Sinusitis is an inflammation or swelling of the tissue lining in your sinuses.
According to the Centers for Disease Control and Prevention, 28.5 million adults are diagnosed with sinusitis each year.
Listen in as Dr. Lyon defines chronic sinusitis and the best surgical and nonsurgical treatment options.
Selected Podcast
What You Need to Know About Chronic Sinusitis
Featured Speaker:
Steven Lyon, MD
Dr. Lyon is an Otolaryngologist (ENT) and sees patients at the Stoughton Dean Clinic. Transcription:
What You Need to Know About Chronic Sinusitis
Melanie Cole (Host): Have you felt that pain and tenderness and swelling around your eyes, your cheeks, your nose, your forehead, and you feel like you have nasal obstruction or congestion, maybe some difficulty breathing through your nose? Well, it could be chronic sinusitis. But how do you know? My guest today is Dr. Steven Lyon. He’s an otolaryngologist, and he sees patients at the Stoughton - Dean Clinic. Welcome to the show, Dr. Lyon. People feel these things. They think first it’s a cold, maybe an allergy. How do we know when it progresses and it’s not a sinus infection that it’s chronic sinusitis?
Dr. Steven Lyon (Guest): Well, those are great questions, Melanie. It’s very tough frequently to make a distinction between some of the different symptoms that people experience when they have sinus or nasal problems. They know that they have a problem, they can feel the symptoms, but the diagnosis can be difficult. Some of the time, people will have nasal problems that they feel like are sinus problems and sinus problems that they feel like are nasal problems. So the real key comes, as your question implies, with making that proper diagnosis, and that depends on getting a good history of the symptoms that they’ve been having and then also backing that up with an exam and sometimes additional testing beyond that. People who come in with symptoms, which you mentioned—nasal pressure, pain, congestion, sometimes dental pain, cough, sore throat, green and yellow drainage—that’s pretty typical for an acute sinus infection most of the time. People can have more mild symptoms that can also be evidence of an acute sinus infection and not necessarily have these pronounced symptoms. Sometimes though, those symptoms can suggest that there are other problems, whether it be a cold that’s lingering or other problems such as a deviated septum or swelling of the tissues inside the nose or nasal polyp. Sometimes it can be a symptom of chronic sinusitis, as you suggested, because people with chronic sinusitis, while they will generally have more mild symptoms, can frequently have flare-ups on intermittentbasis where they get the full-blown symptoms and it’s more acute sinus infection with all the more severe symptoms. The more mild symptoms, unfortunately, are more subtle, and people have a tendency to make adjustments to those symptoms so they begin to think that those things are really normal. And so they may come in with a just a few subtle nagging symptoms. Maybe there’s stuffing. Maybe they get some facial pressure. Maybe they have drainage. It’s tougher then to know that there is really something going on, because frequently, they’ve had it for so long that they regard most of the symptoms possibly as just kind of the normal thing for them. It’s tough sometimes with a regular physician to make that distinction because since the symptoms are more subtle, it’s hard for them to tell whether it’s an allergy problem, whether it’s a deviated septum, whether they just have swelling. That’s what the exam and additional evaluation come in in helping us make those distinctions because the most important thing for people to understand is that the effectiveness of any given treatment is only as good as the diagnosis that we make. Unless their physician has taken a thorough history and really examined the nose and has a good understanding of those things, it may be that there are parts of the process that have been missed. The treatment won’t necessarily give them the relief that they are looking for.
Melanie: Dr. Lyon, how do you diagnose that that’s what this is? Do people have to have that thing where you put something down your nose, really kind of uncomfortable? What do you do?
Dr. Lyon: Well, we start out by taking a close look in the nose. Frequently, we’ll put medication in there that will decongest the mucous membranes, and then we can see the structure of the nasal cavities so we can spot polyps. We can see if there’s a deviated septum. We can see if there’s infected drainage. We can palpate the face, the cheeks, forehead, teeth, see if there’s tenderness in any of those regions, see if there’s infected drainage that’s going down their throat. If we continue to have a suspicion that there’s something that’s going on within the sinuses, we can sometimes stick a tiny little nasal endoscope in the nose and see if there is abnormal drainage from the sinuses. See if there’s nasal polyps that are coming from chronic sinus disease. Then we can get additional information beyond the exam by doing a CAT scan because a CAT scan lets us actually look inside the sinuses, which we can’t do with just a nasal endoscope or with the exam. We use the history and the exam to give us a suspicion that there may be something more going on. The CAT scan gives us that additional confirmation that yes, there is chronic damage, swelling, inflammation to the mucous membrane. That’s really the hallmark of chronic sinusitis. These are people who really never get quite normal until they’ve had the diagnosis recognized and the appropriate treatment instituted.
Melanie: Let’s speak about the appropriate treatment. What’s involved? Is this antibiotic? Is it a long course? Nasal lavage? What do you do for people that are suffering from chronic sinusitis?
