Posts for tag: Surgery
I may be correct in saying that nobody ever really WANTS to have surgery. It involves IVs, anesthesia, uncertainty, and it HURTS. That being said, surgery is often the solution to a medical problem that is not fixed by medication. Sinus surgery has changed tremendously over the last few decades. This blog is intended to dispel myths that often frighten people about it and/or cause them to postpone treatment and prolong suffering.
Sinusitis is inflammation of the sinuses-these are air filled cavities in the face-the exact purpose of which is unknown. However, we think the sinuses humidify the air we breathe, lighten the skull, and resonate the voice. That being said, they can fill with infection, lead to pain, drainage, fatigue, and infect surrounding structures. For acute sinusitis (less than 4 weeks), an antibiotic with a nasal steroid and sinus rinse will usually fix the problem. Occasionally, this doesn’t work and the infection becomes chronic (lasting 12 weeks or more). Often, a prolonged course of antibiotics (3 weeks!), nasal and oral steroids, and a sinus rinse will solve the problem. When this does not do the trick and we see evidence of persistent disease on a CT scan, we will recommend surgery. Obviously, this is an oversimplification-but-you get the point.
When surgery is the “next step,” we often hear the following questions/concerns:
Q: “MY (insert relative here) had sinus surgery 20 years ago and they PACKED his nose-He said it was the WORST thing in the world…do you pack the nose?”
A: No, we do not pack the nose. This is something that surgeons used to do quite frequently after surgery to prevent bleeding or scar tissue growth. Today, we have absorbable packing and ointments we can place in the nose to prevent bleeding, and our surgical techniques have changes to minimize risk of scarring
Q: “Do you SCRAPE the sinuses??”
A: No, we do not scrape the sinuses. The point of surgery is widen the opening where the sinuses naturally drain, and to avoid damage to the mucosa (tissue lining the sinuses) as much as possible. We can irrigate the sinuses and remove inflamed growths such as polyps. But, no scraping.
Q: “Will sinus surgery prevent me from ever having another sinus infection?”
A: Unfortunately, no. The purpose is to open the sinuses up and remove diseased tissue. You can still get sinus infections in the future, but we may treat them with “topical” antibiotics and steroids (in the sinus rinse) which will reach the cavities better because they are more open. Your risk of developing future problems depends on why you had this in the first place (severe allergies, polyps, fungus, etc.)
Q: “I had sinus surgery 10 years ago, and now I am having problems again. What are you going to do differently?”
A: You may have recurrent disease for a number of reasons; however, our goal in surgery is the same. Because you had surgery before, things may scar certain ways that predispose you to infection again-Often, we will use “image guidance” which is a new technology that helps us identify structures in the nose during surgery to ensure good drainage (and correct identification of infected areas).
Q: “Are you going to use balloons on me?”
A: Balloon sinuplasty is a new technology that uses a balloon to widen the natural opening of the sinuses. It can be a helpful tool in sinus surgery (especially the frontal sinus) or used alone. Not all doctors offer this procedure, and some patients are not good candidates for this technology, so this will need to be a discussion between you and your physician.
Every now and then in medicine a new technique comes along that revolutionizes the field. Imagine a world without cardiac catheterization and repair of coronary disease. How about living in a time without penicillin? These are two of the myriad medical advances that have improved the lives of people worldwide since the 1940s. Balloon sinuplasty is NOT one of those advances despite the advertising.
Sinus surgery has evolved over the years to the remarkably effective procedure we have today. The introduction of endoscopes brought a level of safety not seen before. Operating in the nose where the sinuses drain to improve the natural function of the nose has resulted in great success for patients. As with any operation there are risks, and some of them are pretty scary. However, in experienced hands those risks are minimized and patient outcomes are excellent.
Enter the new technique. The balloon has evolved for use in the nose from the aforementioned cardiac catheterization. The idea is that we dilate the sinus opening (instead of physically removing tissue to enlarge it), drainage improves, and chronic infection resolves. Unfortunately, there is no data to show that this is a safer or more effective technique than standard approaches. Is it bad? Probably not. Is it safer? Probably not. Is it marketable? Very much so!
The marketing strategy has been direct to consumers – “ask your doctor about…” – and to primary care doctors – “send your patients for balloon sinuplasty.” To me that is, at best, medically meddlesome. At worst it may be unethical.
Balloon sinuplasty is not evil. It is a tool that, when applied correctly, has applicability to modern sinus care. It is not proven to be safer or more effective. Nor has it proven to be unsafe or less effective. It is what it is, a tool. Don’t be taken in by the advertising. Go to a doctor who focuses on patient care, not the marketing of a technique.
Oh by the way, there is one thing balloon sinuplasty excels at - increasing the price of a procedure.
Mark T. Brown, MD, FACS
Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX. Dr. Brown is Board Certified in both Otolaryngology, Head and Neck Surgery as well as Sleep Medicine. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.
Image is not a licensed Simpsons™ graphic and is not meant to be an actual representation by Matt Groening or the Fox Broadcasting Company.