Diagnosing sinusitis is not as simple as one might expect because the hallmark symptoms are often found in other medical conditions. Accurate diagnosis is critical, as misdiagnosis can lead to inappropriate treatment.
Postnasal drip, for example, is the most common symptom attributed to sinusitis. But postnasal drip is more often caused by stomach acid coming up into the esophagus (gastroesophageal reflux, or GERD) and into the throat (laryngopharyngeal reflux, or LPR) than it is sinusitis. Patients who suffer with reflux often complain of excessive throat clearing, mucus, hoarseness and sometimes burning, but they typically have no heartburn or indigestion. It is often assumed that these individuals are suffering from sinusitis and they are treated as such, sometimes undergoing unnecessary sinus surgery.
As well, facial pain and headache may also be caused by non-sinus conditions such as:
- temporo-mandibular muscle and joint problems causing muscle tension headaches;
- cervical spine or disc problems;
- dental infection;
- primary neurological headaches, including migraines, which can cause pain over the sinuses;
- laryngopharyngeal reflux, which frequently causes sinus pain that is often made worse by chocolate, peppermint, caffeine, tomatoes and nicotine;
- exposure to certain chemicals and molds in contaminated indoor environments.
Allergies, deviated septum, nasal polyp or tumor, and exposure to molds or chemicals may also cause nasal congestion and stuffiness, which is often misdiagnosed as sinusitis.
Advances in Medical Management
The diagnosis and treatment of sinusitis has been revolutionized over the past 20 years by numerous technological advances, including the introduction of the fiberoptic endoscope and high resolution CAT scans. Doctors are now able to better determine whether a sinus infection is present, which sinuses are involved, and, by utilizing endoscopically directed nasal and sinus cultures, what specific bacteria is responsible for infection. These tools can also help identify small areas of sinus obstruction that lead to ongoing sinus infection.
New York Sinus Center specialists firmly believe that the successful treatment of chronic sinusitis is primarily non-surgical and requires identification of the underlying causes of continued sinus infection. The appropriate treatment plan for any one patient is developed only after first identifying the underlying factors contributing to their sinusitis issues.
In most cases simple low-tech approaches, including dietary changes, allergen avoidance, and daily nasal wash with a special salt solution, are enough to dramatically improve or even cure sinus problems.
When episodes of infection do occur, it is sometimes necessary to obtain samples of the infection that is draining from the sinuses into the nose. This is now easily done in the office with a nasal endoscope. Analyzing the sample directs the selection of appropriate antibiotics needed to successfully treat the infection. At least 14 days of antibiotics, often in conjunction with nasal or oral steroid medications, are usually necessary to eradicate episodes of infection. Sometimes longer courses are necessary. In unusual situations, intravenous antibiotics may be needed.
In some cases of chronic or recurrent infection, minimally invasive endoscopic sinus surgery may be necessary to improve sinus drainage and resolve infection.
The Benefits of Nasal Cleansing
Cleansing the nose and sinuses with saltwater has been recommended for centuries as a method of improving nasal breathing and promoting health. Recent medical studies have affirmed the efficacy of this common home remedy.
New York Sinus Center physicians find that daily nasal cleansing with a buffered hypertonic saline solution is a crucial component in efforts to maintain sinus health and decrease episodes of infection. Daily nasal hygiene helps clear the nasal passages of mucus, shrinks nasal membranes, improves breathing, and removes inhaled material including pollen, dust, mold and other pollutants. It also promotes mucociliary flow, the body’s natural cleansing and filtering system.
In light of the recent findings by Mayo Clinic researchers confirming inhaled mold as the main cause of sinusitis, the argument for daily nasal cleansing becomes even more compelling.
We have developed a unique, comprehensive approach to sinus care that is based on the latest scientific knowledge and utilizes advanced technology to accurately identify, treat, and ultimately prevent sinusitis and its underlying causes.
Our unique approach to chronic sinusitis integrates state-of-the-art sinus care with traditional methods, including daily nasal cleansing and dietary controls, to minimize such underlying causes of sinusitis as acid reflux and allergy.
- Accurate diagnosis, especially identification of acid reflux, allergy and environmental problems, such as indoor mold exposure;
- The concept that chronic sinusitis is primarily a medical disease with multiple causes, and that surgery plays a role in combination with other therapies;
- Modern, minimally invasive-tissue sparing sinus surgery, performed by experienced surgeons, with image guidance, when surgery is truly necessary;
- Patient education, so that sinus patients learn to help control their own sinus health.