The Seattle Sinus Surgery Center™
William A. Portuese, M.D.
1101 Madison Street, #1280
Seattle, Washington 98104
Phone: 206.624.6200
   
   
   

Diagonsis


Symptoms

Headaches

Facial headaches can be caused from many different factors inside the nose, including chronic sinusitis, a septal bone spur, allergies, congestion and even migraines. Migraines are treated medically by a neurologist. Chronic headaches are caused from chronic polyps and chronic sinusitis. Sinus problems cause facial headaches and are addressed usually through endoscopic sinus surgery. Sometimes it can be addressed medically if it is acute sinusitis, but chronic sinusitis is typically treated surgically. A CAT scan of the sinuses will determine whether or not there are any polyps present inside the sinuses. Maxillary sinusitis tends to cause pain in the cheek area, Ethmoid sinusitis tends to cause pain between the eyes where the glasses ride, Sphenoid sinusitis tends to cause pain on the top of the head and Chronic Frontal sinusitis causes forehead pain. Bone spurs are a sharp angulation of the septum created from either a fracture or from congenital origin, but if present they can cause headaches. It is a sharp spur impacted into the sidewall of the nose and inferior turbinate and needs to be addressed at the time of the physical examination. Allergies can cause many different issues inside of the nose and sinuses, including swelling of the nasal lining and tissues, including turbinates. These can all cause a congestion headache. The allergies can also cause polyps on the inside of the sinus cavity which will have to be addressed surgically with endoscopic sinus surgery. Finally, the common cold can give a temporary headache, but this usually will go away on its own.

Facial Pain and Pressure

Chronic sinusitis and sinus polyps cause a vapor lock or pressure lock between the sinus cavity and the nasal passageway; hence a pressure differential occurs. Whethe sinuses become plugged, the oxygen is used up inside of the sinus cavity, fluid is trapped and polyps form. The sinus itself becomes infected with bacteria and fungus and then a long cycle of chronic sinusitis begins. This creates facial pain and pressure, including the upper teeth aching, decreased sense of smell and intermittent facial pain and pressures particularly when flying in an airplane. It tends to exacerbate when sinuses are inflamed with such an infection.

Congestion

Facial congestion can be caused from multiple different symptoms, including hypertrophy of the inferior turbinates caused by allergies or sinus infections. Once the airflow has been obstructed, the facial pain and pressure can occur with congestion. Congestion can also be caused by allergic nasal polyps inside the sinuses and usually when there is congestion there is also a decreased sense of smell. Congestion can also be caused from allergies, a deviated nasal septum and chronic sinusitis with polyps.

Drainage

The nose produces at least a quart of mucus a day, which normally goes down the back of the throat, and patients are not aware of it. Clear drainage from the nose is usually caused by allergies and treated with nasal sprays and antihistamines. Clear drainage is caused by hay fever; consisting of sneezy, itchy and watery eyes however can also be caused when a viral upper respiratory tract infection occurs, such as a head cold. Colored drainage yellow or green is usually caused from a sinus infection and needs to be treated either medically or surgically. Acute sinusitis is treated medically and chronic sinusitis is treated surgically. Antibiotics usually clear up any colored drainage. Viruses are treated only symptomatically and antibiotics are not necessary.

Airway Obstruction

Airway obstruction is usually caused from on of three factors. A deviated nasal septum is the most common and can be caused congenitally or from a nasal fracture or trauma. When the septum is deviated, surgery is indicated if is causing a unilateral or bilateral nasal obstruction. Turbinate hypertrophy is also a very significant factor in nasal obstruction and can be addressed either medically or surgically, depending upon the degree of severity of the obstruction. Mild turbinate hypertrophy is treated medically with nasal sprays, antihistamines and decongestants. For those who have failed a medical plan, a surgical intervention will be needed, consisting of a submucous resection of the inferior turbinates and outfracturing. Fulminant polyposis of the nasal cavity with extensive pansinusitis can also cause nasal obstruction where the polyps are literally hanging down and completely obstructing the nasal passageway bilaterally.

Sinus Pain

Sinus pain is usually caused by chronic or acute sinusitis over the cheek, forehead and nasal area. Extensive nasal polyps that are usually allergic in origin also cause this pain. Sinuses are swollen, have become chronically infected and inflamed with bacteria in an anaerobic environment, and have created a vapor lock or pressure lock between the sinus cavity and the nasal passageway. This will only be temporarily helped with antibiotics. Antibiotics do not make any polyps disappear, and if they are present for more than three months, will have to be surgically removed.

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The Seattle Sinus Surgery Center™
William A. Portuese, M.D.
1101 Madison Street, #1280
Seattle, Washington 98104
Phone: 206.624.6200