Chronic Sinusitis and Its Surgical Options for Relief

Q: Chronic Sinusitis and Its Surgical Options for Relief

Your issue is that the pus in the sinuses does not easily drain into the nasal cavity, but when more mucus enters the sinuses, it can cause swelling and discomfort. <br>These are likely symptoms of chronic sinusitis. <br>However, there is still a possibility of recurrence after s

Endoscopic Surgery for Chronic Sinusitis

Hello Dr.
Li, I have allergic rhinitis with hypertrophy, and due to severe fatigue and excessive daytime sleepiness, I have been diagnosed with moderate to severe obstructive sleep apnea (OSA).
Although CPAP (which can be adjusted to normal levels) has not improved my symptoms, I have undergone multiple stages of multilevel surgery.
Currently, my apnea-hypopnea index (AHI) is mild, my blood oxygen saturation is at 90%, and I still snore.
However, the key issue is that I remain extremely sleepy and mentally fatigued, with no improvement from CPAP (I sleep through the night without insomnia and have a good appetite; my BMI is 22).
Of course, there has been a significant improvement compared to before the surgeries.
During this time, various internal medicine tests have returned normal results.
I also have another condition: every time I catch a cold and the toxic symptoms subside, I inevitably develop sinusitis, with increased sleepiness and mental fatigue.
The ENT specialist prescribes antibiotics, which I take as directed, but it still turns into a situation where Augmentin cannot eradicate it, and only Ciprofloxacin seems to control it (the culture results are the same).
However, I still feel that I am not completely well; although I do not have much nasal discharge, it is all post-nasal drip, and the first sputum in the morning contains yellowish foreign matter.
Recently, I caught another cold and it has turned into sinusitis again.
The doctor suggested that I consider the necessity of surgery for chronic sinusitis.

1.
After spending some time in the swimming pool, I notice a burnt smell in my nasal passages.
Additionally, after each acute rhinitis episode with a lot of nasal discharge, I also detect a burnt smell.
Since sinusitis can also cause abnormal odors, does this indicate that my chronic sinusitis has never truly resolved?
2.
My sinusitis often presents with a situation where I can smell odors, have nasal congestion, and experience post-nasal drip, but upon endoscopic examination, there seems to be no thick mucus flowing out.
This time, the endoscopy did not reveal anything, but an X-ray showed sinusitis.

3.
After OSA surgery (using CPAP at a pressure of 7, AHI < 2), I still experience excessive daytime sleepiness, mental fatigue, and a persistent feeling of pressure and dull pain behind my eyes, along with visual disturbances and fatigue (the ophthalmologist found no issues).
Could this be related to chronic sinusitis?
4.
I have heard that functional endoscopic sinus surgery (FESS) merely enlarges the sinus openings and may not provide a cure.
Is 3D navigation necessary for this procedure? Thank you.

JS, 40~49 year old female. Ask Date: 2018/08/21

Dr. Li Jiaxuan reply Otolaryngology

Your issue is that the pus in the sinuses does not easily drain into the nasal cavity, but when more mucus enters the sinuses, it can cause swelling and discomfort.
These are likely symptoms of chronic sinusitis.
However, there is still a possibility of recurrence after surgery for chronic sinusitis.
Generally, 3D navigation is used only when there are anatomical variations or when frontal sinus surgery is performed.
Therefore, it is recommended that you first go to the hospital for a CT scan, after which a physician can assess the necessity of surgery.
Wishing you good health.

Reply Date: 2018/08/21

More Info

Chronic sinusitis is a common condition that can significantly impact a person's quality of life. It is characterized by inflammation of the sinus cavities, which can lead to symptoms such as nasal congestion, facial pain, pressure, and a reduced sense of smell. In your case, it seems that you have a complex medical history involving allergic rhinitis, obstructive sleep apnea (OSA), and recurrent episodes of sinusitis, which complicates your treatment options.

1. Understanding Your Symptoms: The sensation of a "burnt" smell or taste, particularly after exposure to water or during episodes of acute sinusitis, may indicate ongoing inflammation or infection in your sinuses. This could suggest that your chronic sinusitis has not fully resolved, even if you are not experiencing overt symptoms like thick nasal discharge. The presence of post-nasal drip, where mucus drains down the back of your throat, can also contribute to a feeling of discomfort and may exacerbate your symptoms.

2. Nasal Endoscopy and Imaging: The fact that your endoscopic examinations do not reveal significant discharge while imaging studies show sinusitis indicates that the inflammation may be more subtle or localized. Chronic sinusitis can sometimes present with minimal visible discharge but still cause significant symptoms due to the underlying inflammation and blockage of the sinus drainage pathways.

3. Connection to OSA and Other Symptoms: Your ongoing symptoms of excessive daytime sleepiness and the sensation of pressure behind your eyes could indeed be related to your chronic sinusitis. Inflammation in the sinus cavities can lead to discomfort and pressure that may mimic or exacerbate other conditions, including OSA. The fact that your AHI (Apnea-Hypopnea Index) is now in the mild range suggests that your OSA may be better managed, but the lingering symptoms could still be a result of sinus-related issues.

4. Surgical Options: Functional endoscopic sinus surgery (FESS) is often recommended for patients with chronic sinusitis who do not respond to medical management. This procedure aims to improve sinus drainage by enlarging the openings of the sinuses, allowing for better ventilation and drainage of mucus. While it may not be a "cure" in the traditional sense, many patients experience significant relief from their symptoms post-surgery. The use of 3D navigation during surgery can enhance precision, particularly in complex cases, but whether it is necessary depends on the specific anatomy and extent of your sinus disease.

5. Considerations for Surgery: Before proceeding with surgery, it is crucial to have a thorough discussion with your ENT specialist about the potential benefits and risks. They will consider your overall health, the severity of your symptoms, and the results of previous treatments. If surgery is deemed necessary, it can often lead to improved quality of life, reduced frequency of sinus infections, and better management of associated symptoms like sleepiness.

In summary, your symptoms suggest that chronic sinusitis may still be a significant issue for you, and surgical intervention could be a viable option to consider. It is essential to work closely with your ENT specialist to evaluate the best course of action tailored to your specific situation. They can provide guidance on the potential outcomes of surgery and whether additional diagnostic tests or treatments are warranted before making a final decision.

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