reduce the weight of the facial bones, give the bones shape and support, assist in mucus drainage from the nose, and help the voice resonate. Healthy sinuses are filled with air. When their mucous membranes swell from allergies, the common cold, infection or another cause, the sinuses become blocked, the pressure inside them drops, and they can fill with fluid, which easily leads to bacterial infection (called sinusitis, or rhinosinusitis if the nasal tissues are also affected). Blocked, inflamed or infected sinuses can be very painful. Pain at the back of the head or in the area of the temples is not due to sinus problems.

Diagnosis of Sinusitis

A diagnosis of sinusitis is made after a description of symptoms, a physical examination and potentially one or more imaging tests such as an x-ray, CT scan, or endoscopic examination under local anaesthesia. Treatment may include a nasal spray, antibiotic, corticosteroid or antihistamine. In some cases the patient may have to undergo surgery to clean the sinuses, improve drainage or realign a deviated septum.

Sinusitis may be acute (short-term, as after a cold or flu) or chronic (more than 8-12 weeks). Acute sinusitis symptoms include thick yellow or green discharge from the nose, sharp pain, headache and fever. Symptoms of chronic sinusitis are less obvious and may include nasal blockage or congestion, post-nasal drip, reduced sense of smell, and malaise or feeling as if you constantly have a cold.

Recurrent attacks of sinusitis, or worse still, constant sinus congestion, require definitive treatment, because antibiotics frequently fail in these cases. This is because there is a problem with drainage of the sinuses and re-infection occurs as a consequence. Such cases require expert attention of an ENT surgeon who specialises in nasal disease, a rhinologist.