Chronic rhinosinusitis


Paranasal sinuses, in normal conditions, are air-filled spaces and communicate with the nasal cavity by apertures called ostia. The mucous membrane that is lining the sinuses wall, continuously produces mucus that is moved by microscopic cilia in the direction of ostia.

 

Common rhinitis (common cold) is caused by a viral infection. It is believed that viral infection involves at once both the mucous membrane of the nasal cavity and paranasal sinuses, that’s way the correct name should actually be "acute viral inflammation of the nasal cavity and paranasal sinuses." By definition, a runny nose is characterized by the occurrence of at least two symptoms: nasal congestion (blocked nose) and the leakage of discharge (watery, pus or mucous), which may be accompanied by a feeling of tightness in the head or face, and impairment of smell.

 

If after 5 days, symptoms worsen, or if not disappear after 10 days, we have to deal with acute rhinosinusitis. we can talk about chronic rhinosinusitis when symptoms persist for three months. Chronic rhinosinusitis (abbreviated CRS) is a group of conditions whose symptoms are very similar, but the base and the mechanisms leading to their occurrence are different, and not fully explained. Currently, there are two main types of chronic rhinosinusitis:

 

  • chronic rhinosinusitis with polyps
  • chronic rhinosinusitis without polyps.

 

Both types require in most cases the surgical treatment, which often must then be aided with chronic pharmacological treatment. The diagnostic process carried out for confirmation of the diagnosis, and then allowing the surgeon orientation  during the procedure, is computed tomography (CT) of the paranasal sinuses and nasal endoscopy.

 

Most patients with CRS without polyps require treatment to improve the permeability of sinus ostia, called FESS (functional endoscopic sinus surgery). This treatment contains of limited,  precise surgical intervention enlarging paranasal sinuses ostia and facilitating the drainage of mucus.

 

In the case of CRS with polyps, surgery has wider range and aims to remove polypoid lesions and to create access to drugs administered to the nose (topical steroid). Currently, these treatments are mainly under the control of endoscopes, which are optical devices that allow us looking into various "corners" inside the nasal cavity and paranasal sinuses. Most often, these operations are carried out under general anesthesia. The complications of these procedures might be leak of cerebrospinal fluid, damage to orbital structures, lacrimal paths and (slightly more) bleeding from the nose. Serious complications are fortunately less than 0.5 % of cases.

 

The majority of patients after surgery nose is filled with tampons that inhibit bleeding. Typically, they are removed the next day after the treatment, accompanied by a small and short (usually) bleeding. In the postoperative period, it is essential to frequently lavage nose with saline, which is conducive to proper healing and clears the nose. Blood clots may appear in nasal discharge after surgery to 2 weeks. During this time it is required to, avoid physical exertion, hot foods and drinks, alcohol, sharp bending (they may predispose to bleeding), flying airplane (swollen sinuses ostia during the healing does not equalize the pressure during take-off and landing).

 

For purification of the sinus cavities from secretion and clots,in most patients is performed one week after surgery the cleaning using suction devices. "Cleaning" is performed under local anesthesia or without anesthesia. It is unpleasant, but unfortunately necessary that for the next two weeks, patient could breathe freely. About the problem with "sinuses" patient do not completely forget, because usually has to continue administer medication to the nose.

 

Thomas Gotlib, MD