Cold season is fast approaching
and Margaret S is not a happy camper. Last winter she
suffered through endless bouts of what she believed
was an awful cold: stuffy nose, unbearable headache,
pressure between her eyes and pain that felt like a
toothache. She was dependent on OTC meds for a good
part of the winter. It was only after a visit with her
GP that she realized it wasn't a cold she was battling
— she had chronic sinusitis.
Over four million Canadians suffer
from the condition. Stats from the US show that chronic
sinusitis is one of the most prevalent chronic diseases,
affecting more patients than hypertension or arthritis.
"[Chronic sinusitis] significantly impairs quality of
life, similar to chronic low back pain and angina pectoris,"
says Dr Martin Desrosiers, director and chair of the
nasal and sinus disorder group of the Canadian Society
of Otolaryngology and an associate professor at both
McGill and the University of Montreal. To top it off,
sinusitis is also one of the main causes of absenteeism.
Dr Emad Massoud, an otolaryngologist
at the QEII Health Sciences Centre in Halifax and an
associate professor at Dalhousie, points out GPs often
overdiagnose, although they sometimes also underdiagnose,
chronic sinusitis. "Not every facial pain or frontal
headache is sinusitis," he says. With that in mind,
here are some tips on the specifics of chronic sinusitis
and what to tell your patients about the disease.
MORE
THAN JUST A STUFFY NOSE
When it's chronic Symptoms of chronic sinusitis
are different from your run-of-the mill sinus infection.
"Chronic sinusitis isn't so much acute sinusitis gone
bad," says Dr Desrosiers. "it's more of a chronic inflammatory
condition." You can tell patients that symptoms are
usually prolonged and include facial pain, congestion,
decreased sense of smell and clear or coloured drainage
— yellowish, greenish or creamy specifies Dr Massoud
— from the nose. "Chronic sinusitis, by definition,"
continues Dr Massoud, "is symptomatic for more than
12 weeks." Patients suffering from chronic sinusitis
may also experience frequent episodes where symptoms
become more severe. Nasal polyps are also signs of chronic
sinusitis and affect about 20-25% of sufferers. They
can contribute to symptoms of the disease.
The right diagnosis "The
gold standard in diagnosis is the CT scan," says Dr
Massoud. Dr Desrosiers agrees, adding that an endoscopy
can also add support to a clinical diagnosis. In terms
of treating and managing the disease, Dr Massoud explains
that it will vary depending on the type of chronic sinusitis
a patient has: whether it is bacterial, fungal, allergic
or polypoid, which is more common in patients with asthma.
Generally speaking, you can tell patients suffering
from chronic sinusitis that nasal steroids help tremendously.
Some form of nasal irrigation (like saltwater or a saline
solution spray) can also be helpful. In some cases antibiotics
are used. Finally, if patients aren't responding to
pharmacologic treatments, surgery is an option. "The
surgery has advanced tremendously in the last 15 years,"
says Dr Desrosiers, "it's minimally invasive, with minimal
pain." The surgery consists of opening up blocked nasal
passages using an endoscope.
The next generation of Tx
A new even less invasive treatment is on the horizon.
Called balloon sinusplasty, the procedure uses a catheter
to relieve sinus obstruction. Using an endoscope, a
small catheter is placed into the nose. A guidewire
is then introduced into the sinus to target the affected
area. Once in the sinus, a balloon device is inserted
into the swollen passageway under x-ray guidance. The
balloon is dilated and gently restructures and widens
the walls of the passageway. The procedure was presented
to surgeons during the Annual American Rhinologic Society
meeting in September. Though the procedure is still
at the clinical trial stage, its inventor, Aussie physician
William Bolger, believes it will be a viable new treatment
option.
TAKE-HOME
TIP
• "Really take a bit
more history," suggests Dr Massoud. "Ask about quality
of nasal discharge." He encourages examining the nose
with an open-style otoscope with good lighting.
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