Doctor, I have a stuffy nose! PART TWO

Interview with a specialist in the field of diseases of the ear, nose and throat, Professor Igor Newman Eye and Ear Infirmary Igor BRANOVAN

PART TWO

In our last conversation, I began to talk about those diseases of the nose and nasopharynx in which patients, along with other complaints, very often note nasal congestion. Continuing this story, I would like to draw attention to the next category of diseases. This refers to inflammation of the paranasal sinuses of the head (sinuses), there are 4 pairs of them (see picture). These include a pair of frontal sinuses located behind the forehead, the maxillary sinuses (behind the cheeks under the eyes), the ethmoidal or ethmoid sinuses between the eyes, and the sphenoidal sinuses behind the nose. The full function of the paranasal sinuses has not yet been studied. Many scientists believe that they are vestigial remnants from the process of human evolution. Apparently, this is precisely what can explain the fact that the outflow of mucus from the sinuses occurs best when a person stands on all fours (in the position of our “forest ancestors”). We know that the paranasal sinuses have a certain effect on the timbre of the voice and reduce the weight of the skull. Unfortunately, when a person is in an upright position, many of the sinuses become clogged, which leads to the development of acute and chronic sinusitis. By the way, this is one of the reasons to see a doctor. The frequency of the disease can be judged by the annual costs of its treatment ($3 billion).

I want to briefly look at the picture of the disease. Any acute upper respiratory tract disease leads to fluid accumulation in the maxillary sinuses. In this case, patients often feel heaviness behind the cheeks and between the eyes. This does not mean that the patient has sinusitis. Most often, during the week, this fluid gradually flows away and the swelling of the nasal cavity gradually disappears.

All the paranasal sinuses communicate with the nasal cavity through thin passages, so the swelling of the nose often leads to fluid accumulation or mucus in the sinuses. Unfortunately, in some patients (10-15%) the minimal inflammatory process can lead to the development of sinusitis. This happens when a bacterial infection falls into the paranasal sinuses, which leads to acute inflammation. Its typical symptoms are: purulent nasal discharge for more than 7 days, high fever, and pain in the eyes and behind the cheeks. In this case, the patient needs treatment. Antibiotics are usually prescribed for 7-10 days. You can also use drops in the nose, which reduce swelling of the nose (afrin or ephedrine). It is important to note that these drops can be used no more than 3-4 days, since their long use leads to side effects and even to deterioration.

Unfortunately, in 10% patients, acute sinusitis can turn into chronic. Chronic sinusitis is a more serious problem. This is a disease that lasts more than 3 months and a short course of treatment does not help. The fact is that in chronic inflammation the maxillary sinuses are blocked, and the pus and mucus accumulated in them do not have an outflow in the nose, which leads to the continuation of the chronic process. In some cases, this can lead to complications from the eyes or the brain, which can be fatal.

What we base the accurate diagnosis of acute or chronic sinusitis? To do this, we use the examination with special instruments, probes through the nasal cavity, with which the maxillary sinuses communicate. Often, when probing, we find huge polyps covering not only the cavity of the sinuses and nose, but also hanging in the nasopharynx, and in some cases even in the larynx. Most recently, a patient turned to me with a polyp covering half of the larynx. One of the main symptoms indicating a polyp is difficulty in breathing. Therefore, with a significant development of a polyp, the patient needs surgical intervention. X-ray scanning is also used for accurate diagnosis. With the help of special equipment, the state of the sinuses is investigated, as pus flows from them. It is especially important to note that scanning cannot be performed during acute inflammation, since in this condition one cannot make a correct diagnosis.

Treatment of sinusitis. It is carried out using a long course of antibiotics. Numerous experiments have shown that the most favorable course of treatment is up to 6 weeks. The patient also needs special drops in the nose, which include hormonal drugs that help reduce the swelling of the sinuses and improve the outflow of pus.

And one last thing. On the surgical treatment of chronic sinusitis. In those few cases where, despite a full course of drug treatment, a scan shows that pus continues to fill the sinuses, surgical intervention is necessary. Over the past 10 years, surgical techniques have changed significantly. In the past, these approaches were quite radical. In order to open the sinus and remove as much mucus and pus as possible, incisions were made under the lip. Currently, all operations are performed through the nose using special endoscopic equipment. For the last 5-6 years I have been performing such operations without general anesthesia, using drugs that freeze the sinuses. The anesthesiologist administers the medicine intravenously, after which the patient quietly falls asleep for a few minutes while I freeze the sinuses. The rest of the operation takes place without anesthesia. Thanks to this technique, after the operation the patient feels well and has no nausea or vomiting. Postoperative recovery is extremely fast. Such operations must be performed by a highly qualified specialist. This is dictated by the fact that the patient’s eyes and brain are located very close to the operated area. But in the hands of experienced surgeons - otolaryngologists, complications are extremely rare - no more than one out of 10-15 thousand operated patients.