- Chronic Sinusitis
Anyone plagued by sinusitis will know how painful and debilitating it can be: throbbing headaches, a constantly runny nose, fatigue. For Cape Town businessman Sterling Kotze, this story is all too familiar. “I’ve had sinus problems my entire adult life,” the 66-year-old says. “As a young student, I kept getting hayfever and was allergic to almost everything except dog hair. I took antihistamines and injections to prevent flare-ups – but I always figured my allergies and sinusitis were just things I had to live with. It was only when my dentist – after reviewing X-rays of my jaw – refused to do an implant until I’d seen an ENT specialist, that I realised how severe my sinus problems were.”
As Dr Nic Goncalves, an ENT specialist at Mediclinic Cape Town, explains, chronic sinusitis is a broad term for inflammation of the nasal cavity and the sinuses. “It can affect a patient’s quality of life because they have decreased productivity and generally feel unwell a lot of the time,” he says. “Other symptoms include a blocked nose, chronic post-nasal drip, decreased sense of smell and pressure build-up in the face associated with chronic headaches. Often, if left untreated, a patient can get depressed because they don’t realise they can get help.”
Dr Goncalves explains that many chronic sinusitis patients respond well to medical treatment. “This can include topical medication into the nose, including salt water rinses and corticosteroid nasal sprays to decongest the nose. Oral antibiotics and short courses of cortiscosteroids can also give patients with mild to moderate symptoms a degree of relief – which can then be maintained with nasal spray once a day. If, after two months of medical treatment, a patient shows little response, we offer them a CT scan to see what is happening within the sinuses.” And this is when surgery might be the best option.
“There are two types of patients with chronic sinusitis – those with nasal polyps (overgrowths of the lining of the nose, stimulated by an allergic response or chronic infection) and those who don’t have polyps, but have anatomical variations within the nose instead,” Dr Goncalves explains. “Because polyps block up the nasal cavity, a topical spray isn’t getting where it needs to go – and blocked sinuses can lead to chronic infections and a build-up of pus.
If it’s an anatomical issue, the septum might be bent, or the turbines (little structures within the nose) might be out of proportion, causing blockage of the sinuses. In both cases, it’s the same clinical picture, just caused by two different things. Patients also often have underlying allergies that cause swelling and inflammation of the lining of the nose.”
With minimally invasive endoscopic sinus surgery, an ENT surgeon uses an endoscope with high-definition camera systems to gain access into the nose. “While this surgery isn’t a cure for chronic sinusitis, it allows us to get medication into the right areas of the nose,” Dr Goncalves explains. “As it’s minimally invasive, the patient doesn’t have to deal with any scars or cuts, which is very positive.
During the operation, done under general anaesthetic, the ENT surgeon uses micro-instruments to open up the sinuses and drain the pus or infection. This is sent to the lab to see if it’s bacterial or fungal, and then treated with the correct antibiotics.
If the patient doesn’t have polyps that need to be removed, the surgeon will correct the anatomical variations during surgery. “Polyps, which can be seen as asthma of the nose, can recur if the patient doesn’t take regular medication after surgery,” Dr Goncalves explains.
For Sterling, the operation was a life-changer. “Dr Goncalves removed 28 polyps and although I felt like I’d been in the boxing ring for the first couple of weeks afterwards, I now feel brilliant,” he says. “I still use a nasal spray every day – but now I have great energy, I sleep better, I snore less and I feel fantastic!”