Dr. Lyon: Well, all those things are important, and it depends on the severity of the problem. Some people have more than one of these problems. Each one might require a little bit different treatment. In general, what people can do on their own is the nasal lavage or the nasal irrigation that you mentioned is very, very, very helpful. Everybody thinks about brushing their teeth every day. This couple of inches north of the teeth area, your nose, and what do we do for the nose every day? It takes a tremendous amount of abuse and use and has to do a lot of things but we don’t do anything to care for it. People should think of the nasal irrigation as brushing your teeth for your nose. That little maintenance really goes a long way in not only treating but preventing this problem. If people have a periodic flare-up and have signs that suggest that they have infection, then of course they’ll need antibiotic. People who have allergies need treatment for some of the allergic, sneezy, itchy, runny, stuffy type symptoms. And that can either be an oral antihistamine or possibly a topical nasal steroid spray. But there’s still other people for whom those treatments are not going to be effective because they have something that might require additional surgery, whether that’s a deviated septum, nasal polyps, or this condition that you mentioned, chronic sinusitis, where the sinuses, an established pattern of swelling and inflammation and damage that really requires a surgical approach in addition as well as application of medication to really settle down the inflammation that the body is producing, allowing that mucous membrane to heal and become more normal and then function more normally so they don’t have those chronic symptoms. That care involves not only frequently having typicalprocedure to open the sinuses, let them drain better, let us access them for treatment, but also close follow-up afterwards to make sure that we have achieved the recovery of those mucous membranes with ongoing irrigation or medication so that they become normal and then the person continues to feel normal and makes surgery that much more effective. It really is a combination of not only a surgical approach in some of these patients with more stubborn problem, but ongoing care to make sure that they have resolution of the inflammation and management of the inflammation that really underlies the problem.
Melanie: Dr. Lyon, in just the last minute or so, give patients your best advice for those suffering from chronic sinusitis and why they should come to Stoughton Hospital for their care.
Dr. Lyon: My best advice is that if you’re managing this on your own, for more mild problems, then nasal irrigations are going to give the best bang for the bucket in terms of treatment of the symptoms and managing the underlying problem. When it comes time to be evaluated by a physician, being a specialist can be very important because having a very specific and accurate diagnosis is the key to getting the treatment, and they will then be able to recommend and perform that specific treatment that will address the underlying problem and get the best opportunity for a sustained long-term relief of those miserable symptoms. Most important thing to remember is you don’t need to suffer with these symptoms, because we have very effective ways of managing the symptoms and problems at this point. That didn’t use to be the case. But the tools we have, when properly applied, when the right diagnosis is made, really allow the patients to get excellent and long-term relief.
Melanie: Thank you so much. And remember, you do not have to suffer from chronic sinusitis. There is treatment and help out there. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.
What You Need to Know About Chronic Sinusitis
Melanie Cole (Host): Have you felt that pain and tenderness and swelling around your eyes, your cheeks, your nose, your forehead, and you feel like you have nasal obstruction or congestion, maybe some difficulty breathing through your nose? Well, it could be chronic sinusitis. But how do you know? My guest today is Dr. Steven Lyon. He’s an otolaryngologist, and he sees patients at the Stoughton - Dean Clinic. Welcome to the show, Dr. Lyon. People feel these things. They think first it’s a cold, maybe an allergy. How do we know when it progresses and it’s not a sinus infection that it’s chronic sinusitis?
Dr. Steven Lyon (Guest): Well, those are great questions, Melanie. It’s very tough frequently to make a distinction between some of the different symptoms that people experience when they have sinus or nasal problems. They know that they have a problem, they can feel the symptoms, but the diagnosis can be difficult. Some of the time, people will have nasal problems that they feel like are sinus problems and sinus problems that they feel like are nasal problems. So the real key comes, as your question implies, with making that proper diagnosis, and that depends on getting a good history of the symptoms that they’ve been having and then also backing that up with an exam and sometimes additional testing beyond that. People who come in with symptoms, which you mentioned—nasal pressure, pain, congestion, sometimes dental pain, cough, sore throat, green and yellow drainage—that’s pretty typical for an acute sinus infection most of the time. People can have more mild symptoms that can also be evidence of an acute sinus infection and not necessarily have these pronounced symptoms. Sometimes though, those symptoms can suggest that there are other problems, whether it be a cold that’s lingering or other problems such as a deviated septum or swelling of the tissues inside the nose or nasal polyp. Sometimes it can be a symptom of chronic sinusitis, as you suggested, because people with chronic sinusitis, while they will generally have more mild symptoms, can frequently have flare-ups on intermittentbasis where they get the full-blown symptoms and it’s more acute sinus infection with all the more severe symptoms. The more mild symptoms, unfortunately, are more subtle, and people have a tendency to make adjustments to those symptoms so they begin to think that those things are really normal. And so they may come in with a just a few subtle nagging symptoms. Maybe there’s stuffing. Maybe they get some facial pressure. Maybe they have drainage. It’s tougher then to know that there is really something going on, because frequently, they’ve had it for so long that they regard most of the symptoms possibly as just kind of the normal thing for them. It’s tough sometimes with a regular physician to make that distinction because since the symptoms are more subtle, it’s hard for them to tell whether it’s an allergy problem, whether it’s a deviated septum, whether they just have swelling. That’s what the exam and additional evaluation come in in helping us make those distinctions because the most important thing for people to understand is that the effectiveness of any given treatment is only as good as the diagnosis that we make. Unless their physician has taken a thorough history and really examined the nose and has a good understanding of those things, it may be that there are parts of the process that have been missed. The treatment won’t necessarily give them the relief that they are looking for.
