The sinuses are the most maligned of all body parts. Radio and television ads, newspaper and magazines constantly remind patients that various nose drops, nose sprays, pills and decongestants will all help their “sinus problems.”
In fact, true sinusitis or infection of the sinuses is rare. More commonly, the patients suffer from blocked nasal passages, but the patient can’t distinguish between an infection of the sinuses and just a blocked nasal passage, which can be due to deviated septum and/or enlarged turbinates.
The sinuses, which are air-filled chambers numbering 7, all rely on an open nasal passage to pass air into their openings. There are sinuses within both cheek bones, on either side of the eye, just above the nose on the forehead, and one far back in the skull underneath the brain and above the highest part of the throat.
True sinusitis is a diagnosis that will always come to the attention of a physician because the symptoms are so profound. The patient will be acutely ill with high fever, weakness and lethargy. Green, yellow or brown pus will come out of the nose. There will be a severe headache or, if the sinuses involved are those within the cheek bones, the sensation of an upper toothache. There may be swelling and redness on the face. In extreme cases, one may even have the eyeball pushed forward.
Typically the patients who are most susceptible to attacks of sinus infections are those who have nasal obstruction due to a broken nose, deviated septum, enlarged turbinates and nasal allergy. Also a contributor is cigarette smoking.
Typically patients that have sinus problems will be those who live in a cold weather climate in the winter where indoor heating to compensate for the outdoor cold carries with it dryness. Dryness is the enemy of normal nasal and sinus function.
It is very important that before patients have rhinoplasty, a purely cosmetic surgery, that there is a determination as to whether or not they have harbored sinus infections in the past. The reason is that if there is still an ongoing indolent sinus infection then there is a chance that the nose is seeded with bacteria which is not a good idea if one is contemplating an elective procedure.
There are x-rays and CT scans available to either establish or eliminate the diagnosis of sinusitis, and these should be performed prior to surgery if there is any question about the patient’s history of sinus infections.