The truth about the sinuses and sinus surgery…

Can’t breathe easily through your nose? Well, you are not alone. Sinus symptoms are in the top ten diagnoses primary care physicians make. But, despite how common these issues are, there are still many misconceptions about the sinuses, which often keep patients from receiving the proper treatment.

To help us better understand the sinuses, we checked in with Stacey T. Gray, M.D., a sinus surgeon in the Mass. Eye and Ear Sinus Center, who shared the 5 most common myths related to the sinuses:

1) Sinus symptoms? You must have a sinus infection.

Many people attribute sinus symptoms to a sinus infection, when that might not be the case. There is a difference between acute sinusitis (sinus infections) and chronic sinusitis.

• Acute sinusitis is an inflammation of the cavities around your nasal passages (sinuses) caused by a variety of infections, including the common cold, a bad viral upper respiratory infection (URI) or bacteria. This is what is commonly known as a sinus infection.

• Chronic sinusitis is when that inflammation continues for more than three months and can be caused by a variety of conditions or is associated with allergies, asthma or nasal polyps.

By definition, the hallmark symptom of acute sinusitis is discolored drainage and is often associated with nasal congestion and facial pain and pressure. Treatment for this includes getting rest, staying hydrated, decongestants, over the counter pain medication and nasal saline sprays/irrigations. Sometimes, an antibiotic is suggested if a bacterial sinus infection is suspected.

All too often, sinus headaches and pressure are mistaken for sinus infections and are treated with antibiotics, but don’t resolve the problem because another condition, such as chronic sinusitis, is actually the culprit. Anyone who has had persistent sinus pressure for more than three months or has had more than four acute infections within one year should see an otolaryngologist (ear, nose and throat specialist). Other causes of facial pain and pressure can include migraine headaches, TMJ (jaw pain) and neuralgias (nerve pain), and seeing a specialist can also help with these conditions.

2) You always need an antibiotic to treat your sinus symptoms.

Because sinus infections are frequently diagnosed, many patients are taking antibiotics unnecessarily. If there is no bacterial infection to treat, then antibiotics will not help the patient feel better and could begin to create bacteria that are resistant to treatment with antibiotics. The most common scenario is a viral sinusitis (which can occur with the common cold or a viral URI). Viral infections typically resolve within 7 to 10 days and do not require treatment with antibiotics. If your symptoms include sinus pressure associated with discolored drainage that has lasted for more than 7 to 10 days, then seeing your primary doctor is appropriate and an antibiotic may be needed.

3) Surgery is the only treatment for chronic sinus problems.

For patients with chronic sinusitis, surgery is sometimes one of the last options considered. This is not because surgery is ineffective; rather, there are medical therapies available for patients that may delay or prevent the need for surgery.

In addition to oral medications, some therapies include:

• Topical nasal medications (through nasal sprays or irrigations)

• Allergy treatments such as allergy shots

• Alternative therapies such as acupuncture

The type of treatment recommended by physicians depends on the symptoms the patient is experiencing and the degree of sinus disease that is present. Whether it’s recurrent infections, nasal congestion or facial pressure, physicians will work with patients to best tailor the treatment to their symptoms.

4) There is only one type of nasal or sinus surgery.

When people think about sinus surgery, many think about a deviated septum being fixed, and while this is one of the most common types of nasal surgery, it is not the only one.

• Deviated septum surgery: Many nasal symptoms are due to a deviated septum, when the septal cartilage (the part that divides the right and left side of the nose) is crooked. For many, this displacement will cause blockage and trouble breathing through the nose. The procedure is intended to move the bone and cartilage back to the midline to improve nasal breathing.
• Turbinate surgery: Turbinate surgery is also designed to help nasal breathing. Many people have enlarged turbinates, which are normal structures in your nose that warm and humidify the air we breathe. Enlarged turbinates are most commonly caused by allergies. This surgery decreases the size of those turbinates for easier breathing.
• Endoscopic sinus surgery: Endoscopic sinus surgery aims to widen or open the normal drainage pathways that connect the sinuses to the nasal cavity. The sinuses are connected to the nasal passage through tiny openings and for people with chronic sinusitis, those openings can be too swollen for proper drainage. The surgery is designed to improve that drainage and is intended for patients with chronic or recurrent sinusitis.

5) Sinus surgery doesn’t work.

Sinus surgery is very successful in improving quality of life for some patients. The notion that sinus surgery is ineffective is one of the most common myths you might hear. It is important for those considering sinus surgery to understand what the surgery is going to address, whether it is improving nasal breathing or removing blockage of the sinuses.

Sinus surgery can’t cure all problems that affect the nose, such as allergies, and surgery is most successful when included as part of a full treatment plan that often includes continued medical therapy after surgery. Many people think that surgery will completely stop them from getting sick, but infections happen from exposure to a virus or bacteria, so no surgical procedure will be able to eliminate that. The common cold or a viral URI can still happen even if a patient has sinus surgery.

The idea behind sinus surgery is that if you do get sick, the sinuses will be able to drain more easily, so your symptoms will not be as severe and you won’t be sick for as long. The most satisfied patients are the ones that fully understand the procedure.

For patients experiencing sinus symptoms, it is important to understand what those symptoms are. Seeing an otolaryngologist can be extremely helpful to understand your symptoms better and to understand what treatment options are available. For patients with both acute and chronic sinusitis, taking the appropriate steps to care for yourself can significantly increase your quality of life and help you live more comfortably.