Ear, Nose + Throat (ENT) - Head + Neck Surgery

The Sinusitis Center at Tufts Medical Center in downtown Boston, MA is a comprehensive program for patients with chronic sinus issues. Led by specialists from both Allergy and ENT/Otolaryngology, the Center is designed to help expedite the diagnosis and treatment for chronic sinusitis, which usually involves separate visits and revisits to multiple departments of a hospital. We can usually provide most or all of the initial evaluation in one day. It also ensures collaboration between a team of specialists, all dedicated to getting you the best possible result.

Finding the underlying cause of your sinus symptoms

Have you had something that feels like a cold that never goes away? Or a sinus infection that just won’t stop? The experts in the Tufts MC Sinusitis Center will work together to evaluate symptoms like the examples listed below to find the underlying cause.

• Nasal drainage and related issues like hoarseness
• Nasal obstruction and related issues like trouble sleeping and changes in voice quality
• Facial pain and related issues like migraines and vascular headaches
• Reduced or loss of the sense smell

The above symptoms are often grouped under the terms “chronic sinusitis” or “rhinosinusitis”

These symptoms are often hard to trace back to a distinct illness. Patients with chronic sinus symptoms often have a long history of multiple kinds of treatment including frequent courses of antibiotics, nasal steroid sprays, surgical procedures, allergy shots and even steroid pills with inadequate relief and constantly relapsing symptoms. If you and your physicians are frustrated by your lack of response to treatment and want a reassessment and comprehensive treatment plan you have come to the right place. 

Our team evaluates each individual  to understand why they are experiencing their distinct symptoms. There are a number of possible causes for these symptoms, including:

• Structural or cartilage abnormalities of the nasal passage – These patients often have a history of nasal surgery, sometimes without a marked benefit. One common cause is bone abnormalities obstructing where the sinuses drain.  
• Nasal polyps – Nasal polyps are sac-like growths of inflamed tissue that can line the nose or sinuses. They can be removed but sometimes grow back. They can be associated with aspirin sensitivity (Aspirin Exacerbated Respiratory Disease) and asthma which can complicate management of sinus issues.
• Reflux disease – Gastrointestinal Reflux Disease (GERD) or Laryngeal Reflux Disease (LPR) are often suspected when difficulty swallowing, hoarseness and changes in voice quality are prominent symptoms.
• Environmental allergy – Allergies to environmental allergens are relatively common and can be a major factor in the development of chronic rhinosinusitis.

Other less common conditions that cause chronic rhinosinusitis and sinusitis include immune deficiencies, forms of vasculitis that involve the sinuses including Wegener’s Granulomatosis and fungal hypersensitivity sinusitis. 

To determine the condition that is causing your sinus issues, our team of allergists and otolaryngologists may use one or a combination of the following diagnostic tests depending on your unique symptoms and medical history.

• Rhinoscopy with laryngoscopy
• Sinus CT scan
• Allergy skin testing
• RAST testing for allergy to unusual environmental allergens
• Testing of the immune system including immunoglobulin levels and responses to pneumococcal polysaccharide vaccines
• Testing for aspirin sensitivity with challenge

After the initial evaluation and determination of the cause of your symptoms, our ENT and allergy specialists will work together to plan the best course of treatment.  We work together to help eliminate needless testing and keep your care as efficient and effective as possible.

If you come from a distance we typically will work with your local physicians and communicate closely with them on a treatment plan. Typically an initial course of treatment will be set up with a time interval to decide whether or not it is working.   Chronic long standing conditions often require a number of treatments together or in sequence.

Treatment options vary based on your condition but may include:

• Nasal surgery or functional endoscopic sinus surgery (FESS)
• Topical nasal corticosteroid regimens and nasal irrigations
• Oral corticosteroid regimens (typically short term and used to treat bacterial or fungal infections or nasal polyps)
• Antibiotics used in conjunction with other measures
• Allergen immunotherapy (subcutaneous immunotherapy is the standard but sublingual immunotherapy is considered in certain cases)
• Immunoglobulin replacement for immunodeficiency
• Aspirin desensitization