Chronic sinusitis has impacts beyond a runny nose

The onset of symptoms of sinusitis are all too familiar to sufferers: postnasal drip, nasal mucous, congestion and loss of smell and taste. But for some individuals, these are not short-term bouts of a troublesome condition, nor are they confined to the nose. Patients with chronic sinusitis experience symptoms that are more systemic, with effects that are more profound.

“In these patients, we tend to see depression, loss of productivity, problems concentrating and sleeping, and the sense that you’re constantly living in a brain fog,” says Jeffrey Suh, MD, a rhinologist in the UCLA Nasal and Sinus Disease Program. “It’s these intangible effects — not just the runny nose — that tend to bring patients to us for surgery.”

The UCLA Nasal and Sinus Disease Program offers medical and surgical management of complex nasal and sinus problems, including chronic sinusitis, allergic rhinitis and nasal-breathing problems associated with allergic and structural problems of the nose. For patients with chronic sinusitis, the impact of their condition can be far greater than might be appreciated. Research indicates that chronic sinusitis sufferers report lower scores on measures of bodily pain and social functioning than patients with congestive heart failure, chronic obstructive pulmonary disease and back pain, for example, Dr. Suh notes.

These patients can improve significantly from endoscopic sinus surgery, a minimally invasive approach to opening up and cleaning out the sinuses. The program’s endoscopic techniques avoid the facial incisions and numbness that are associated with other forms of sinus surgery, Dr. Suh says. The vast majority of patients can be treated on an outpatient basis and are nearly or completely symptom-free within weeks. “Many patients feel better than they have for decades — if not their entire lives — after sinus surgery,” Dr. Suh says.

Care of the patient doesn’t end after the surgery. “It is just as important that we identify the cause of the sinus problem and make sure it’s treated postoperatively,” Dr. Suh says. Unlike acute sinusitis, which is almost always caused by a viral or bacterial infection, chronic sinusitis usually is multifactorial, with infections, genetic conditions, immune deficiencies and long-standing, untreated allergies all serving as potential culprits, Dr. Suh explains. The sinus program’s physicians work closely with allergists and other specialists to ensure that patients receive proper postoperative medical management.

In addition to chronic sinusitis, other types of cases treated by the sinus program include rhinitis, a potentially debilitating condition characterized by a stuffy or runny nose; allergic or structural problems such as a deviated or crooked septum that can interfere with nasal breathing; and more complicated cases, including revision surgeries, sinus tumors and cerebrospinal fluid leaks. Many of these conditions can be resolved endoscopically, often in conjunction with other specialists at UCLA, Dr. Suh says. “Most patients who walk in to an ENT doctor don’t need a super-specialist,” he notes. “Our goal is to be a resource for the more complicated or unusual problems.”

Dr. Suh notes that sinus surgery has changed substantially over the last decade, particularly with the advent of highdefinition audiovisual technology and intraoperative navigation. Also, use of nasal packing that has to be removed after surgery is uncommon. “There is a misconception that sinus surgery is ineffective, and that patients who go through it are likely to have recurrent disease and require multiple operations,” Dr. Suh notes. “Sinus surgery does work, and our goal, by managing these cases from beginning to end, is to make sure it is the patient’s only operation.”