Contrary to many non-medical beliefs, chronic conditions of the sinus (and airway at large) are rarely infective in nature. Simple bacterial infection rarely causes chronic sinus and lung problems. Chronic inflammation (like we see in psoriasis or dermatitis of the skin) is usually linked to chronic sinus problems and produces the obstruction, mucus, pressure and loss of smell that many patients with chronic sinus disease describe. One of the hallmarks of a chronic ‘inflammatory’ sinus condition is that the inflammation seen on a CT scan is NOT limited to one sinus but spread in a patchy or diffuse pattern across the sinuses.
CT scan normal sinuses
CT scan of chronic inflammatory rhinosinusitis
When this chronic inflammation persists, two processes begin; mucus doesn’t clear from the sinuses and bacteria cause a secondary infection which is entirely opportunistic. Secondly, the inflamed mucosa becomes thickened and creates a polypoid like appearance. These ‘nasal polyps’ are not growths like tumours of polyps found in the gut/colon but simply areas of mucosa that have become thickened and chunky with inflammatory cells and fluid.
Infected mucus
Nasal polyps
Chronic rhiniosinusits is managed successfully in about 40-50% of patients with medical therapy alone as one-off treatment, about 20-30% of patients are able to suppress their symptoms well with medical therapy alone and can simply take short courses of oral medicine 2-3 times a year to control inflammation or and secondary infections. The remaining 20-30% have very active disease or dysfunctional sinuses and surgery is applied to reshape the sinus cavity from a honeycombe of multiple small interconnected cells into one simple single neo-sinus cavity. This allows for easy washout of mucus with nasal irrigations and delivery of topical therapy to the sinus cavity. All the ‘walls’ to the sinuses and critical structures are preserved but the internal compartments are made into one.
Healthy sinus cavity after sinus surgery