Sinusitis Treatment in Pokhara: Medical and Surgical Options at A&B
Sinusitis is among the most common conditions driving ENT outpatient visits in Pokhara. The city’s valley geography, variable air quality, high pollen burden from surrounding forests, and dusty dry season create conditions that chronically stress the sinonasal mucosa. Many patients endure months or years of facial pain, nasal congestion, and postnasal drip — managing symptoms with over-the-counter decongestants — before seeking specialist assessment. This is often the wrong approach, and it delays appropriate treatment.
What Is the Difference Between Acute and Chronic Sinusitis?
Acute sinusitis lasts less than 4 weeks. Chronic sinusitis is defined as sinonasal symptoms persisting for 12 weeks or longer, with or without nasal polyps. Recurrent acute sinusitis is four or more episodes of acute sinusitis per year, each lasting less than 4 weeks, with symptom-free intervals between. These distinctions matter because the causes, investigations, and treatments differ.
Acute sinusitis is most commonly viral, arising as a complication of the common cold. It resolves spontaneously in 70% of cases within 2 weeks. Bacterial acute sinusitis — suggested by failure to improve after 10 days, or worsening after initial improvement — accounts for a minority of cases but requires antibiotic treatment.
Chronic sinusitis involves sustained mucosal inflammation with a different pathophysiology from acute infection. Structural factors, allergy, and microbial biofilms all play roles. The treatment approach is correspondingly different and more complex.
What Causes Sinusitis and Why Is It Common in Pokhara?
Viral upper respiratory infection is the most common precipitant of acute sinusitis. Seasonal allergic rhinitis — driven by tree pollen in spring, grass pollen in summer, and dust mite exposure year-round — causes chronic mucosal swelling that impairs sinus drainage and predisposes to recurrent infection.
Structural factors contributing to chronic sinusitis include a deviated nasal septum (impairing airflow), concha bullosa (air-filled middle turbinate), and anatomical narrowing at the ostiomeatal complex — the drainage pathway of the frontal, maxillary, and anterior ethmoid sinuses. These structural abnormalities are not self-resolving and in some patients require surgical correction.
Nasal polyps are smooth, grape-like benign growths of the sinonasal mucosa that block drainage pathways. They are associated with chronic sinusitis, allergic rhinitis, and aspirin sensitivity. They do not become cancerous but cause progressive nasal blockage, loss of smell, and treatment-resistant sinusitis.
Pokhara’s seasonal air quality fluctuates significantly. The pre-monsoon months (March–June) bring dusty conditions from agricultural burning and decreased precipitation. The valley traps particulate matter in the colder months. These are real environmental drivers of sinonasal disease in the local population.
What Are the Symptoms of Sinusitis?
The four cardinal symptoms are nasal blockage, nasal discharge (anterior or posterior/postnasal drip), facial pain or pressure, and reduced smell. For a diagnosis of chronic rhinosinusitis, at least two of these symptoms must be present for 12 weeks, with nasal blockage or discharge as one of the two.
Headache associated with sinusitis is typically located over the affected sinus — frontal sinusitis produces forehead pain, maxillary sinusitis produces cheek pain. The pain is often worse in the morning and improves through the day as drainage occurs with activity. This pattern — unlike the unilateral throbbing headache of migraine — helps with differentiation, though the two conditions can coexist.
Loss of smell (hyposmia or anosmia) is a cardinal symptom of chronic sinusitis, particularly when polyps are present. It significantly reduces quality of life and is often under-reported because patients adapt over time.
How Is Sinusitis Diagnosed?
Acute sinusitis is typically diagnosed clinically based on symptom duration, characteristics, and examination. Routine imaging is not indicated for uncomplicated acute sinusitis.
For chronic sinusitis, CT scan of the paranasal sinuses is the definitive investigation. It delineates the extent of mucosal thickening, identifies polyps, reveals anatomical variants contributing to drainage obstruction, and provides the surgical roadmap if FESS is planned. CT should be performed after a course of medical treatment has been tried and has failed — not as the first investigation.
Flexible nasal endoscopy, performed in the ENT clinic, allows direct visualisation of the nasal cavity, middle meatus, and nasopharynx. It identifies polyps, discharge from sinus ostia, deviated septum, and suspicious lesions that are not visible on anterior rhinoscopy.
Allergy testing is indicated in patients with chronic sinusitis associated with allergic features — sneezing, itching, watery eyes, and clear discharge. Identifying specific allergens enables targeted avoidance strategies and allergen immunotherapy where appropriate.
What Are the Medical Treatment Options for Sinusitis?
Treatment is stepwise, based on chronicity and severity.
Saline nasal irrigation (using an isotonic or hypertonic saline solution) is the safest and most evidence-based first-line treatment for both acute and chronic sinusitis. It physically removes mucus and allergens, reduces mucosal swelling, and improves ciliary function. The neti pot or syringe technique is effective and inexpensive.
Intranasal corticosteroid sprays (mometasone, fluticasone, budesonide) are the cornerstone of chronic sinusitis and allergic rhinitis management. They reduce mucosal inflammation, shrink polyps, and improve drainage. They require consistent daily use for at least 4–6 weeks to show full benefit. They are not systemically absorbed in meaningful amounts and are safe for long-term use.
Antibiotics are indicated in bacterial acute sinusitis (amoxicillin-clavulanate first-line) and in acute exacerbations of chronic sinusitis with purulent features. Prolonged low-dose macrolide therapy (e.g., azithromycin) has anti-inflammatory properties and is used in some cases of chronic sinusitis refractory to standard treatment.
Antihistamines and leukotriene receptor antagonists (montelukast) are useful when allergic rhinitis is a contributing factor.
Oral corticosteroid short courses can rapidly reduce polyp size and restore smell before a more definitive treatment strategy is implemented.
When Is FESS (Functional Endoscopic Sinus Surgery) Required?
FESS is indicated when adequate medical treatment — at least 12 weeks of intranasal steroids plus antibiotics for any infectious component — has not produced sufficient symptom relief. It is also indicated for significant anatomical obstruction that prevents medical treatment from working, for complicated sinusitis (orbital or intracranial extension), and for nasal polyps causing significant obstruction.
FESS is performed under general anaesthesia, using an endoscope inserted through the nostril. There are no external incisions. The surgeon removes diseased mucosa, widens natural drainage pathways, and removes polyps under direct visualisation. The goal is to restore normal sinus drainage function while preserving as much normal tissue as possible.
Recovery involves nasal packing removal within 24–48 hours, saline irrigation starting shortly after surgery, and clinic review at 1–2 weeks for debridement. Smell typically begins to recover within weeks. Recurrence of polyps is possible; ongoing intranasal steroid use post-operatively reduces this risk.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
If you have had nasal congestion, facial pain, or loss of smell for more than three months, specialist ENT assessment at A&B International Hospital can provide an accurate diagnosis and a structured treatment plan — medical or surgical. ECHS polycards accepted.
