Chronic sinusitis Q&As
Published by Bupa's health information team, March 2009.
Answers to questions about chronic sinusitis
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- What is functional endoscopic sinus surgery (FESS)?
- Can I fly if I have chronic sinusitis?
- Will using decongestants help chronic sinusitis?
What is functional endoscopic sinus surgery (FESS)?
Functional endoscopic sinus surgery (FESS) involves removing any bone or soft tissue that is obstructing your sinuses and causing your symptoms of sinusitis. You will only be offered FESS if other treatments haven't helped.
Explanation
You may be offered functional endoscopic sinus surgery (FESS) if all other treatments such as inhalations and allergy medicines haven't improved your symptoms. The procedure uses an endoscope - a narrow, flexible, tube-like telescopic camera - to look inside your sinuses. This is passed into your nostrils and then into your sinuses through holes made in the bone and cartilage inside your nose. Your surgeon can use the endoscope to examine the passageways that connect the different sinuses. If these passageways are blocked or too narrow, your surgeon can widen them using an instrument passed down the centre of the endoscope. Any areas of the mucous membrane lining your sinuses that are diseased and sticking together or filling the sinus can be removed at the same time. You may have small growths called polyps which can also be removed. This helps to relieve your symptoms by allowing air to flow more easily and mucus to drain better.
This is an example of 'keyhole' surgery. The aims of the procedure are the same as with traditional 'open' surgery which involved making cuts through the skin of the face or nose. FESS is now used more often than open surgery.
Research has shown that FESS is a safe procedure. However, there is only limited good quality scientific evidence to prove it works any better than alternatives, such as flushing out your sinuses with warm water.
Sources
- Ah-See K, Evans AS. Sinusitis and its management. BMJ 2007; 334(7589):358-361
- Khalil HS, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004458. DOI: 10.1002/14651858.CD004458.pub2. www.cochrane.org
Can I fly if I have chronic sinusitis?
Flying can cause sinus pain so you may not wish to fly if you're going through a bad patch with chronic sinusitis. However, using decongestants and nasal sprays may relieve your symptoms enough for you to be able to fly more comfortably.
Explanation
When you go up in a plane the air pressure is lower than on the ground. You may have noticed that a bottle of water expands as the plane gets higher and will give a hiss of air escaping when you open it. This is because the air that was sealed inside when you were on the ground expands when the air pressure outside is reduced. The same thing happens to the air inside your sinuses. Usually the expanded air flows out through your sinuses so the air pressure inside them is the same as that of the surrounding air. This is called equalising. However, if your sinuses are inflamed, the air may be trapped inside and expand against the walls of your sinuses causing pain that can be very severe. You may get a headache or facial pain. In extreme circumstances the expanding air can cause bleeding inside your sinuses or may damage the nerves in some of them.
If you have chronic sinusitis, you may also have problems when the plane lands. If air doesn't flow into your sinuses on landing, the air trapped inside takes up less space. This may cause painful "sucking" on your sinus walls.
Using nasal decongestant drops or a spray such as xylometazoline (eg Otrivine) may help your sinuses to equalise. Oral decongestants may help too, however, you shouldn't use these if you have high blood pressure or heart disease. If you have allergies that make sinusitis worse, make sure they are under control. See your GP or pharmacist for advice. If you do fly but get ongoing pain afterwards for more than one or two days, or if your symptoms get worse, you should see a GP.
It may be hard for you or your GP to know for sure whether your sinusitis is going to be a problem when flying. If you know that you have difficulty equalising the pressure in your sinuses, you may decide that it's better not to fly.
Sources
- Aerospace Medical Association. Medical guidelines for airline travel, 2nd edition. Aviation, Space and Environmental Medicine 2003; 74(5): Section II (supplement)
Will using decongestants help chronic sinusitis?
If you already have chronic sinusitis, decongestants are unlikely to have a long-term effect. However, you may find they help at times when your symptoms are worse.
Explanation
Chronic sinusitis is caused when the drainage of mucus from your sinuses is blocked, usually because your sinuses are inflamed and swollen. Decongestant medicines work by reducing the blood supply to the linings of the sinuses, making them less swollen and less able to secrete mucus.
You can buy decongestants as tablets or as a liquid that you spray or drop into your nose. Neither type of decongestant is likely to give you relief from chronic sinusitis in the long term, but using them temporarily can help in certain situations, such as flying.
The decongestants that you spray into your nose, such as xylometazoline (eg Otrivine), may work at first but can eventually make your symptoms worse. This is because after about a week of using them the effect starts to wear off and you can get what is called rebound congestion. This happens because the blood flow to your sinuses increases again, making them more swollen and causing production of mucus and further congestion.
Rebound congestion isn't a problem with decongestants you take by mouth, but they may not be as effective as sprays or drops. Decongestant tablets aren't suitable if you have certain medical conditions including high blood pressure and diabetes. Speak to your GP or pharmacist before taking these medicines.
Sources
- Ah-See K, Evans AS. Sinusitis and its management. BMJ 2007; 334(7589):358-361
- Joint Formulary Committee, British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
Related topics
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: March 2009
Chronic sinusitis factsheet
Visit the chronic sinusitis health factsheet for more information.
Rate this page
