ALL ABOUT SINUSES
Patients commonly describe multiple problems such as nasal congestion, headache, facial pressure, post nasal drainage, cough and a history of repeated treatment for sinus infections.
For most patients, there are two main causes of sinus disease. One cause is an unfavorable or obstructed sinus drainage pathway anatomy. Another possibility is environmental factors such as allergies or airborne irritants and infectious agents like viruses or bacteria that cause inflammation of the sinus mucosal lining rendering it swollen and non-functional.
The Jackson Clinic Otolaryngology team uses clinical expertise, specialized endoscopic techniques and sophisticated imaging studies to make a reliable, accurate and individualized diagnosis for each patient.
An otolaryngologist, commonly known as an ENT (ear, nose, throat) physician, has capabilities in office to evaluate the inside of the nose. After a history of symptoms and previous treatments is discussed, a detailed physical examination of the head and neck will be performed. Your detailed sinusitis evaluation may include an internal inspection of the nose with a flexible fiber-optic endoscope and high-resolution CT imaging. Patients visiting our office benefit from the convenience of on-site imaging provided by our Xoran MiniCat™. This method results in both specific and accurate diagnosis of an acute or chronic disease process.
Patient CT scan using the Xoran MiniCat™
Patients generally have a history of many courses of medical treatment for a similar constellation of symptoms. These often include sudden-onset nasal congestion, headache, post-nasal drainage, cough and ear fullness. It is not uncommon for patients with middle ear problems to have occult sinus disease as the primary source. Frequently, those patients that have completed a course of medical treatment before coming to the ENT may feel better temporarily and not have any disease on their sinus scan. However, further investigation is warranted to discover the possibility of abnormal nasal or sinus drainage anatomy that could predispose someone to recurrent infections.
A complete head and neck examination is performed with specific attention for signs of sinus disease. Using a headlight, evaluation for postnasal drainage in the nasopharynx, inspection of the ears for middle ear effusions (fluid behind the ear drum) are also completed. If appropriate, a highly specialized examination of the nose is then performed in order to identify anatomy that could contribute to recurrent sinus infections. Topical numbing spray is first applied to each side of the nasal cavity. With the nose anesthetized the internal structure and anatomy of the nose is carefully examined in detail using a rigid or flexible fiber-optic endoscope. Next, if appropriate, high-resolution images of the nasal contents and sinus outflow tract anatomy are obtained and reviewed with the patient. Commonly the sinus symptoms reported by the patient correlate with abnormal exam findings found through endoscopic investigation and CT Imaging.
If it can be determined that acute sinusitis symptoms can be controlled medically, the first step in the treatment process would be the development of a personalized maintenance algorithm. Nasal irrigation, topical nasal sprays and formal allergy testing and treatment may also be recommended to minimize the chance of recurrent episodes of sinusitis.
If it becomes evident that symptom management cannot be maintained using medical treatment alone, a patient-specific surgical plan is carefully considered and developed. Additional procedures may be considered to improve nasal breathing.
Surgical treatment of nasal and sinus anatomy commonly include:
• Turbinate reduction
• Functional Endoscopic Sinus Surgery using Image Guidance
• Balloon Sinus Dilation
The main objective of any sinus operation is to reestablish normal function of the affected sinuses. Aeration of the sinus cavity is achieved by modifying abnormal anatomy and removal of sinus obstructing tissues. Our ENT specialists will develop course of treatment that is specific to your disease and anatomy.
Sinus operations generally require a healing time of 3 to 5 days, with most patients back to work in 3 days or so. Normal activities can be resumed in 5 – 7 days. Contemporary sinus procedures generally do not require extensive nasal packing or splints. Patients are discharged to home on an outpatient basis with an at-home protocol of nasal and saline sprays. We often will suggest sleeping in a recliner the first night after surgery in order to minimize swelling and drainage. Bruising is always a concern, but rare.
