For more detailed information about sinus disease click here to view our 10-part Video Guide to Sinus Problems & Treatments… –
Otolaryngologist and sinus specialists, Dr. Monty Trimble and Dr. Jonathan Wu, provide comprehensive ENT and Sinus services that include medical treatment, in-office balloon sinuplasty and standard functional endoscopic sinus surgery (FESS) to treat allergic rhinitis and non-allergic rhinitis, chronic sinusitis. For their patient’s convenience they have a in-office CT scanner to evaluate sinuses.
Sinusitis is a word commonly used to describe hay fever,
allergies, nasal congestion, facial pain and pressure, and headache. Sinusitis is infection or inflammation of the air filled, mucus-lined cavities that occupy a large part of our face and space between the eyes. Sinus complaints reach beyond the scope of the sinus cavities, and are among the most common reasons people buy over-the-counter products and seek medical treatment.
When the nasal sinus irrigation (Neti pots), Benadryl, Sudafed, and Mucinex fail to help, you pick up the phone and make an appointment with your doctor. Your doctor wants to know if the cause of your symptoms is allergies, non-allergic irritants ozone, smoke, exhaust, etc–or acute sinusitis. Allergic Rhinitis, or allergies, can be treated with antihistamines, nasal antihistamines, and nasal steroid sprays. For some, avoidance of what you are allergic to can be effective, and others may choose to do immunotherapy, or as I say, shots or drops. Upper Respiratory infections (URI) or colds are viral and usually run their course in 7 to 10 days. URIs and allergic rhinitis, as well as non-allergic rhinitis, can lead to sinusitis.
Acute sinusitis, which is a sinus infection lasting less than 1 month, tends to be characterized by facial pain and pressure, nasal obstruction, discolored drainage, sore throat, and occasionally fever. Antibiotics, decongestants oral and nasal–and short courses of steroids are usually effective treatment. If these infections become recurrent, additional diagnosis and treatment for allergic and non-allergic rhinitis can be helpful in decreasing the frequency of the infections. When these infections are prolonged, requiring more than 2 courses of treatment, or recurrent, more than 3 per year, referral to an ENT (Ear, Nose, and Throat) specialist, or Otolaryngologist, is indicated.
So what should you expect as a patient who suffers from these problems when you seek treatment from a sinus specialist? A good history and physical examination will lead to appropriate diagnostic testing and treatment. Nasal endoscopy, which is placing a small rigid tube with a light on the end into your nose, may be performed in the office at your initial visit. This will tell an ENT doctor if you have any nasal polyps, infected drainage from the sinuses, swelling or edema caused by allergies or infection, and allow cultures to be obtained. If you have had previous surgery, it allows the ENT doctor to assess previous surgical treatment and the current health of the sinus cavities.
Initial treatment involves a course of antibiotics, nasal steroid or antihistamine spray, nasal saline irrigations, and possibly steroids. Oral or nasal decongestants may be used for some patients. Next, the patient will return in 3 to 4 weeks and obtain a CT scan of the sinuses. Those with chronic sinusitis will have evidence of this on their scan. Nasal obstruction may also be evident. Patients who only have recurrent sinusitis with resolution of symptoms between infections may have no evidence of sinus disease. It is their sinus anatomy, among other factors, that may predispose them to getting sinusitis.
So what should you do if you suffer from chronic sinusitis, recurrent sinusitis, and/or chronic nasal obstruction that does not respond to medical treatment. Surgical options to improve breathing include straightening the septum or, septoplasty, and/or inferior turbinate reduction. Inferior turbinate reduction is reducing in size the tissue in the nose that causes obstruction. This procedure can be performed in the operating room with other sinus procedures or in the office setting. In my office, I do Coblation turbinate reduction.
For sinusitis, sinus surgery has also evolved significantly over the past 25 years. Minimally invasive approaches and techniques have been developed that result in fewer complications, less bleeding, and faster recovery times. I have found that nasal packing and nasal splints are largely unnecessary. This leads to much increased patient satisfaction. Balloon sinuplasty is the most recent development in the treatment of sinus disease. By threading a small balloon into selected sinuses under guidance of fluoroscopy (x-rays) or a small light, sinus tracts can be dilated with minimal destruction or removal of sinus tissue. This may allow in office treatment of some sinus disease and lower the threshold at which you might choose to have a procedure performed.
Surgery for sinusitis and nasal obstruction is highly effective. Most patients have complete resolution or significant improvement in breathing problems. Studies have shown that functional endoscopic sinus surgery appropriately performed has success rates of 85 to 92%. For most sinus patients, ongoing medical treatment for allergic and non-allergic rhinitis is required after surgery to maintain these success rates.
For those of you who have decided to suffer with your sinus symptoms, it is time for you to ask your doctor for help or seek out a highly trained sinus specialist.
Balloon Sinuplasty, In-Office (Minimally Invasive Sinus Treatment)
Balloon Sinuplasty is a minimally invasive procedure used to treat sinusitis. This technology has been available for use in the operating room since 2005. It is now available for use in the office setting. If you have recurrent sinus infections–more than 2 to 3 infections per year–or chronic sinusitis, then you may be a candidate for this procedure.
Candidates for Balloon Sinuplasty are anesthetized with topical and local anesthetics. I have found this is very well tolerated in almost all patients. Then using a small endoscope with a camera attached; a guide, small balloon, and lighted guide-wire are positioned into the sinus to be dilated. The balloon is then inflated, and in less than 10 to 15 seconds the sinus dilation is completed. The next sinus is then treated. There is no removal of tissue so bleeding is minimal. Return to normal daily activities is almost immediate. I see patients back in the office the next week for a follow-up visit to look at the dilated sinus openings.
In-office Balloon Sinuplasty
Anyone who suffers from recurrent and/or chronic sinusitis, nasal congestion, facial pain or pressure, headaches, decreased sense of smell, recurrent ear infections, recurrent upper respiratory infections that last longer than 7 to 10 days may be a candidate for this procedure. For those who aren’t, excellent treatment for all of these are available in our office. Read more about balloon sinuplasty on DFWSinus.com.
If you have any questions or if you would like to learn more about the services we provide, please call TRIMBLE ENT and Sinus at 817-529-6200 or complete our contact form.