Call us today: (214) 382-5100
Call us today: (214) 382-5100

The ENT Doctors at Dallas Sinus Center can diagnose the causes of sinusitis and provide treatment and care options.


What is sinusitis?


Sinusitis is a large group of diseases of the sinus lining and sometimes the surrounding structures. Sinusitis occurs when the lining of the sinuses, called the mucosa, becomes inflamed or irritated. The inflammation of the lining of the sinuses can become so extensive that it causes the very small sinus ostia to become blocked.

In turn, the obstructed ostia trap the mucus within the sinuses. Sinuses are warm and dark spaces that when filled with wet mucus can create the ideal conditions that are perfect for organisms to grow. These are the conditions that are also ideal for fungal organisms to grow.

These infectious bacterial and fungal organisms can themselves call additional tissue irritation and swelling or inflammation that slows normal mucus clearance within the sinus, further propagating the cycle of inflammation and infection. Sinus cavities that are infected and/or swollen cause the major symptoms that most people call sinusitis.


What are the causes of sinusitis?


Anatomic, genetic and environmental factors can all contribute individually, but often jointly, to the development of sinusitis. Anatomic factors are those that affect the shapes of the sinus drainage pathways. Genetic factors are how your body’s enzymes and proteins react and environmental factors are the outside factors that can influence the sinuses.

An overgrowth of normal organisms or new growth of unusual organisms can lead to an infection in the sinus cavities. The infection in sinusitis may be caused by either fungal or bacterial organisms, or even both types can be present at the same time. Sinusitis often develops after a cold, when the lining of the nose and sinuses becomes inflamed. This leads to swelling of the drainage pathways and the sinus ostia becomes blocked.

Aside from blocked sinus ostia, anatomic variations in the structure of the nose and sinuses may also predispose to sinusitis. Drainage of the frontal, maxillary and sphenoid sinuses may be blocked by the various types of ethmoid sinus cells that grow into narrow spaces and tighten or limit the openings even more.

The major sinuses in the front of the nose, which are the ethmoid, maxillary and frontal sinuses, all drain into a similar pathway. This area is called the ostiomeatal complex region. This region can also be narrowed by enlargement of the turbinates or a deviated nasal septum.

Certain factors may predispose patients to sinus problems. For instance, hereditary disorders such as cystic fibrosis may cause patients to be prone to develop sinusitis. Certain autoimmune diseases may also have nasal manifestations and predispose patients to sinusitis.

Immunocompromised states caused either by medications such as long-term steroid therapy or chemotherapy, human immunodeficiency virus (HIV) infection, or chronic illnesses such as diabetes, may also predispose patients to sinus infections.

Environmental factors, such as exposure to smoke, allergens, and pollutants, can cause irritation and increased inflammation of the mucosal membranes of the nasal cavity and contribute to the development of sinusitis.


What is the difference between acute, subacute, and chronic sinusitis?


Sinusitis is often classified into three groups that are determined by the duration of the illness.

Acute infections most often last less than six weeks. This is the most common type of sinus infection. Many of us have already experienced what these may feel like, including the drainage, facial pain and pressure that often come with it. This occurs most commonly following a cold (virus) that gets more complex when a bacterial infection gets involved. A course of antibiotic medications may be needed to treat these infections.

Subacute sinus infections last between six to twelve weeks. These are felt to be persistent acute infections that often have a fair amount of swelling (inflammation) as a result of the tissues response to the first acute infection. Fatigue, cough, decreased sense of smell and nasal blockage are often the symptoms that are most common in the subacute patient.

Chronic sinus infections are those that last longer twelve weeks. These are often the patients that present to ENT surgeons as they have failed to clear up after many courses of different medications. These patients are often considering surgery for sinus drainage. These infections may actually not be related to bacteria anymore. They are more likely due to the tissues being chronically swollen or inflamed which then closes the sinus drainage holes (ostia) and does not allow clearance of the normal sinus fluids. These fluids may then get secondarily infected. This cycle of infection leading to inflammation and then inflammation leading to more infection is often the vicious circle that chronic patients get caught in. For many chronic patients, this circle has to be broken at more than one point to make them better.


Can sinusitis be cured?


Acute sinusitis is often treated with a course of antibiotic pills. Most of the milder episodes of acute sinus infection can actually resolve on their own without prescribed medicines. The body’s immune system kicks in and fight off these infections. Patients will also self-treat with over the counter medications to decrease some of the symptoms while the body deals with the infection. Most acute episodes are cured by the body itself or with the help of a course of medications. In many cases where acute sinusitis occurs over and over again minimally invasive surgical techniques can help.

Subacute infections are more difficult to cure and treat. They often require several weeks of treatment. They may also require courses of steroids to help decrease the swelling of the tissues to open the ostia and drainage pathways. Occasionally, surgery is needed to achieve control.

Chronic sinusitis is the most difficult to treat. It often is not curable but minimally invasive surgical treatment can decrease many of the symptoms to tolerable levels. Patients with chronic sinusitis will often present with a wide range of symptoms and some of these are treatable but some symptoms may be due to the sinus tissues being damaged. As an example, some patients with chronic sinusitis will lose their sense of smell, and sometimes taste, due to damage to the nerves at the top of the nose during the illness. The PROPEL dissolvable sinus implant is clinically proven to improve surgical outcomes for chronic sinusitis sufferers. See video for additional information.

At this time, there is no definitive absolute cure for chronic sinusitis. Ongoing treatment is usually needed to control the symptoms of the disease. Good control of disease can often be achieved through a combination of medical and surgical therapy. After surgery, maintenance medical therapy is sometimes required to prevent relapse of the disease and keep the sinuses as calm as possible.

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