Sinus Treatments

Types:

Sinusitis can be classified depending on how long the condition has been persistent. It can be classified as follows:

• Acute sinusitis: It lasts for less than four weeks and is usually caused by viruses like a common cold.
• Subacute sinusitis: This condition shows sinusitis symptoms that last for four to twelve weeks.
• Chronic sinusitis: In this condition, the sinusitis symptoms last for a minimum of twelve weeks. It usually occurs due to bacterial infection.
• Recurrent acute sinusitis: In this condition, the sinusitis symptoms usually come back four or more times in a year and last for less than two weeks each time.

Sinusitis can also be classified according to its cause as follows:

1. Bacterial and viral sinusitis: Viruses, such as the common cold, may lead to sinusitis. Bacteria may cause sinusitis or may infect an individual after viral sinusitis. A stuffy or runny nose, and facial pain that does not disappear after ten days, may indicate bacterial sinusitis. The symptoms may improve but return in a worse form than the initial symptoms. Decongestants and antibiotics normally work well in treating bacterial sinusitis.
2. Fungal sinusitis: People having a weakened immune system may develop sinus infection due to fungus, which is a more serious form of sinusitis compared to other types of sinusitis.

Causes:
Bacteria, viruses, fungi, and allergens may lead to sinusitis. The specific triggers that may lead to sinusitis include:

1. Common cold
2. Flu (influenza)
3. Nasal and seasonal allergies
4. Streptococcus pneumoniae bacteria
5. Moraxella catarrhalis bacteria
6. Haemophilus influenza bacteria

Symptoms

Risk factors:
The following factors could increase the risk of developing sinusitis:

1. Asthma
2. Nasal allergies
3. Nasal polyps or growths
4. Smoking
5. Weakened immune system due to illnesses like cancer, HIV, or use of certain medications 
6. Deviated septum (the deviation of the line of tissue dividing the nose)

Symptoms:

The following symptoms could be associated with sinusitis:

1. Stuffy nose
2. Runny nose with green or thick yellow mucus
3. Ear pain or pressure
4. Postnasal drip (mucus dripping down the throat)
5. Pain or pressure in the teeth
6. Facial pressure, especially around the eyes, nose, and forehead, which usually worsens on moving around the head or bending over
7. Fever
8. Cough
9. Halitosis (bad breath)
10. Bad taste in the mouth
11. Headache
12. Fatigue

Diagnosis

1. Physical examination: The patient will be examined physically, and asked about his or her symptoms.
2. Nasal endoscopy: It is a procedure performed to look at the inside of the nasal cavity and openings to the sinus passage by passing an endoscope (a tube with a camera on one end) into the nose to examine the nasal and sinus region.
3. Nasal swabs: A soft-tipped stick is used to obtain a fluid sample from the house. This sample will be tested for viruses or other organisms that may be causing sinusitis symptoms.
4. Imaging tests: Computed tomography (CT) scan is a type of imaging test performed to obtain a clear image of the inside part of the sinuses.
5. Allergy testing: In case of chronic sinusitis, the doctor may test you for allergies that could be triggering the condition.
6. Biopsy: A tissue sample may be obtained from the nose region for testing.

Treatment

There are several treatment options available for sinusitis, depending on the symptoms that the patient has and for how long the symptoms have been present. The different treatment options include:

1. Non-surgical treatments:

Sinus infection can be treated at home using the following treatment options:
Decongestants
Nasal saline rinses
Drinking lots of fluids
Over-the-counter or OTC cold and allergy medicines

If the symptoms of sinusitis fail to improve after 10 days, the following treatment options may be suggested:
Antibiotics like augmentin, amoxicillin, levofloxacin, doxycycline, cefixime, cefpodoxime, and clindamycin
Oral or topical decongestants
Prescription intranasal steroid sprays for no more than three to five days, as they may lead to increased congestion due to prolonged use

Chronic sinusitis can be treated by focusing on the underlying condition. The different treatments may include:
Intranasal steroid sprays
Leukotriene antagonists, like montelukast
Oral pills or topical antihistamine sprays

2. Surgical treatment: When medications fail to work in the case of chronic sinusitis, then surgery is performed as a last resort to treat structural defects like fungal infections or polyps.

