Otolaryngology – Head and Neck Surgery – Rhinology
Sinus problems can be very common, but for those who suffer from chronic sinus issues, there is relief. At Penn State Health, we begin with you in mind – evaluating the symptoms and providing a detailed examination to identify the underlying issues and possible treatment.
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Almost everyone has experienced a sinus infection in his or her lifetime. The sinuses are outpouchings from the nose, and scientist are still not clear on why we have them. Most people develop sinuses in the forehead area, cheeks, and between the eyes, although there is some variability amongst individuals. The sinuses are connected to the nose by small openings. When everything is working correctly, your nose and sinuses make about one liter of mucous a day. This normal mucous drains from our sinuses to our nose, and then down the back of the throat where we swallow it. This mucous is important for the natural cleaning process of the nose and sinuses. If the mucous is more than typical, or thicker than usual, we may feel it as post-nasal drainage.
What is sinusitis?
“Sinusitis” is a term frequently applied to a variety of nasal symptoms, but specifically refers to inflammation or infection of the sinus lining. Symptoms of sinusitis may include nasal congestion, runny nose, post-nasal drainage, cough, facial pressure, and fatigue. Acute viral sinusitis (“the common cold”) is caused by various viruses, whereas acute bacterial sinusitis is caused by bacteria. They are really identical in symptoms, but differ in the length of time you suffer with the symptoms. If your nasal symptoms do not improve after 7-10 days, or worsen after 5, you should consider seeing your doctor to discuss antibiotic use. Antibiotics are not helpful, and may be harmful, if used inappropriately for viral illnesses.
Relief from chronic sinusitis
It is estimated by the Centers for Disease Control that 32 million people suffer with chronic sinusitis. Chronic sinusitis may be diagnosed if you have sinus problems lasting more than 3 months. Not all chronic nasal symptoms are sinus related, as those patients with allergies (allergic rhinitis) or chronic nasal irritation from their surroundings (non-allergic rhinitis) will suffer with the same symptoms. Evaluations with special x-rays, such as CT scans, are essential in making the diagnosis of chronic sinusitis. Initial treatment may include antibiotics, nasal steroid sprays, and other medical therapies.
In cases not cured by medical therapy, surgery may be recommended. Sinus surgery evolved during the 1980’s from a procedure involving incisions on the face and in the mouth, to surgeries that can be accomplished through the nostrils, with no visible incisions. 200,000 to 350,000 people undergo sinus procedures every year. Many of these patients will have significant improvement in their daily symptoms and quality of life. While not a cure for all sinus problems, the surgery may be very helpful for these patients. The surgery involved removing tissue (lining and bone) from around the openings of the sinuses, where they connect to the nose. By enlarging these opening, the drainage of the sinuses necessary for good health can be improved.
Johnathan McGinn, MD, FACS, Associate Professor of Otolaryngology – Head and Neck Surgery, has been performing traditional sinus surgery for many years, but has incorporated a new technique, balloon sinuplasty, into his sinus practice.
Many of us take for granted the ability to breath comfortably through our nose, or go about our day without a box of tissues at our side. Sinus and nasal conditions can have a big impact on our daily routine, and the goal of care is focused on the control of a patient's symptoms.”
Frequently asked questions about balloon sinuplasty
Q: What is balloon dilation sinus surgery, or balloon sinuplasty?
A: Traditional functional endoscopic sinus surgery (FESS) involves the removal of tissues around the sinus openings using instruments and cameras through the nostril. This tissue removal assists in sinus drainage, but yields raw areas, which must then heal. The balloon dilation technique instead moves the bone and lining within the nose to open the sinuses, but does not remove tissue. Healing times and bleeding are thus reduced.
Q: How is the balloon sinus surgery done?
A: Sinus surgery is typically done as a same day surgery (no overnight stay in the hospital), but patients are under general anesthesia. Often balloon sinus surgeries techniques are combined with traditional endoscopic sinus surgery techniques. In balloon sinuplasty, a balloon catheter, similar to those used in blood vessel procedures like cardiac catheterizations, is inserted through the sinus openings. By inflating this balloon, the bone and tissues around the opening are moved to open the sinus drainage pathway. In select cases, balloon sinuplasty may even be done in the office under local anesthesia.
Q: Does this balloon technique for sinus surgery work for everyone?
A: No. Consultation with an otolaryngologist with a sinus CT scan will be necessary to decide what surgical options may be available. The balloon technique can be used in many of the sinuses, but not all. Often the balloon dilation technique is used in combination with traditional surgery to yield the best results.
Q: What are the success rates with this surgery?
A: Sinus surgery as a whole is successful in reducing the severity and frequency of nasal symptoms of chronic sinusitis in most patients. The balloon technique has been shown to be safe and effective when compared with traditional FESS techniques. A study from 2008 showed that 95% of patients had improved symptoms, and 74% were freed of sinus infection at an 8-month follow-up.
Q: How long does surgery take?
A: Surgery usually lasts one to two hours, depending on how many of the sinuses must be addressed, and if both sides are involved.
Q: What is recovery like?
A: With sinus surgery, there is some expected discomfort, bloody nasal drainage, and drainage. When the balloon dilation technique is used, similar or reduced post-operative symptoms should be seen. Patients go home the same day, usually within hours.
Q: Are there any risks involved with this procedure?
A: As with any surgical procedure, risks exist. Traditional sinus surgery techniques carry a very small risk to surrounding tissues of the eye or brain. (less than 1 %), balloon sinuplasty has similar or smaller risks.