After your operation, you’ll need to return to the office for a check up around 5-7 days. During this exam the inside of the nose is anesthetized, inspected and cleaned if needed. At this stage patients often report improved breathing and relief of symptoms. At a subsequent post OP visit a medicated sinus rinse is introduced as a method to assure continued symptom suppression.
Dr. Stephen Chandler recently developed an Acute Migraine Treatment that can be performed in the office setting providing immediate relief from painful migraines in less than 20 minutes. Using a balloon dilation technique, CephalgiaCath, a catheter is inserted through the nasal cavity allowing dilation of a balloon to hold medication in place that relieves the migraine pressure by allowing the medication to be held and absorb through the mucosa to the sphenopalatine ganglion. While this not a curative treatment for recurrent migraines, current studies support migraine relief lasting weeks. Dr. Chandler recently introduced ResQRinse™ to the nasal rinsing market.
Sinonasal allergies and sinus infections are two of the most common medical problems worldwide. Sustained contact with reactive environmental allergens and accumulation of nasal debris often result in symptoms of nasal congestion, sneezing, rhinitis and post-nasal drip. In cases of sinus infection, virus, fungi or bacteria destabilize the natural self-cleaning sinonasal mechanism, resulting in sinonasal lining trauma and stagnation of infectious material.
By eliminating the buildup of nasal debris, decreasing contact time of allergens and infectious agents and cleansing damaged mucus membranes, sinonasal lavage helps to stabilize the lining of nasal passages and promote healing of sinus cavities.
Balloon Sinus Dilation
Advances in this procedure now permit safe and painless in-office treatment with minimal patient downtime. The procedure is performed in the office setting using local anesthesia such as nasal sprays and lidocaine. The nasal anatomy is carefully inspected using video endoscopes. The balloon is then placed into the blocked or narrow sinus drainage pathway and inflated. Once fully inflated, the balloon displaces the sinus outflow tract anatomy. This process results in a permanently widened sinus outflow pathway.
The procedure generally takes less than 20 minutes to perform. While the nasal pathways are numb, other improvements to the anatomy, such as turbinate reduction, can be performed at the same time. With balloon sinus dilation alone or in combination with other anatomical improvements patients report the procedure results were as expected. Immediately after the procedure, many patients report relief of symptoms and enhanced nasal breathing. Patients treated with balloon sinus dilation in office can often return to work the next day. Bruising is not a concern with this procedure and there is generally no use of packing.
Because of the development of balloon dilation technology treating sinus disease without a trip to the operating room is celebrated by many patients who would otherwise not be able to afford the required downtime of a larger operation. The doctors with The Jackson Clinic Otolaryngology have received extensive training in this procedure and have performed hundreds of in office cases.
The key to normal sinus physiology is that the lining requires oxygen to function. If the sinus drainage pathways are chronically obstructed, the sinus lining is deprived of air. Under these abnormal anaerobic conditions the mucosal lining becomes devitalized and non-functional. The cilia on the sinus lining can no longer clear secretions, resulting in an accumulation of mucus and debris within the sinus cavities. Protein rich, stagnant sinus secretions contained within a warm dark environment, represent favorable conditions for a bacterial infection.
Chronic sinusitis may be the result of unrecognized acute phase sinusitis, under treatment of acute disease, or other pathology and anatomy that prevents the sinuses from functioning normally such as polyposis, fungal infections or sinus cysts.
Treatment typically requires on-going aggressive medical management, nasal sprays and procedures to obstructed sinus drainage pathways. The use of medicated sinus rinse often becomes part of a patient’s daily routine.
What’s right for you?
A formal evaluation by a board certified ear, nose, throat specialist is the best choice when sinus symptoms become unmanageable. A customized, collaborative approach using one or a combination of the above mentioned therapies will be used to best satisfy individual patient requirements.
With so many advances in treating sinus disease currently available, patients have tremendous opportunity to understand their disease process and unprecedented options in choosing management strategy. Our goal is to educate our patients and empower them to act sooner and gain control of their sinuses.