New techniques can help ease the sinus woes

A cold is bad enough. But for millions of Americans, the common cold mutates into the stuffy nose, yellow-green nasal discharge and headache that are hallmarks of a sinus infection.

"People complain about sinus problems more bitterly than they do about heart conditions," said Dr. James Chow, an ear, nose and throat specialist at Central DuPage Hospital in Winfield. "When the sinuses become blocked, those people are very miserable."

There are a lot of miserable people out there this winter. The National Institute of Allergy and Infectious Diseases estimates 37 million Americans suffer bacterial sinusitis -- an inflammation of the sinus cavities that lie behind the nose and face.

Chow and other experts say you shouldn't ignore lingering sinus infections. It could be a sign of a more serious issue, and repeated infections can also lead to scar tissue that ultimately will make your problems worse.

Fortunately, new treatments are emerging that could spell relief from sinus pain and pressure.

Clear again

Thomas O'Brien of Northbrook suffered recurring sinus infections for over a decade. Every time he caught a cold, his sinuses would throb for weeks until he got a prescription for antibiotics.

"At times I'd consider an operation, and then I'd get better and decide not to," said O'Brien, who is retired at age 74.

O'Brien didn't want the weeklong recovery required for a sinus surgery to clear his blocked sinus passages. Then his doctor told him about a relatively new procedure that uses a balloon to open the sinuses.

Dr. Gregory Bussell, an ear, nose and throat specialist at Advocate Lutheran General Hospital in Park Ridge, operated on O'Brien in November.

"You're in and out of the hospital the same day," O'Brien said. "Now when I have a sniffle or something, it doesn't seem to progress as it used to."

The procedure is similar to angioplasty, in which a surgeon uses a balloon to prop open a clogged artery in the heart. In sinuplasty, the doctor inserts a catheter into the sinus and inflates a tiny balloon to widen the sinus opening. An X-ray helps guide the balloon to the right spot.

Compared to traditional endoscopic sinus surgery, which uses tools to cut away tissue or bone that is causing blockages, balloon sinuplasty is less invasive, has less risk of bleeding and a little quicker recovery, Bussell said.

"It creates microfractures and pushes the bone out of the way to dilate things, rather than removing bone," he said. "People have only been doing it a year or two, but there have not been any significant complications."

Studies show most patients' sinuses remain clear a year after the procedure, Bussell said.

Chow, who also performs balloon sinuplasty, said the procedure is particularly effective for bacterial infections in the frontal sinuses, which lie in the center of the forehead between the eyes.

"The major advantage is it doesn't traumatize the tissue, which can cause scarring," he said.

But it's unlikely to replace traditional endoscopic sinus surgery, Chow and Bussell said. Patients who have polyps or fungal infections will still need surgery to remove that material, and some sinus cavities are only accessible via endoscopic surgery, Chow said. In many cases, a doctor will use both techniques on the same patient.

"It's basically another tool that allows us to get into the sinus and open it up," Chow said.

Antibiotics debate

Surgery of any kind is usually the last option in treatment of sinus problems. Doctors often start with medical therapies.

An acute case of sinusitis will clear up in four weeks or less, often with antibiotics, decongestants and steroid nasal sprays, Bussell said.

The effectiveness of antibiotics for these infections is open to debate. A study published in the Dec. 5 Journal of the American Medical Association found people who had no treatment got better just as fast as those who took amoxicillin for a bacterial sinus infection. Steroid nasal sprays made little difference.

Other studies have found antibiotics do have an effect, but only a small one. Chow believes they remain an important part of a treatment plan. Antibiotics can shorten the illness and thus prevent scar tissue that could block the sinus and lead to chronic problems, he said.

"It's my belief that initiation of treatment early on will prevent some of the more severe symptoms like headaches, more congestion, more drainage," Chow said.

People who have already had surgery to open their sinuses may benefit from a new method of delivering antibiotics using a nebulizer.

"It puts the antibiotics in an aerosolized form so that when you breathe it gets directly into your sinuses," Chow said.

Of course, that only works if your sinuses are open to begin with. Chronically blocked sinuses are more difficult to clear and may require surgery, doctors said.

A doctor can diagnose chronic sinusitis with a CT scan that shows a build-up of fluid or a blockage.

"For chronic sinusitis, there's not a single antibiotic indicated by the FDA for use, which tells you something," Bussell said. "When you get to the point of chronic infection, it's more inflammation, polyps, scar tissue. It's a mechanical issue that's keeping things from draining."

Sinus 101

What are they?

The sinuses are cavities that lie behind the nose and face. In healthy individuals, these chambers produce mucus that drains through openings into the nose and throat. The sinus may also give resonance to the voice and help humidify the air that you breathe.

Why do they get clogged?

Inflammation, an allergen or a polyp can easily block the tiny passages, which are about the size of a pencil lead. That leads to a painful build-up of mucus and pressure.

The same problem can be triggered by allergies, chemical exposures or the hormone changes that come with pregnancy. A broken nose can push the septum over, blocking a sinus cavity.

How do you take care of them?

• Don't ignore sinus infections; if you're suffering prolonged symptoms, see your doctor.

• Maintain good control of your allergies. Mechanical irrigation of the sinuses using a neti pot or other products can help flush allergens from the nasal passages, though be careful to sanitize your equipment.

• Nasal saline rinses can also help thin secretions and humidify the sinuses.

• Don't smoke; smoking damages the little hairs that help drain the sinuses.

Source: Daily Herald interviews