As you probably already know, sinusitis is a
common complaint. In the office setting we see chronic sinusitis, with an acute
exacerbation. Symptoms include a long history of "post nasal drip" with recent
onset of facial and teeth pain, fever and purulent drainage. This is the acute component
that requires antibiotics.Usually, but not always, allergic rhinitis is present. If
using anti-histamines, these should be stopped and a decongestant substituted, as well as
oral steroids.
Diagnosis is made with history, physical and sinus x-rays such as a Water's view to
confirm acute maxillary sinusitis. Cultures help, and can be obtained with a nasopharynx
swab, or with Antral Irrigation. The latter may be required if the infection does not
resolve.
Once a chronic pattern is established, control of symptoms is usually possible with
nasal steroid inhalers such as Rhinocort. Also, allergy testing and desensitization may
help. Determination of the severity of disease should be undertaken at this stage with a
CT sinus exam.
If symptoms persist or escalate, surgery is considered. The CT scan is used as a guide
to FESS sinus surgery. If frontal, ethmoid or sphenoid disease is significant and/or it is
repeat surgery, we often use the new InstaTrak device.
The InstaTrak requires a spiral CT that is then converted to a 3-dimension display in a
Sun workstation for use at surgery. This allows accurate and safe removal of disease.
Prevention of eye and CNS complications with this device is the goal.