Understanding Sinuses & Sinus Infections

At Rancho ENT we aim to treat the underlying causes of sinus disease as well as relieve the symptoms through medical and surgical care.

The sinuses are 4 paired air spaces that connect to the nasal passages. The maxillary sinuses are at the level of the cheeks. The frontal sinuses are at the level of the for-head. The ethmoid sinuses are multiple spaces within the nasal cavity itself. The sphenoid sinuses sit deep within the head underneath the brain and pituitary. The purposes of the sinuses are unknown, but they are thought to decrease the weight of the head on the neck to allow better neck mobility.

The sinuses are self-cleaning by design. They produce a mucus layer on the perimeter of the air spaces. Small hair-like arms on the lining of the sinuses known as cilia move the mucous around the sinus to keep the sinuses clear of debris and infection. The mucous is removed out of the sinuses through small openings/doors (known as antra) that deposit the mucous into the nose where it is eventually swallowed as it drips back down the throat. Ideally the sinuses are kept sterile this way, and the usual progression of mucous down the throat is imperceptible.

Sinuses can get infected for a variety of reasons. Typically there is some sort of swelling or inflammation in the nose that causes the lining inside the nose to swell and block the drainage pathway for the sinuses. Causes for swelling include a cold virus, inflammation from allergies, or physical obstruction from bad anatomy or cold virus, inflammation from allergies, or physical obstruction from bad anatomy or growths such as polyps within the nose. Mucous then collects inside the sinus when it is blocked. Bacteria from the nose then have a culture media to grow in. As bacteria find their way back into the sinus from the nose they grow and replicate there, resulting in an infection.

Distinguishing between a common viral infection (a common cold) of the nose and a true sinus infection is important. Antibiotics will not be beneficial for a viral infection, whereas a viral infection that results in a secondary bacterial infection of the sinuses will be often treated with antibiotics.

Patients with recurrent infections can have debris or thick mucus trapped in the sinus, chronic inflammatory conditions that keep the passage ways swollen, or poorly shaped sinuses that do not allow the sinuses to drain properly. Less likely, the sinuses may have improper function of the cilia or the immune system that make infections more likely.

Treatment For Sinus Disease

Rancho ENT patient having receiving sinus infection treatment in San DiegoEvaluation of sinus disease at Rancho Ear Nose and Throat is designed to be a comprehensive evaluation involving both medical and surgical solutions to optimize outcomes from sinus disease. Through the availability of allergy treatments, medical treatments, judicious use of medications, minimally invasive surgical solutions as part of endoscopic sinus surgery, and availability of macro surgery when needed, we are able to offer the full complement of sinus treatment options.

Patients with repeated sinus infections benefit from evaluation by San Diego sinus specialist Dr. Wadhwa to evaluate for anatomical and inflammatory causes of swelling that cause mucous to back up into the sinuses. Patients may be identified to have polyps, fungus, thickened mucous debris in the sinuses, anatomic obstruction from a deviated nasal septum, amongst other problems that may cause them to have repeated sinus infections.

Medical treatment for chronic and/or recurrent sinusitis may involve the use of steroids, antibiotics, topical nasal sprays, and allergy medicines. Allergy testing as an adjunct is also beneficial many times to identify something in the environment that may be triggering the inflammation that is happening in the nose.

Surgery and medication for recurrent and chronic sinusitis generally target facilitating the drainage of the sinuses so the sinuses are less likely to back up. Medications primarily decrease the inflammation of the lining that is swelling to block the sinus or thin the mucous so it may drain easier. Sinus surgery is generally directed at enlarging the openings of the sinuses so they do not become blocked in the first place.

Surgery for sinuses has evolved considerably over the years. In past years, open surgery such as Caldwell-Luc (which involved direct cuts underneath the cheek to gain access to the sinuses) was popular. As technology has evolved, endoscopic sinus surgery has emulated the older techniques. Endoscopic sinus surgery involves using small telescopes and cameras within the nasal cavity itself to target surgery to those areas where the sinuses need to drain (the antrums of the sinuses). By working on the areas in the nose and sinus where the cilia are moving mucus, better outcomes can be achieved. Further recent advancements in sinus surgery aim to decrease the amount of cutting to limit scar formation. Balloon sinus surgery has become popular as a recent technique to enlarge the sinus opening with minimal cutting, resulting in less scarring. In certain patients, endoscopic and/or balloon sinus procedures can each be offered in office.

Balloon Sinuplasty in San Diego

The painful symptoms associated with chronic sinusitis can be overwhelming. If symptoms are difficult to control with medications alone, Dr. Ashish Wadhwa can determine the best course of treatment, including further medication therapy or surgery to open the sinus passage ways.

There is an additional surgical option for treatment of blocked sinuses called Balloon Sinuplasty™ Technology. If you have been diagnosed with chronic sinusitis and are not responding well to antibiotics you may be a candidate for surgery.

Balloon Sinuplasty™ Technology is an endoscopic, catheter-based system for patients suffering from sinusitis. The FDA-cleared technology uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways, restoring normal sinus drainage. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.

Illustration of the first step of surgical treatment for sinusitis
Gain Access to the Sinus.
To gain initial sinus access, our sinus guide catheter is introduced into the nasal cavity to target the sinus ostia under endoscopic visualization. Our sinus guidewire or our sinus illumination system is introduced through the sinus guide catheter and gently advanced into the target sinus.
Illustration of balloon sinuplasty from Rancho ENT in San Diego
Inflate Balloon Across Ostium. The sinus balloon catheter is introduced over the sinus guidewire or sinus illumination system and positioned across the blocked ostium. The position of the sinus balloon catheter is confirmed and the balloon is gradually inflated to open and remodel the narrowed or blocked ostium.
Illustration of the results of balloon sinuplasty in San Diego
Deflate and Remove Balloon. The sinus balloon catheter is then deflated and removed, leaving the ostium open allowing the return of sinus drainage. There is little to no disruption to mucosal lining.

Balloon Sinuplasty Video


At Rancho Ear, Nose and Throat we are a doctor’s office:

  • Where we strive to keep you on time because we know your time is valuable.
  • Where phone calls are answered by our helpful team members, not an automated system.
  • Where our staff looks you in the eye when you walk in—and greets you by name.
  • Where appointments last as long as it takes to answer all your questions.
  • Where your doctor learns your history & works with you to create a treatment plan you are completely comfortable with.
  • Where the focus is on you, not your paperwork.
  • Where you are a person as well as a patient.