SINUSITIS, ALLERGY AND SINUS SURGERY
Dr. Joseph J. Donzelli, MD
(630) 420-2323
One-third of the population of the country has complained to a physician about a “sinus
condition.” Many people equate “sinus headache” and “sinus infection.” However, an
acute sinus infection is more commonly associated with facial pressure and pain rather
than headache. Other associated symptoms include upper teeth pain, foul taste in the
mouth, discolored drainage, and nasal obstruction. Chronic sinusitis can have similar
complaints but by definition has lasted greater than one month.
Allergic rhinitis overlaps with sinusitis in that it, too, can cause facial pressure and pain
as well as nasal congestion, runny nose and post nasal drip. Other associated symptoms
of allergic rhinitis include sneezing fits and itchy, watery eyes. Environmental allergies
can also cause inner ear symptoms.
After reading the above, one should come away with the generic term “sinus condition”
as the most common diagnosis in patients complaining of “chronic sinus headaches.”
There are both anatomical and functional reasons for these conditions. Surgery only
treats the anatomical component, and therefore, many patients who are allergy sufferers,
in addition to having chronic sinusitis will need both surgery and aggressive allergy
treatment to maximize their condition.
Typically, one would obtain at least one CAT scan of the sinuses while going through
workup and treatment. If your CAT scan does not support the degree of symptoms you
have, and you appear to have allergic rhinitis complaints, I will very often obtain allergy
testing on you. This involves skin endpoint testing with common environmental and food
allergens (i.e. trees, weeds, grass, dust mites, pets, molds and feathers). The results of
this test will direct treatment recommendations in one or any combination of the
following three:
1) Environmental control
2) Medication control
3) Immunotherapy or shots
When shots are recommended, they are take weekly for two years and then every other
week for an additional two to three years, patient dependent. Shots and testing are
usually benign in nature. Risks for testing and shot therapy include asthma exacerbation
and local reactions. For these reasons, testing and shots are usually not administered
when asthma is not well controlled. An extremely rare condition called anaphylaxis is
when the body has a severe swelling reaction to the item to which it is exposed. It is very
rare, but you should know that all of our offices are prepared to handle this situation were
it to arise.
If your sinus CAT scan is significantly bad, you will probably be put on any combination
of the following: antibiotics, nasal sprays, decongestants, and possibly oral steroids. If
this does not resolve the problem, you may be recommended to undergo sinus surgery.
Sinus surgery should be thought of as a ventilation procedure. Your sinuses are cavities
in your head, which are usually filled with air, and they usually have openings to allow
pressure release. Like a refrigerator unplugged and closed, diseased sinuses are under
ventilated. Surgery opens the sinuses so as to allow them to drain and equalize pressure
more easily. It is not expected that surgery will cure all of your sinus conditions. By
now, I am sure you understand that there are many variables affecting your sinuses- not
just anatomy. Nonetheless, my surgical goal is to reduce the frequency of infections and
to reduce the duration of each infection.
Surgery is outpatient and may take from one and a half to two hours to perform. If your
septum is deviated and blocking the entrance to the sinuses, you may need your septum
straightened as well. After surgery, you may have packing in your nose form anywhere
between one and five days after surgery. This is removed in the office usually on the first
visit. This sounds scary but is well tolerated. Surgery itself is not extremely painful but
is more uncomfortable because you nose will be packed with gauze and/or blood.
After surgery, you will have approximately three visits within the first month. These
visits are the most difficult part of sinus surgery, and each successive one is easier. I will
be cleaning your nose out of old blood and scabs for the first few visits. You will be
required to use saline nasal spray a minimum of three times daily. Surgery in the
recommended patient is successful in reducing the frequency and duration of sinus
infections in approximately 80 percent of the patients. Nasal congestion, sense of smell,
and headache symptoms are very unpredictable. These symptoms very often have
multiple causes and, therefore, may not be completely resolved with surgery.
Allergy usually is the other major contributing factor and is usually addressed as above.
Twenty percent of patients may require additional surgery for scar tissue or to open areas
not addressed at the original surgery and also, occasionally, for re-growth of polyp tissue.
Expect some nasal bleeding for the first several days after surgery. You may require a
nasal mustache dressing until after the packing is removed.
As always, if any questions arise, please call (630) 420-2323. Please save emergent calls
for after hours because you only have a 25 percent chance of speaking with me, and the
doctor on call may not know your individual case.
Joseph J. Donzelli, MD