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CHRONIC SINUSITIS

Our physicians provide diagnosis and treatment, including endoscopic sinus surgery, for patients who suffer from complex sinus diseases.

What are the sinuses?
The sinuses are air filled spaces within the skull. There are four groups of sinus:

  • Maxillary sinuses, a paired group located below the eyes and lateral to the nasal cavity.
  • The ethmoid sinuses, typically numbering about 10-15 and arranged in a honeycomb pattern between the eyes.
  • Frontal sinus, a large single or divided cavity above the eyebrows.
  • Sphenoid sinus, a single or divided space located behind the nose, nearly in the center of the skull.

CT scan which show some sinuses under normal conditions, you would see the bone is white, and air shows up as black. In the healthy state the sinuses are filled with air, and therefore will be totally black.

The sinuses are normally lined by a thin layer of tissue called mucosa. Glands within the mucosa produce a secretion called mucous. Mucous helps to moisten and clean the nose, and also helps in the sense of smell. These mucosa cells have tiny hairs called cilia that sweep the mucous to small openings in the sinus wall. Under normal circumstances the mucous produced in the sinuses is cleared in a self-cleaning process. However, if the natural openings between the sinuses and the nasal cavity are blocked, the mucous can accumulate in the sinuses. This can lead to infection.
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Treatment of Sinus Infections:
The first line of treatment for sinus infections is a combination of antibiotics and other medical measures. There are many antibiotics available which are active against different types of bacteria. In addition to antibiotics, oral decongestants (like pseudoephridine) are useful. Nasal decongestants like oxymetazoline may be effective for a short time, but should not be used for more than several days. If there is a history of allergies, anti-histamines may be useful.

In addition to these medicines, it is often helpful to irrigate the nasal cavity with a saline solution. This helps to keep the nasal mucosa moist and cleans the nasal cavity.

If sinus infections persist despite maximum medical treatment, surgery may be necessary.

Sinus surgery is performed when an individual with recurrent sinusitis has failed treatment with medicines. The major goal of most sinus surgery is to improve the natural drainage of the sinuses. Usually this means enlarging the pre-existing openings between the sinuses and the nasal cavity.

Most sinus surgeries can now be done with special small telescopes, called endoscopes. These endoscopes are similar to those used in knee surgery. Some sinus surgeons operate looking directly through the scope.

It is also possible to hook up a small camera to the telescope. The image can then be displayed on a large monitor in the operating room. These endoscopes give the sinus surgeon a clear and magnified view of the inside of the nasal cavity and the sinuses.

Prior to performing any sinus surgery, a CAT scan is usually required to confirm the diagnosis and to show the anatomy of the sinuses.

Septoplasty:
We also offer laser surgery in our clinic for patients with sleep disorders due to snoring, known as Septoplasty. A septoplasty is a surgical procedure in which the nasal septum is straightened.

The nasal septum is the part of the nose that divides the right nasal cavity from the left nasal cavity (see diagrams). The septum usually lies directly in the center of the nose and rests on a bony ridge called the maxillary crest. The septum is made up of several layers. In the front, the central portion of the septum is cartilage, a relatively soft material that is fairly flexible. More posteriorly, the central septum is made up of thin bone. Lying on top of the bone and cartilage is the lining of the nose, called the mucosa.

A septoplasty is done if the septum is so crooked that it interferes with breathing or causes other problems. Few people actually have a perfectly straight septum, but in most cases the amount of bending is not large enough to be noticed.

The most common symptom from a badly deviated (crooked) septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections. The septum may also need to be straightened in individuals undergoing sinus surgery just so that the instruments needed for this operation can be fit into the nasal cavity.

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SITES OF PRACTICE
 
Children's Hospital and Regional Medical Center
 
 
Harborview Medical Center
 
 
University of Washington's Medical Center
 
 
Veterans Affairs Puget Sound Health Care System
 

 
   
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