Sinus

Sinuses are air-filled cavities in the cranial bones; those near the nose are called as Para nasal sinuses.

The four major pairs of sinuses are:

• Frontal sinuses (in the forehead above eyes)
• Maxillary sinuses (behind the cheek bones)
• Ethmoid sinuses(between the eyes)
• Sphenoid sinuses (behind the eyes)

When sinuses are healthy, the lining (mucosa) of each sinus cavity makes mucus, which helps trap dust and other particles. Tiny hair like structures called cilia sweep the mucous out of the sinus, into the nasal cavity and down the throat.

When sinus linings become inflamed or swollen it blocks mucus from draining. Overtime cilia become damaged and cannot move the mucus. Mucus then pools and can become infected with bacteria or fungi causing acute and chronic sinus infections.

Most Common Disorders of Nose and Sinuses:

• Allergic Rhinosinusitis
• Chronic Rhinitis
• Deviated Nasal Septum
• Hypertrophic Turbinates
• Nasal Lesions and Nasal Deformities
• Perforations of Nasal Septum
• Sinus Headaches and Facial Pain

Chronic Sinusitis: Chronic sinusitis significantly impairs patient’s quality of life. Patient may have difficulty breathing through the nose, experience frequent headaches, tenderness in the face or ache behind the eyes. A yellow or greenish discharge from the nose or drainage, down the back of the throat is common.

The first step in the diagnosis of sinus disease is the patient’s history. A thorough patient’s history will reveal past treatments, known possible allergies, exposure to irritants such as tobacco smoke and how long the symptoms have been going on.

Acute sinusitis is often caused by a bacterial infection, which usually develops as a complication of a viral respiratory infection or a common cold. Acute sinusitis symptoms may last less then four weeks, sub acute sinusitis last four to eight weeks, and recurrent sinusitis is 3 or more episodes of acute sinusitis within a year.

Chronic sinusitis is one of the most commonly diagnosed chronic illnesses in the United States affecting 30 to 40 million American each year.

Examination
A thorough examination of the nose and sinus disease by the Dr. in the office may includes, Diagnostic nasal and sinus endoscopy.

A culture (sample of mucus) is taken; this is analyzed in a lab to identify strain of bacteria or fungus.

The Dr. may also order x-rays to check the level of fluid in sinuses also CT (computed tomography) this imaging test can show fluid levels, details of drainage, pathways and source of blockage.

Allergy Testing
Skin or RAST test may be ordered to find out if the nose and sinus disease is due to allergies to common antigens.

Treatment
Treatment may include antibiotics, antifungal, steroids, and or other medications to treat the infection and inflammation caused by bacteria or fungi. Allergy medications, decongestants, nasal or oral are also prescribed to control the allergies.

Surgery may be needed if the sinus is completely blocked or sinusitis recurs and medications aren’t helping.

Sinus surgery can be used to

• Drain sinuses, This relieves pressure and helps antibiotics to be more effective
• Correct a defect that hinders proper drainage of the sinus, this can, help relieve the current infection and prevent future ones.
• Remove polyps, this benign (non-cancerous) growth can block sinus openings, retaining mucus drainage and infections.

Common Sinus Procedures Done in Our Practice

• Endoscopic Sinus Surgery of Maxillary, Ethmoid, Frontal and Sphenoid Sinuses.
• Endoscopic polypectomy and removal of tissue
• Endoscopic reduction and Restructuring of the Turbinates
• Septoplasty and Septal reconstruction
• Endoscopic or direct tumor or cancer Surgery of the sinuses
• Endoscopic control of Nosebleeds.

New Procedures Introduced In Practice are Balloon™ Sinuplasty and Image Guided Sinus Surgery

Balloon Sinuplasty™ Technology

This technology utilizes a small flexible sinus balloon catheter that is placed into the nose to reach the sinuses. The sinus balloon is introduced into sinus opening and slowly inflated to restructure the blocked sinus natural opening. Balloon sinuplasty ™ device gently opens blocked sinuses, and in many cases, without tissue removal or bone removal. This may result in reduced bleeding and less post-procedure discomfort leading to quick return to normal activities.

While use of any surgical instrument involves some risks, clinical research has indicated the balloon sinuplasty ™ system to be safe and effective in relieving symptoms of sinusitis. The procedure is done under general anesthesia in an out-patient setting.

