| Over
the last 10 years, many doctors have become convinced that
the answer to chronic sinusitis could be successfully treated
with surgery.
The introduction of fiber optic surgery,
involving tiny scopes with cameras attached to a monitor,
has become common, giving doctors access to the cramped, convoluted
sinus passageways. Before the new technique was developed,
doctors cut through the roof of the mouth or made incisions
in the eyebrows to clear away scarred tissue or polyps.
Dr. John H. Krouse, a professor and the director
of rhinology and otolaryngic allergy at the Wayne State University
School of Medicine in Detroit, agreed. For years, Dr. Krouse
said, ear, nose, and throat surgeons were puzzled when patients
returned to their offices just months or weeks after having
surgery. Some patients had six operations, Dr. Krouse said.
The disillusionment with surgery occurs as
recognition is increasing that other common remedies for chronic
sinus disease like antibiotics, steroids, antihistamines and
decongestants also are falling short of expectations.
Researchers say they are beginning to suspect
that they have to rethink the underlying causes. Instead of
allergies and infections, long considered the primary culprits,
doctors are asking why sinuses become sick in the first place.
Increasingly, they are looking at inflammation or the responses
of the immune system.
The sinuses, hollow spaces surrounding the
nose like grape clusters, are something of a mystery. Anthropologists
theorize that they originated from evolution, allowing the
head to be held upright. They also warm, cool and humidify
air entering the lungs, equalize barometric pressure and provide
resonance for the voice.
Dr. Benninger of Detroit asks patients to
complete a questionnaire about physical, emotional and social
difficulties. Routinely, patients report high levels of fatigue,
depression and sexual dysfunction. ''This disease is so much
more than just its symptoms,'' he said.
Many doctors encourage patients to avoid wine
and beer, which can cause passageways to swell. Smoking and
tobacco smoke should also be avoided.
The doctors agree that patients should exercise,
drink enough water and irrigate their noses with a homemade
saline solution. Many over-the-counter solutions have a preservative,
benzalkonium chloride, that can be irritating and may paralyze
cilia.
Some doctors also find promise in an over-the-counter
nasal saline spray made with xylitol, a natural sweetener
used in chewing gum and mints since the 1960's. Xylitol is
also produced in small amounts in the human body in normal
metabolism.
The doctors who treat patients with chronic
sinusitis are frustrated, too. ''We're not even close to having
all the answers,'' Dr. Setzen said. ''Our big hope is that
we can help these people who are nasal cripples. A functioning
nose is essential to the quality of one's life.'' |
