CHRONIC SINUS INFECTIONS

Dr. Atkins recognizes that sinusitis, allergies, sinus headaches, septal deviation, and other common sinus problems negatively impact the quality of South Texans’ lives. He opened Atkins Expert Sinus Care, formerly Texas Sinus Center, in 2002 and has devoted his practice to treating sinus problems affecting people in San Antonio and South Texas ever since.

Sinus Infections

There are four types of sinus infections. Chronic sinusitis is by far the most common problem that we see. We are all familiar with acute sinus infections; these are the that cause major cold-like symptoms and may even include fever and congestion severe enough to keeps you in bed for several days. Those types of infections are typically managed by your regular health care provider and do not need to be treated by a sinus specialist.

1. Chronic Sinus Infections

Some patients can have a chronic sinus infection for years. Sounds strange, but we see this all the time; it is the most common type of sinus infection we treat. This usually occurs because many of the symptoms of chronic sinusitis can be mistaken for other problems. For example, common allergy symptoms such as congestion, post nasal drainage, stuffy nose, and sinus headaches can all be due to a chronic sinus infection. By definition, a chronic sinus infection (also known as chronic sinusitis) refers to a sinus infection that's been present for more than 12 weeks, although people with chronic sinusitis don’t report fevers or having to stay in bed for 12 weeks. What they complain about most of the time is just being exhausted and that sinusitis inferers with aspects of their daily life from work to social activities. (24)

2. Recurrent Acute Sinus Infections

There is a type of sinusitis called Recurrent Acute Rhinosinusitis or RARS. RARS is acute sinusitis that clears up, or appears to clear up, and then recurs again several weeks to several months after the last episode. This pattern of being sick, getting better, being sick, and getting better is basically the definition of recurrent acute sinusitis. If you are getting several sinus infections a year with periods of time where you clear up in between, you should definitely see a doctor to determine if you are suffering from RARS.

3. Sub Acute Sinusitis

This type of infection refers to an infection that lasts more than four weeks but fewer than 12 weeks. Patients experience all of the typical symptoms of sinus infection, including sinus pain and pressure, drainage, lethargy, etc. Symptom severity will determine whether or not you choose to see a doctor or let the infection clear up on its own.

4. Acute Sinus Infections

This type of sinus infection is the type we're most familiar with. It's the sudden onset of facial pain, pressure, snotty nose, cough, and sometimes it's associated with fever. Usually, the symptoms are bad enough that it will require a trip to the doctor. 

Symptoms of Chronic Sinusitis

We treat sinus problems for a living and experience has taught us that no two sinus patients suffer from the same symptoms. Some may have congestion severe enough to keep them inside for days, others have symptoms that are mild and live with symptoms for years. Here is a list of common complaints from our sinus patients.

 

  • Fatigue, disrupted sleep

  • Inability to take in air through one or both sides of the nose 

  • Nasal drainage 

  • Congestion

  • Nasal obstruction, blocked sinuses

  • Post nasal drip, sometimes with sore throat 

  • Runny nose

  • Snoring

  • Headaches or facial pain

  • Pressure that may worsen when bending over

  • Discolored nasal drainage (green or yellow)

  • Nasal congestion

  • Mouth breathing

  • Sore upper teeth​

  • Cough 

  • Ear pain 

  • Sore eyes

An Overview of Sinus and Sinusitis 

If you've ever had a cold or allergy symptoms that lingered on for days, chances are you’ve probably had sinusitis. Sinusitis simply refers to inflammation or swelling of the lining in your nose and sinuses.(4) Sinus inflammation can cause sinus infections and miserable symptoms. There are over 30 million people diagnosed with chronic sinusitis each year and it accounts for over 8 billion dollars in doctor visits, medications and missed work.  (1) (16) 

Basic Sinus Structures

If you've ever had a cold or allergy symptoms that lingered on for days, chances are you’ve probably had sinusitis. Sinusitis simply refers to inflammation or swelling of the lining in your nose and sinuses.(4) Sinus inflammation can cause sinus infections and miserable symptoms. There are over 30 million people diagnosed with chronic sinusitis each year and it accounts for over 8 billion dollars in doctor visits, medications and missed work.  (1) (16) 

What Do the Sinuses Do?

Our sinuses have various functions, including lightening the weight of the head, humidifying and heating inhaled air, increasing the resonance of speech, and serving as protection in the event of facial trauma. (27)

What Can Go Wrong With Sinuses?

There are a lot of possible reasons for sinus symptoms. The most common causes of chronic sinus problems we see at Atkins Expert Sinus Care are due to:​

  • Sinus Infections

  • Abnormally shaped sinus passages that don't drain well

  • Septal deviation, crooked nose

  • Allergies

  • A chronic lingering infection that you may have developed years ago that never went away

  • Immune system problems

  • Previous sinus surgery which was poorly or incompletely performed

The basic problem behind all of these types of sinus infections and sinusitis is that mucus isn’t draining properly. Sinuses that don’t drain or are blocked, cause the unpleasant sinus symptoms. In fact, millions of adults seek treatment from their ear nose and throat doctor (ENT), family physician or medical clinic each year.

