Sinusitis is the inflammation of the nasal and paranasal sinus mucosa, osteitis of the underlying bone can occur. Nowadays we prefer to use the term rhino-sinusitis instead of sinusitis or paranasal sinusitis because the contiguous lining of the nose and sinuses are usually affected at the same time. According to this approved definition, the key pathologic finding of the rhino-sinusitis is the inflammation, not the bacteria infection, of the nasal and sinus mucosa. The realization of this concept is very important to the successful way of management. That's why you can not rely on antibiotics only to treat sinusitis. That's why we highlight the importance of pulsatile warm saline nasal irrigation.
What happened in the inflammation of the nasal and sinus mucosa? It is the impairment or damage of the muco-ciliary movement of the nasal and sinus mucosa. In acute sinusitis, the muco-ciliary movement impairment may be transient or mild and can be returned to normal easily by removing the causative factors or secondary bacteria infection. That's why antibiotics is more effective in the treatment of acute sinusitis than chronic sinusitis. However in chronic rhino-sinusitis ( the sinusitis that lasts for longer than 3 months ), the muco-ciliary movement impairment is more severe or even permanent and can be returned to normal gradually even after removing the causative factors or secondary bacteria infection. That's why you can not expect immediate relief and cure of the chronic rhino-sinusitis by antibiotics or surgery.
Do you think sinusitis can be cured only by surgery? Do you worry about the recurrence of the rhino-sinusitis even after surgery? Is surgery a must for successful management of chronic rhino-sinusitis? Many doctors emphasize that the obstruction of the sinus ostium that prevents the outflow of the sinus secretions is the main cause of the chronic rhino-sinusitis, so sinusitis can be cured if we reopen and enlarge the sinus ostium by surgery. If the sinus ostium obstruction is mechanical obstruction or irreversible obstruction like scar, then surgery is a must to reopen the sinus ostium; however if the sinus ostium obstruction is physiological or reversible obstruction, many can be relieved by adequate medical treatment, so surgery is not a must. Pulsatile warm saline nasal obstruction is helpful to resume the auto-controlled protective sinus ostium.
Dr. Hung Cheng Tseng