Sleep Apnea & Snoring
Upper airway obstruction is the main cause of both sleep apnea and snoring problem. When a patient has a partial collapse of the soft tissues of the upper airway a noise is produced during breathing which is called snoring. Patient with total obstruction of any portion of the collapsible airway can experience a condition called apnea (total cessation of breathing for 10 seconds or longer) or hypopnea (50% or greater decreased in air exchange for 10 seconds or longer).

Central sleep apnea is a less common type of sleep apnea, it happens when the area of the brain that controls the breathing doesn’t send the correct signals to the breathing muscle. Central sleep apnea often occurs with obstructive sleep apnea but it can occur alone. Snoring doesn’t typically happen with central sleep apnea, untreated sleep apnea can increase the risk of high blood pressure, heart attack, stroke, obesity and diabetes.

Tumors of Nose and Sinuses
Tumors of nose and sinuses are rare and often not diagnosed earlier, as symptoms are similar to allergic and inflammatory diseases. Most tumors that originate in the sinuses and nasal cavity are benign (non- cancerous) and incapable of spreading to another part of the body. These tumors are slow growing and surgical removal is the main form of treatment.

A rare type of polyp called inverted papilloma, is usually found on one side of the nose and can change into malignancy. Exposure to industrial work place and chemical environment may be related to the development of cancers of the sinuses and nasal cavity.

Tools of diagnosis are similar to other type of cancers and treatment may include surgery, radiation and chemotherapy.

Septoplasty

Septoplasty involves the surgical correction of a deviation of the septum with partial or complete unilateral or bilateral obstruction of nasal airflow. Septoplasty is also indicated for persistent or reoccurring epistaxis evidence of sinusitis secondary to septal deviation obstruction, sleep apnea/hypopnea syndrome and as an approach to transphenoidal approach to the pituitary fosa.

Turbinoplasty or Turbinate Reduction
Inferior turbinate hypertrophy constraints the nasal airway. Conditions that produce hypertrophy include allergies & vasomotor phenomenon. where patient react to environmental entities with out being allergic to them e.g. nasal blockage from perfume inhalation which can act as one of the causes of nasal blockage and recurrent sinusitis.

Surgery is done to reduce turbinates and reshape the lining to have a smooth nasal airflow. It is usually done under endoscopic guidance, and sometimes lasers or coblators are also used.

The procedure is performed through the nostrils; therefore, no bruising or external scars occur. Surgery might be combined with a rhinoplasty in which case the external appearance of the nose is altered.

Polypectomy
Chronic Rhinosinusitis is commonly subdivided into polypoid and non-polypoid disease. Nasal sinus polyps are most common in patients with allergic rhinosinusitis. Nasal steroids are the only approved drugs for the treatment of nasal polyps. Most doctors use both topical and systemic steroids for the nasal polyps patients. Polypectomy the removal of polyps is a surgical procedure in the poor surgical candidate with one or a few large obstructive polyps, polypectomy alone may be sufficient to provide limited relief.

Endoscopic Sinus Surgery (ESS)
The most common surgery for chronic sinus inflammation, it is performed by the help of a small telescopic endoscope. This corrective surgery precisely removes tissue and bone, opens the sinuses and helps to restore chronic disease to health. With this procedure post operative discomfort is minimal, however an on going medical therapy may be required to control underlying causes of inflammation.

Serious complications are rare with this kind of surgery but like any other surgery it is not risk free. Techniques that are similar to ESS are also used to treat benign (non-cancerous) tumors and sometimes even selected malignant (cancerous) tumors.

Endoscopic sinus surgery can also be used to close a rare defect in the passage between the nose and intracranial (brain) cavity that can lead to spinal fluid leaks.

The surgery usually lasts one to three hours or more, done in an out patient setting under general anesthesia. After the surgery sinus is packed with temporary sterile packing at the surgical site. Patient may expect to go home same day. If sinus surgery is recommended then the severity and the extent of you sinus problem will be carefully considered. As a patient may require only a limited procedure, such as clearing the middle meatus area or the doctor may recommend clearing other sinuses as well.

Frontal Sinusotomy
Surgery of the frontal sinuses endoscopically is one of the more difficult one, as the anatomy of the area has relatively narrow openings. Surgery in this complicated region can be assisted with the use of an image-guided surgery system.

Sphenoidotomy
When the sphenoid sinuses become inflamed and blocked and if only the sphenoid is involved and there is no disease in the other sinuses Endoscopic guided surgery through the nose is usually an option. The doctor may also elect to employ an image-guided surgery system to help identify surgical landmarks during the operations.