Sinusitis and Sinus Surgery Explained (Balloon Sinuplasty and Endoscopic Sinus Surgery)

Author: Fauquier ENT

Sinusitis is the inflammation of the mucosal lining of the paranasal sinuses leading to infection and pus formation. Sinus infections may involve all or only a few of the sinus cavities including the frontal sinuses located above the eyes, maxillary sinuses located in the cheeks, ethmoid sinuses located between the eyes, and the sphenoid sinuses located behind the eyes. Normally, the sinuses are air-filled spaces with openings that allow ventilation of not only air but also mucus to freely flow into the nasal cavity. With infection, the mucosal lining starts to swell and eventually close off the sinus openings. With closure, mucus is no longer able to escape leading to pus accumulation. At this point, symptoms of pain, pressure, and congestion may be experienced by the patient. With medications, the infection may resolve along with resolution of the mucosal swelling. However, should the mucosal swelling persist even though the infection has resolved, this may lead to yet another infection with pus formation.

This cycle may repeat over and over again. Surgical intervention is when the sinus openings are physically opened up allowing for pus removal as well as restoring normal ventilation. Surgery may involve a balloon which is inserted over a light guidewire and inflated to enlarge the sinus opening. Here we see this balloon sinuplasty being performed of the frontal and maxillary sinus cavities. Traditional sinus surgery involves physically removing bone and mucosa around the sinus openings using instruments. The openings are made much larger than normal to minimize the chance they will clog closed in the future. Discuss with your surgeon when and what type of sinus surgery may be appropriate versus continuing with medical management.

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