Ask the experts - sinusitis

Q. I’ve had bouts of sinusitis for several years. Although various medications seem to take care of these attacks, my doctor has suggested that I consider sinus surgery. What does that involve?

A. Sinusitis is an inflammation of the sinus cavities in the head. And because these attacks keep happening, your doctor has suggested surgery. The goal is to enlarge the sinus cavities so that they can drain more effectively. With improved drainage, the damaged sinus lining can return to normal.

The first step is to pinpoint the problem area. That may involve a number of tests, including a CT scan. Previously, sinus surgery required that the sinuses be entered through the cheek—a major procedure that left prominent scars. Today the surgery is much less invasive. There are 3 basic options.
• One is functional endoscopic sinus surgery (FESS). An endoscope (a thin flexible viewing tube) is inserted through the nostrils so that the doctor can look closely at the sinus cavities and remove any obstructive tissue. The procedure can be performed on an outpatient basis. It leaves no scarring.
• Another approach is image-guided surgery, which combines CT scanning with infrared technology to monitor positioning of surgical instruments. This method may be indicated for severe cases of long-term sinusitis or when abnormal sinus anatomy makes FESS inappropriate.
• A third option is called the Caldwell-Luc operation. It focuses on improving drainage of the maxillary sinus. One such sinus is under each eye. The surgeon goes through the upper jaw to reach this sinus and then creates a “window” to connect the sinus to the nose.

Q. My wife can’t take penicillin or any drug in the penicillin family. She says she’s allergic to penicillin, but her doctor calls it a “drug hypersensitivity.” What’s the difference?

A. An allergic reaction to a drug is one form of drug hypersensitivity. Both fall under the larger category of adverse drug reactions—unwanted effects of a particular medication. Most adverse drug reactions don’t involve the immune system, but both allergy and hypersensitivity do. They occur when a person’s immune system reacts to the medication or to substances produced when the body processes the medication.

An allergic reaction most frequently occurs when the drug is given either intravenously (into a vein) or by injection. It is less likely when a drug is taken by mouth. The allergic reaction occurs only when a person has had a previous exposure to the medication. Penicillin is among the medications most likely to trigger an allergic reaction. Other antibiotics also cause problems for some people.

Symptoms of drug hypersensitivity include hives or a skin rash, wheezing, and swelling. The most serious reaction is anaphylaxis, which is potentially life-threatening and thus a medical emergency. Although these symptoms generally occur within minutes to hours after taking the drug, they can also appear a week after the medication has been discontinued.

If symptoms are mild, the reaction usually goes away once the person stops taking the medication. If symptoms are severe or longer-lasting, a doctor may give corticosteroids, antihistamines, or other drugs to reverse the reaction.

Most of the time, if a person is allergic to a particular medication, a doctor can find an effective alternative.