What is Recurrent Sinusitis?

Recurrent sinusitis is a condition that is best described as repeated incidents of sinusitis, despite well thought out medical treatment, or surgical procedures performed to improve the patient's well being.

Recurrent sinusitis may be due to:

• Mechanical obstruction at the opening of sinuses
• Virulent bacteria resistant to previous antibiotic treatment
• Associated medical conditions that the patient may be experiencing
• Congenital syndromes associated with poor ciliary function
• Postoperative complications which have interferred with the healing process
• Noninvasive fungal sinusitis

Any patient who has recurrent sinusitis should be evaluated carefully and if necessary, perform a CT scan. There is usually a good cause for the recurrence; if it is identified and treated adequately, the patient's general condition improves significantly.

In the endoscopic evaluation, these patients should be examined under topical anesthesia and, if necessary, an endoscopic guided culture should be performed. These culture reports should be reviewed and an appropriate antibiotic chosen for coverage of the infection.

The most common cause of postoperative sinusitis is usually secondary scar tissue formation at the surgical site which had produced an obstruction to drainage which leads to repeated infections.

Here are some Triplanar views (click for larger picture):

Enlarged triplanar in haller cell area	Enlarged endoscopic view, haller cell area, obstruction	Enlarged endoscopic view, scarring, obstruction
Enlarged triplanar, scarring and obstruction	Left endoscopic sphenoidotomy revealing aspergillolith in the cavity.

Patients suffering from recurrent sinusitis will require a careful evaluation and the diagnosis is made after a completion of an adequate nasal endoscopy. Once the diagnosis is established the treatment should commence with a proper plan in place. The use of appropriate antibiotics or antifungal agents may be sufficient in some patients. Occasionally the patients will require intravenous antibiotics and this may be delivered through a central intravenous line for a period of four to six weeks. Patients in this category who do not show improvement in spite of maximum medical therapy should be evaluated for hypogammaglobulinemia or immune deficiency. These are the patient's who require an immunological evaluation and treatment. In some patients the use of steroids is necessary in order to facilitate the wound healing and in the avoidance of asthma like symptoms either before surgery or in the immediate postoperative period. The use of the steroids is usually in the form of an oral intake in divided doses.

In patients where recurrent disease involving the sinuses requires surgical attention the use of the computer-aided surgery is strongly recommended. Patients will require a triplanar CT Scans preoperatively and surgery is planned after a careful review of the CT Scans. In these patients the use of intravenous antibiotics preoperatively and in the postoperative period has significantly improved the wound healing process and has enabled patients to return to their work earlier than planned. The postoperative follow-up in patients undergoing revision sinus surgery will require frequent nasal endoscopy for debridement purposes and in the prevention of scar tissue formation at the surgical site.