Posts for category: Sinus
What are Nasal Polyps?
Nobody wants to hear they have polyps in their nose. This is not your garden variety nasal issues. Most of the time caused by allergy, polyps are a chronic condition that is not often cured with surgery. Usually an allergist is going to provide the best long-term control. But there are times when surgery is needed, even repeatedly in the most extreme cases.
Polyps grow in response to nasal inflammation. They are relatively discrete mounds of incredibly swollen nasal mucosa (lining). Most of the time it is something in the air that stimulates them to grow. At times, it is a sinus infection that provides the impetuous for their existence. No matter the cause, polyps are disruptive to nasal airflow and tend to cause secondary sinus infections.
Epidemiology and differential diagnosis of nasal polyps.
Chaaban MR, Walsh EM, Woodworth BA - Am J Rhinol Allergy (2013 Nov-Dec)
Surgery is needed for polyps if medical management can’t keep them at bay and an allergist can’t help you control the environmental reaction that started them in the first place. It is by no means the first choice of treatment unless they are, sometimes quite literally, hanging out of your nose.
Adult-onset woakes' syndrome: report of a rare case.
Schoenenberger U, Tasman AJ - Case Rep Otolaryngol (2015)
The problem with surgery is it is not a permanent fix most of the time. Think about mowing the grass – it just keeps coming back.
When someone has a significant enough polyp issue to require an ENT to take them to the OR, the surgery should be a part of the process. Combining surgery with aggressive medical management pre- and post-op is often the best way to keep you and your nose healthy.
Mark T. Brown, MD, FACS
When is Sinus Surgery Appropriate?
The official name of this sort of procedure is Functional Endoscopic Sinus Surgery (or FESS to those of us in the biz.) If you have tried everything from sinus yoga to big time antibiotics and steroids and you are still sick, it may be time to consider a more invasive but remarkably effective approach.
The “Functional” part of this surgery indicates that we are helping your sinuses aerated and drain properly, the way they are supposed to. Normally the sinuses are connected through small but efficient openings into the nose. If, for whatever reason (cold, allergy, distorted anatomy), those are not able to allow air in and mucous out you are set up for infection. Mucous pools, bacteria have a playground in which to grow, the infection induces swelling, and the drainage is further blocked. We give all sorts of medications to try to reverse this process. If those meds fail surgery physically unblocks the drainage. Properly draining sinuses are happy sinuses. They function normally again and your chronic infection goes away. For most people, this is a permanent fix too. It is rare that we need to go back in to reopen operated sinuses.
Case Report: retained gutta-percha as a cause for persistent maxillary sinusitis and pain.
Hodnett BL, Ferguson B - F1000Res (2014)
The best news is what patients tell us. The vast majority of patients undergoing FESS have a real improvement in the quality of their lives. And they see their doctors a lot less often.
Mark T. Brown, MD, FACS
Turbinate Reduction Surgery
Those pesky turbinates (normal structures that live on the side wall of your nose) can be enlarged and obstructive.
But all is not lost. If medical therapies to control allergies and nasal inflammation are not successful, they can be reduced in the office or in the operating room. Obviously, a procedure without an anesthetic in the OR sounds great. And it is possible to do using a radiofrequency probe to reduce the swollen tissues. But sometimes, turbinate enlargement is only part of the problem. The septum may also need to be corrected, which is something you can’t comfortably do in the office. In that case we can take care of your turbinates during the same surgery.
Surgery because my nose is blocked up? Really? Yes, really. If medications aren’t capable of helping you breathe comfortably, a procedure can make all the difference. Believe it or not, this has been studied scientifically. And the word from patients who have undergone the procedure is a significant improvement in their quality of life.
Surgery is a big deal, no doubt. But, it can make a big difference for your nose and your life. Yes, it requires a general anesthetic but the procedure is short, around 45 minutes. You get to go home the same day. It hurts but typically pain medicine, if needed, is taken only for 3-4 days. The biggest complaint people have is the post-operative congestion. When the plastic splints placed during the surgery are removed in the office, 7-10 days later, life gets immediately better. Lots of smiles when people can breathe like they never have before.
One final note, if you have allergies, this surgery will not fix them. You will likely have to be on the same meds you were on pre-op. However, most people report having better success with the control of their allergies after their septum is straightened.
What is Chronic Sinusitis?
It all starts with a congested nose due to a viral cold or allergy. Not much to do about the virus, it should resolve within 10 to 14 days. Chicken soup is a good idea for a cold. Antihistamines, decongestants, and nasal steroid sprays for allergy control don’t even seem to be enough. But, you just don’t seem to improve even after a couple of weeks.
Facial pressure and pain (particularly when you bend over to tie your shoes), fatigue, persistent discolored nasal mucous, cough, and even wheezing are signs that the congestion has progressed to something more: sinusitis. Now we call in the big guns – antibiotics and even oral steroids like prednisone. Most of the time that infection gets better. But, sometimes all the medicines you have taken can’t get you better.
You may end up in your friendly neighborhood ENT office. But not to worry, there is a way out. Your Otolaryngologist (medicalese for ENT) will likely take a look around, even to the point of putting a scope in your nose to see where the problem resides. And if you are both convinced that you have run out of rational medical options you have to begin to consider surgery. Yes, it comes to that sometimes.
Before you can have any type of procedure the precise nature and location of your infection needs to be found. CT scans are our best bet for this. It is an X-ray, which means radiation exposure. We know and take that into account. But don’t worry, a screening CT is fast, painless (no needles I promise), and has minimal X-rays involved. Without this critical piece of information, a sinus surgeon would just be operating blind – and you don’t want that I promise.
So, now know you know what is going on and you can make decisions based on information. Sinus surgery is surgery (duh) but it is usually VERY effective at relieving those unremitting, chronic sinus infections.
The prevalence of concha bullosa and nasal septal deviation and
their relationship to maxillary sinusitis by volumetric tomography.
Smith KD, Edwards PC, Saini TS, Norton NS - Int J Dent (2010)
Mark T. Brown, MD, FACS