A sinus plug is a small device that is inserted into the nasal cavity to help treat sinusitis. Sinusitis is an inflammation of the sinus cavities caused by an infection, allergies, or environmental irritants. A sinus plug can help relieve symptoms of sinusitis by keeping the nasal passages open and promoting drainage of mucus.
What are the Sinuses?
The sinuses are air-filled cavities located within the bones of the face and skull. There are four pairs of sinuses:
- Maxillary sinuses – located behind the cheekbones
- Frontal sinuses – located behind the forehead
- Ethmoid sinuses – located between the eyes
- Sphenoid sinuses – located behind the ethmoids in the upper region of the nose
Each sinus has an opening into the nasal cavity to allow mucus to drain. Tiny hair-like projections called cilia sweep mucus out of the sinuses and into the nasal cavity. When the sinuses are working properly, air flows smoothly through the sinuses and mucus drains without backing up. However, when the sinus openings become inflamed or blocked, normal drainage may be obstructed leading to a sinus infection.
What is Sinusitis?
Sinusitis refers to inflammation of the tissue lining the sinuses. This inflammation can be caused by:
- Viral, bacterial, or fungal infections
- Allergies – swelling due to allergic reactions
- Nasal polyps – benign growths in the lining of the sinuses
- Structural issues – such as a deviated septum or narrowed sinus passages
- Environmental irritants – such as smog, smoke, or chlorine fumes
When the sinus passages become inflamed, the openings can swell shut preventing normal mucus drainage. Mucus then accumulates in the sinuses leading to congestion and infection. Symptoms of sinusitis include:
- Facial pain and pressure
- Nasal stuffiness and congestion
- Thick, discolored nasal drainage
- Loss of smell
- Post-nasal drip
- Cough
- Fatigue
- Tooth pain
- Headaches
If sinusitis symptoms persist for more than 10 days, the condition is considered chronic. Chronic sinusitis requires medical treatment to resolve the underlying cause and prevent recurrent episodes.
How Can a Sinus Plug Help with Sinusitis?
A sinus plug is a small, tapered medical device made of silicone or bioresorbable material. It is designed to fit into the nasal cavity to prop open the sinus drainage pathways. Keeping the sinus openings unobstructed can help restore normal mucus drainage and airflow.
A sinus plug works by:
- Physically holding open the sinus opening to prevent obstruction
- Allowing mucus drainage and reducing congestion
- Permitting delivery of topical medications directly into the sinus cavity
- Preventing abnormal tissue growth that could block the sinus passage
When inserted correctly, a sinus plug can be an effective way to treat inflammatory sinusitis and improve symptoms. Potential benefits include:
- Relief of congestion and facial pressure
- Improved mucus clearance and reduced infection risk
- Decreased use of oral antibiotics or nasal sprays
- Avoiding more invasive sinus surgery procedures
Sinus plugs are typically used for recurrent or chronic sinusitis when other medical therapies have not been successful. They may be left in place for days to months depending on the severity of symptoms.
What are Sinus Plugs Made Of?
Sinus plugs are small medical devices that come in different shapes, sizes, and materials. Common options include:
Silicone
Silicone is the most frequently used material for sinus plugs. Silicone is:
- Biocompatible – causes little to no immune system reaction
- Non-absorbable – does not dissolve over time
- Easily molded – can be shaped for proper fit
- Easily removed – does not adhere inside nasal cavity
Bioresorbable Polymers
Some sinus plugs are made of special man-made polymers that dissolve over time inside the body. These include:
- Poly-L-lactic acid (PLLA)
- Polyglycolic acid (PGA)
- Polycaprolactone (PCL)
Bioresorbable plugs provide a temporary stinting effect and eventually dissolve away without needing removal.
Medicated versus Non-medicated
Non-medicated sinus plugs are made only of the base material, such as silicone or polymer. Medicated plugs have medication incorporated into the device to provide drug delivery directly to the affected sinus tissue. Common medications include:
- Steroids – to reduce inflammation
- Antibiotics – to treat infection
- Anti-fungals – to combat fungus
How are Sinus Plugs Inserted?
Sinus plug insertion is typically performed in the doctor’s office as an outpatient procedure. The steps include:
- Anesthesia – Numbing medication is applied to the nasal passages for comfort.
- Nasal Endoscopy – The doctor inserts a thin scope into the nose to visualize the nasal anatomy and identify the target sinus opening.
- Balloon Dilation – A small balloon may be used to gently open up a blocked sinus opening.
- Plug Insertion – Using an insertion tool, the plug is carefully guided into the appropriate sinus cavity.
- Position Confirmation – The doctor confirms placement with endoscopy before concluding the procedure.
Typically there is minimal discomfort during the insertion. Afterward, patients may experience some mild congestion, drainage or pressure as the sinuses adjust to the plug. Pain medication and saline sprays are often recommended for a few days.
How Long Can Sinus Plugs Be Left In Place?
Sinus plugs are designed to be temporary devices. The length of time a plug should remain in place depends on several factors:
- Plug material – Silicone plugs remain until removed by the doctor. Bioresorbable plugs dissolve over weeks to months.
- Severity of sinusitis – More severe cases may warrant longer stent times to manage inflammation.
- Individual response – Plugs are removed once symptoms improve sufficiently.
- Complications – Plugs may need early removal if intolerable side effects occur.
In most cases, sinus plugs remain in place for:
- Silicone stent: 1 week to 6 months
- Bioresorbable stent: 4 weeks to 3 months
Patients need regular endoscopic examinations to monitor plug position and assess if ongoing stenting is beneficial. Plugs left too long risk complications.
What are the Potential Side Effects of Sinus Plugs?
While sinus stents can be helpful in managing inflammatory sinus disease, they also carry risks of adverse effects including:
- Infection – Plugs may increase likelihood of recurrent sinus infection.
- Stenosis – Scarring around the plug can narrow the sinus opening.
- Dislodgement – Plugs can shift out of position and fall into nasal cavity.
- Headache – Some patients experience facial pressure or pain.
- Crusting – Stents may cause increased nasal crusting.
- Bleeding – Nosebleeds can occur if plugs cause mucosal irritation.
Patients should promptly report any worrisome side effects to their doctor for evaluation. Plugs may need repositioning or early removal in some cases. Using sinus plugs requires balancing potential benefits against short and long-term risks.
When are Sinus Plugs Contraindicated?
Despite potential advantages, sinus stents are not appropriate for every patient with sinusitis. Conditions where plugs may cause harm and are not recommended include:
- Total nasal obstruction – Plugs require open nasal airway for ventilation.
- Unresolved nasal polyps – Polyps will block stent drainage.
- Uncorrected anatomic defects – Such as severe septal deviation.
- Samter’s triad – Aspirin sensitivity, asthma, nasal polyps.
- Cystic fibrosis – Risk of mucoid impaction from plug.
- Poor sinus development – Hypoplastic or atelectatic sinuses.
- Sinonasal malignancy – Concern for tumor seeding along stent.
A full medical history and nasal exam should always be performed before sinus stent placement to exclude contraindications.
Conclusion
Sinus plugs can be an effective therapeutic option for management of inflammatory sinus disease not amenable to other medical treatments. Small stents inserted into sinus openings help maintain patency, reduce congestion, facilitate drainage, and deliver targeted medication. Ideal candidates for sinus plugs include those with chronic rhinosinusitis refractory to conservative measures. Patients require careful screening and monitoring to minimize adverse effects and ensure appropriate stent dwell times. When utilized properly, sinus plugs provide a minimally invasive approach to improve sinus health.