How Do We Diagnose Sinusitis?

Dr. Atkins believes that having the correct diagnosis before beginning any treatment, is crucial to a successful outcome. This sounds simple, but too often we see patients who have been on medications for weeks, months and years without getting better. They have wasted time and money and lived with uncomfortable sinus symptoms without ever really getting a proper diagnosis.

 

Dr. Atkins has developed a process to quickly diagnose the cause of your problems in our office. It begins with a careful review of your medical history and if needed, we can perform a variety of diagnostic tests in our office. These most commonly include a CT scan of the sinuses, nasal endoscopy and allergy testing. 

CT Scan (Cat Scan) for Sinus Problems

CT scans are used to detect an infection, a deviated septum, sinus polyps, narrow sinus passages and other abnormal sinus anatomy.

The advantage of having a CT scan in our office is that it saves time. The results are ready in as little as a few minutes, so you can leave our office with a diagnosis. For the  CT scan, you sit upright in a chair. It takes about 20 seconds. It has 90 percent less radiation than a traditional CT scan and it's much less expensive. CT scans are covered by most insurance companies.

Nasal Endoscopy

A nasal endoscopy is a quick non-invasive procedure that allows us to look inside your nose using a small telescope. Nasal endoscopy exams are used as an aid to help diagnose nasal and sinus problems such as swelling or inflammation, polyps, infection, bleeding, a deviated septum and allergies, and to assess the overall health of the lining of your nose.

Prior to the exam, we spray your nose with a nasal decongestant and a numbing medicine. Then a thin tube is placed in your nose and the structures of your nose are examined. Nasal endoscopic exams are covered by most insurance plans.

Allergy Test

Allergies make you more susceptible to sinus problems. We offer allergy testing to help determine  how much of your problem is allergy related. Testing is done on your forearm and takes 20 minutes. The test is painless, we do not use needles and allergy testing is covered by most insurance plans.

Other Tests

  • For some patients, we check their vitamin D levels.

  • Nasal cultures are sometimes performed to find the correct antibiotic.

  • Dr. Atkins may recommend checking your immune system.

Treatment for Chronic Sinusitis

Once you've been evaluated, Dr. Atkins will develop a personalized treatment plan based on your history and any test results. Treatment plans are tailored to each individual depending on history, symptoms and diagnosis.

Medication for Sinus Infections

Some medications such as prescription antibiotics are taken for several weeks, while others such as antihistamines, may have to be taken longer. Many medications used to treat sinus and allergy problems are now available over the counter without a prescription.

Prescription Medicating for Sinus Problems
Over-the-Counter (OTC) Sinus Medicine

Note - we frequently make recommendations for over-the-counter medicines using the OTCme app. OTCme is free and easy to use. If you would like to download the app click here.  

Surgery Options for Chronic Sinusitis

There are times when medications are no longer effective enough to make you feel better. In those cases, surgery needs to be considered. In the past, sinus surgery was painful, bloody and removed a lot of tissue and bone. However, over the past decade, there have been great advances in surgical treatments available for chronic sinusitis. With newer technology, sinus surgery is much less invasive. Dr. Atkins has been an advocate of minimally invasive sinus surgery procedures such as Balloon Sinus Surgery

Balloon Sinusitis

Balloon Sinuplasty (BSP) is an easy, quick procedure done at our office under IV sedation for the treatment of chronic and recurrent sinus infections, as well as sinus headaches and sinus pain. BSP uses a small compressed balloon that is threaded with computer guidance by a device (TruDi™) into blocked sinus passages. Once the balloon position is confirmed with TruDi, the balloon is inflated for a few seconds. The sinus passages are widened by the inflated balloon. Since we are dilating and not removing tissue, there is minimal bleeding and a very quick recovery. BSP can be combined with other procedures such as turbinate reduction and septoplasty to improve nasal congestion.

Traditional Sinus Surgery

Functional endoscopic sinus surgery (FESS) means removing diseased and obstructing sinus tissue while viewing the procedure with an endoscope. Most of the removal is done with a shaver which removes tissue by cutting and suctioning at the same time. FESS is more invasive than a balloon sinuplasty because patients who need a FESS usually have a more extensive disease which BSP can’t help.

Hybrid Surgery

FESS is more invasive than a balloon sinuplasty because patients who need FESS usually have more extensive disease which a balloon sinuplasty can’t alleviate. Some patients can undergo a "hybrid" procedure where the most diseased tissue is removed with a shaver (FESS) and the less diseased tissue is dilated with a balloon (BSP). 

Long-Term Outcomes for Sinus Patients

Patients with sinus problems fall into several categories. Many of the patients we see are treated for a short time, recover and never need to see us again. Others with underlying allergy or disease problems are able to get back on track with a course of sinus medicine such as antibiotics and take medicine daily to stay well. Remember, our goal is to make you feel better without surgery. About 25 percent of our new patients have surgery in our office. The majority (93 percent) of patients who undergo balloon sinuplasty report doing well several years later. For others, staying well after surgery may require continuing to use medication in order to optimize surgery results. 

Resources

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