Every human being is born with sinuses. There are 4 types of sinuses viz Maxillary Sinus, Ethmoid Sinus, Frontal Sinus and Sphenoid Sinus. Maxillary sinuses are one in either cheek. Ethmoid sinuses are between eyes on each side of nose. Frontal sinuses are in the forehead area and sphenoid sinuses are behind the ethmoid sinuses i.e behind eyes. When there is infection or inflammation in any of these sinuses then this is called sinusitis.
Why Sinusitis Happens?
To understand the reason for infection, first we need to understand how the aeration in the sinus happens. The air we breathe through our nose goes into the sinuses where it gets humidified. This humidified air goes into the throat from where it goes into the ears through the Eustachian tubes behind the tonsils. So precisely the air we breathe travels from nose to throat and then to an ear which is why ENT (Ear Nose and Throat) is put under one specialty.
However, this circulation of air in many people is not normal as explained above. This can be due to many reasons:
- A Deviated Nasal Septum (DNS) – A Deviated Nasal Septum is a condition where the bone that divides the two nostrils is deviated towards one side. This can cause mild to severe obstruction in airway leading to lack of aeration in sinuses.
- Nasal Polyps – Nasal Polyp is a tissue growth which originates from the sinuses and blocks the airways. Polyps are notorious and tend to come back if not taken care of after removal.
- Hypertrophied Turbinated – Turbinates are long narrow passage in the nose when they swell up or are too large they can lead to blockage in the airway.
What are the types of Sinusitis?
Mainly there are two types of infective sinusitis which can be termed as bacterial sinusitis and fungal sinusitis. There is lot of hue and cry about black fungus which is actually a type of fungal sinusitis and it is nothing new it existed before the Covid era as well. Symptoms of bacterial and fungal sinusitis are almost same. “I have been getting lot of patients who have taken course of steroid during covid and are scared that it might be invasive fungal sinusitis. Let me be very clear that all fungal sinusitis are not invasive. Also to differentiate fungal and bacterial sinusitis you mostly do not need a MRI of PNS. Infact a simple CT scan of para nasal sinuses is also good enough. In the CT images we can differentiate between a fungal and bacterial sinusitis. The best part is that the treatment for both kind of sinusitis is same. In both the cases we need to operate upon the patient through FESS (Functional Endoscopic Sinus Surgery). Yes, there is definitely risk in case of fungal sinusitis as it can start eating into the bone and can invade to optic nerve as well as brain. Hence incase of invasive fungal sinusitis anti fungal needs to be started along with the debridement surgery at the earliest”, says Dr Priyanjana Acharyya Sharma, leading ENT specialist and surgeon in Gurgaon.
Why is oxygen therapy during covid leading to fungal sinusitis?
Fungus thrives on moisture that is why earlier cases of black fungus that emerged in India were mainly in the coastal areas and in the areas close to water bodies. However, when a patient is on oxygen therapy, oxygen is supplied through humidifier. Hence when the patient is on long term oxygen support there is lot of humidification that he gets through the nose which helps the fungus to grow. Invasive fungul sinusitis is mostly seen in patients who are immuno-compromised or having co-morbidities like diabetes.
Like every other disease if fungal sinusitis is diagnosed and treated in time then the risk of invasion can be reduced to minimum.
Sinus Surgery in India
The sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are about an inch across. Others are much smaller.They’re lined with soft, pink tissue called mucosa. Normally, the sinuses are empty except for a thin layer of mucus. Maxillary Sinuses are located in your cheek bones and are the largest ones. Forehead has frontal sinuses whereas centre of eyes has ethmoid sinuses and behind your nose bones are sphenoid sinuses. The problem happens when the sinuses get clogged. Its like a traffic jam in your sinus cavity leading to long jam from frontal till sphenoid sinuses. This in turn leads to post nasal drip of infected mucus into the throat causing throat infection. With the infected mucus dripping into the throat it leads to swelling in the throat and tonsils. Just behind the tonsils we have our ear tubes which in turn get blocked because of which patient experiences ear pain as well. Many times a sinusitis headache is misunderstood as migraine.
The most common indications for endoscopic sinus surgery or FESS are as follows:
- Chronic sinusitis refractory to medical treatment
- Recurrent sinusitis
- Nasal polyposis
- Sinus mucoceles
- Cerebrospinal fluid (CSF) leak closure
- Orbital decompression
- Infections by bacteria, fungi or viruses
- Deviated Nasal Septum
- Headache and Ear pain
Headache is generally one sided and increases if you bend down. Sometimes instead of headache you may feel heaviness in your forehead. The pain might also be felt in the cheek bone, between eyebrows and even jaw.
Symptoms & Treatments
Endoscopic sinus surgery is most commonly performed for inflammatory and infectious sinus disease. Functional Endoscopic Sinus Surgery (FESS)involves the removal of diseased sinus tissue with improvement in the natural drainage channels by the creation of a pathway for infected material to drain from the sinus cavities. Dr Priyanjana Sharma ENT surgeon prefers to try medical management for the sinusitis wherever possible. However if the medical management does not respond then she resorts to the Functional Endoscopic Sinus Surgery. Since the surgery is done endoscopically and that too through the nasal cavities or nostrils hence no cut is required. Due to this reason this is also an almost bloodless surgery. Patient needs to stay in the hospital for 1 day and can leave next day. The sinus surgery is done under general anaesthesia. It has been documented that the best treatment for sinusitis is Endoscopic Sinus Surgery.