Care of a nasal and sinus patient requires a “partnership” between a dedicated surgeon and their team and a compliant patient, dedicated to gaining control of their symptoms. Unfortunately, many patients have been given years of misleading advice and treatment making them resistant to new treatments from physicians. This pathway has been created to help gain understanding of treating nasal and sinus issues to improve compliance and help effectiveness of treatment.

 

Step 1 - Diagnosis

An accurate diagnosis is crucial for initiating the correct treatment for nasal and sinus conditions. This requires a complete history and physical exam (with endoscopic examination) and review of CT scan images. This will help to identify any any sources of nasal and sinus dysfunction (medications, allergies, environmental factors, smoking, drug use, etc) or anatomic causes of nasal blockage (nasal septal deviation, turbinate enlargement or nasal polyps, etc). Once a diagnosis, or potential diagnoses have been identified, treatment can begin.

Step 2 - Treating Inflammation

The underlying cause of the majority of chronic nasal and sinus problems (specifically chronic rhinosinusitis) is related to an inflammatory response made in the nose and sinuses. This will lead to nasal congestion, reduction in sense of smell, thick nasal discharge and occasionally facial pressure. Our dry environment increases symptoms and contributes to inflammation likely by causing increased mucous production, stagnation of secretions and our bodies reaction to the normal bacteria in our nose which are not cleared quickly enough due to the thick, dry mucous we make living here (this is why many people are better when they are away from Calgary and will sometimes get better with recurrent courses of antibiotics - unfortunately, this leads to bacterial resistance). Treatment of nasal inflammation includes:

  • once to twice daily sinus rinses (www.neilmed.com)
  • appropriately prescribed nasal steroids
  • nasal moisturizing gels
  • increasing environmental humidity (to greater than 50%)
  • NOT SMOKING, AVOIDING SECOND HAND SMOKE, AVOIDING COCAINE AND MARIJUANA

Other treatments include antibiotics, oral corticosteroids, biologic medications (used with severe asthma and allergies), allergy treatment, mucous thinners (NAC), Immunoglobulin infusions (for patients with immunodeficiencies).

Step 3 - Surgical Treatment

If medical therapy is not effective at completely controlling the symptoms of rhinosinusitis or if there is an anatomic blockage contributing to symptoms, surgical intervention may be performed. Potential surgical interventions include:

  • Inferior turbinate reduction
  • Septoplasty/ rhinoplasty
  • In-office sinus interventions: polypectomy, balloon sinus dilation/ sinuplasty, maxillary sinus antrostomy/ ethmoidectomy
  • Functional endoscopic sinus surgery
  • Endoscopic nasalization (for severe, recalcitrant rhinosinusitis)

Surgery is not a “cure” for chronic rhinosinusitis but can improve overall symptom control, reduce the amount of medications used and lead to an improvement in quality of life scores!

Step 4 - Ongoing Medical Therapy

Once the symptoms of chronic rhinosinusitis, ongoing medical therapy is necessary to keep symptoms under control. The goal of initial medical therapy and surgery is to use the lowest amount of medications necessary to control symptoms as well as treatment of acute exacerbations. Ongoing medical therapy includes:

  • Once to twice daily sinus rinses
  • Nasal steroids
  • Other medical therapies as listed above