Functional Endoscopic Sinus Surgery (FESS): 
This is a minimally-invasive type of procedure that takes about one to three hours to complete.
The surgeon will give anesthesia to sedate the nasal area.
Using an endoscopic tube the surgeon removes the infected bone, polyps, or tissue that may be causing tissue blockage.
In certain cases, a small rotating burr may be used to scrape out the tissue.
The ENT surgeon will then pack the nose using a bandage and a cotton swab to absorb blood or any other discharge.

Balloon sinuplasty:
It is a minimally-invasive procedure performed using an endoscope, done under the effect of local anesthesia.
A small catheter is inserted into the nose with the aid of an endoscope.
A small balloon is placed in the sinus through the catheter and this balloon is slowly inflated to unblock the sinuses.
The balloon is then removed.

Caldwell Luc surgery:
This procedure is performed under the effect of general anesthesia.
This procedure is performed only when all other treatment methods have failed.
An incision or cut is made in the gum region, between the upper lip and gum tissue to access the maxillary sinus wall.
A small hole is then made in the wall of the sinus to remove the damaged tissue or bone that is causing the problem.
An endoscope will be used to widen the sinus opening.
The incision is then closed using sutures.

Risks

Sinusitis may lead to the following complications if it is left untreated:

1. Abscess (collection of pus in the sinus cavity)
2. Meningitis (a life-threatening type of infection that may cause brain and spinal cord damage)
3. Orbital cellulitis (infection of the tissue that surrounds the eyes)
4. Mastoiditis (infection or inflammation of the mastoid bone present in the head behind the ear)
5. Cavernosa sinus thrombosis (blood clot formation in the cavernous sinuses)
6. Frontal or maxillary osteomyelitis (inflammation of the frontal or maxillary sinus bone)

After Procedure

The following are the post-procedure steps following sinus treatment by surgery:

• Most patients can go home on the same day or the following day after the surgery.
• You need to have regular follow-ups with your doctor at one week, three weeks, and six weeks after the surgery. You then need to visit your doctor every three months till your symptoms improve and your condition becomes stable.
• You may have some pain and swelling after the surgery.
• The doctor may prescribe pain-relieving medications, antibiotics, and oral steroids after the surgery.
• Antihistamine nasal decongestant drops and sprays may be recommended to reduce congestion and discharge, and clear out the blood clots and mucus from the nose.
• You should prevent blowing your nose for the first week after the surgery.
• Nasal saline washes will be recommended twice a day, starting one or two days after the surgery.
• Avoid heavy lifting and strenuous activities for at least two weeks after the procedure.
• Most patients can resume work about one week after the surgery.
• You need to avoid flying for at least two weeks after the surgery.
• You need to avoid swimming for at least two weeks after the surgery.
• You need to avoid scuba diving for four weeks after the surgery.

Home remedies:

There are several home remedies that can help in relieving the symptoms of sinusitis, which may include the following:

1. Sleep or rest with the head and shoulders raised on a pillow. Sleep on the pain-free side of the face.
2. Rinse and clear the nasal passages using saline solution or salt water. A neti pot may be used for nasal irrigation.
3. Warm compresses can be gently applied to the affected areas to relieve discomfort and swelling.
4. Pain-relieving medications like acetaminophen and ibuprofen can help in reducing pain and fever.
5. A hot, moist towel may be placed on the face or steam may be inhaled from a hot water bowl.
6. Addition of a few drops of essential oils, like menthol or eucalyptus oil, to the hot water or towel may help in relieving the symptoms of sinusitis.
7. Nasal sprays containing corticosteroids may help in reducing nasal and sinus inflammation.
8. Decongestants sprays and tablets can help in reducing the swelling and allowing the sinuses to drain. These can be used for up to three days only.

Prevention:

The following tips may be helpful in preventing sinusitis:

• Practice good hand hygiene
• Quit smoking and avoid secondhand smoke
• Keep your vaccinations up to date
• Stay away from people having a cold or other types of respiratory infections
• Use a humidifier to moisten the air at home and keep it clean
• Maintain air conditioners well to prevent dust and mold collection
• Avoid and manage allergens
• Keep yourself well hydrated 

Cost of surgery for sinus treatment in India- 

The cost of non-surgical methods to treat sinusitis in India is between INR 2,000 to INR 20,000.
The cost of surgery for sinus treatment in Mumbai is between INR 45,000 to INR 75,000.
The cost of surgery for sinus treatment in Delhi is between INR 40,000 to INR 70,000.
The cost of surgery for sinus treatment in Bangalore is between INR 40,000 to INR 70,000.
The cost of surgery for sinus treatment in Chennai is between INR 35,000 to INR 65,000.