Melanie: Dr. Lyon, how do you diagnose that that’s what this is? Do people have to have that thing where you put something down your nose, really kind of uncomfortable? What do you do?
Dr. Lyon: Well, we start out by taking a close look in the nose. Frequently, we’ll put medication in there that will decongest the mucous membranes, and then we can see the structure of the nasal cavities so we can spot polyps. We can see if there’s a deviated septum. We can see if there’s infected drainage. We can palpate the face, the cheeks, forehead, teeth, see if there’s tenderness in any of those regions, see if there’s infected drainage that’s going down their throat. If we continue to have a suspicion that there’s something that’s going on within the sinuses, we can sometimes stick a tiny little nasal endoscope in the nose and see if there is abnormal drainage from the sinuses. See if there’s nasal polyps that are coming from chronic sinus disease. Then we can get additional information beyond the exam by doing a CAT scan because a CAT scan lets us actually look inside the sinuses, which we can’t do with just a nasal endoscope or with the exam. We use the history and the exam to give us a suspicion that there may be something more going on. The CAT scan gives us that additional confirmation that yes, there is chronic damage, swelling, inflammation to the mucous membrane. That’s really the hallmark of chronic sinusitis. These are people who really never get quite normal until they’ve had the diagnosis recognized and the appropriate treatment instituted.
Melanie: Let’s speak about the appropriate treatment. What’s involved? Is this antibiotic? Is it a long course? Nasal lavage? What do you do for people that are suffering from chronic sinusitis?
Dr. Lyon: Well, all those things are important, and it depends on the severity of the problem. Some people have more than one of these problems. Each one might require a little bit different treatment. In general, what people can do on their own is the nasal lavage or the nasal irrigation that you mentioned is very, very, very helpful. Everybody thinks about brushing their teeth every day. This couple of inches north of the teeth area, your nose, and what do we do for the nose every day? It takes a tremendous amount of abuse and use and has to do a lot of things but we don’t do anything to care for it. People should think of the nasal irrigation as brushing your teeth for your nose. That little maintenance really goes a long way in not only treating but preventing this problem. If people have a periodic flare-up and have signs that suggest that they have infection, then of course they’ll need antibiotic. People who have allergies need treatment for some of the allergic, sneezy, itchy, runny, stuffy type symptoms. And that can either be an oral antihistamine or possibly a topical nasal steroid spray. But there’s still other people for whom those treatments are not going to be effective because they have something that might require additional surgery, whether that’s a deviated septum, nasal polyps, or this condition that you mentioned, chronic sinusitis, where the sinuses, an established pattern of swelling and inflammation and damage that really requires a surgical approach in addition as well as application of medication to really settle down the inflammation that the body is producing, allowing that mucous membrane to heal and become more normal and then function more normally so they don’t have those chronic symptoms. That care involves not only frequently having typicalprocedure to open the sinuses, let them drain better, let us access them for treatment, but also close follow-up afterwards to make sure that we have achieved the recovery of those mucous membranes with ongoing irrigation or medication so that they become normal and then the person continues to feel normal and makes surgery that much more effective. It really is a combination of not only a surgical approach in some of these patients with more stubborn problem, but ongoing care to make sure that they have resolution of the inflammation and management of the inflammation that really underlies the problem.
Melanie: Dr. Lyon, in just the last minute or so, give patients your best advice for those suffering from chronic sinusitis and why they should come to Stoughton Hospital for their care.
Dr. Lyon: My best advice is that if you’re managing this on your own, for more mild problems, then nasal irrigations are going to give the best bang for the bucket in terms of treatment of the symptoms and managing the underlying problem. When it comes time to be evaluated by a physician, being a specialist can be very important because having a very specific and accurate diagnosis is the key to getting the treatment, and they will then be able to recommend and perform that specific treatment that will address the underlying problem and get the best opportunity for a sustained long-term relief of those miserable symptoms. Most important thing to remember is you don’t need to suffer with these symptoms, because we have very effective ways of managing the symptoms and problems at this point. That didn’t use to be the case. But the tools we have, when properly applied, when the right diagnosis is made, really allow the patients to get excellent and long-term relief.
Melanie: Thank you so much. And remember, you do not have to suffer from chronic sinusitis. There is treatment and help out there. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.