Sinusitis Treatment and Surgery
The inflammation of the cavities around the nose, called the sinus, is called sinusitis. Sinuses are located on both sides of the nose and have 4 different names. The maxillary sinus is the largest sinus of the sinuses located on the side of the nose. In addition, the upper side of the nose, the frontal sinus in the forehead bone, the sinus located in the back and upper side of the nose and the single sinus is called the sphenoid sinus. In addition, the side and upper sides of the nose consists of many small spaces called the ethmoid sinus. All these sinuses open into the nose through a hole. These openings in the nose also provide ventilation of the sinuses.
Symptoms of Sinusitis
Here are a few questions you can test yourself:
1) Do you have a feeling of pressure, fullness or weight on your face?
2) Is there a blockage in your nose?
3) Is there a dark, yellow or green discharge in your nose?
4) Do you have nasal discharge?
5) Is there a decrease in your sense of smell?
6) Do you have a headache?
7) Are you feeling short of breath and coughing?
If you have three or more of the above sinusitis symptoms, you are most likely to have sinusitis. So, what should you do? Our answer is the same: ENT (ear-nose-throat) should see the doctor. The actual diagnosis will thus become apparent. If the diagnosis is difficult, a definitive diagnosis is made by sin computerized sinus tomography ecek, which will be directed by your doctor.
A small note: The plain film (waters radiography), which was often used in the past, is no longer used. In flat films, both high-dose radiation is received and there is a possibility of false results.
Lets be careful!
Sinusitis can often be mistaken for colds, flu and allergic flu. From this perspective; Differential diagnosis / diagnosis is very important. Namely;
• Nasal obstruction and runny nose in sinusitis are also in the foreground in allergy. However, the current of allergy is more transparent. It is not yellow-green.
• Allergic rhinorrhea is usually accompanied by tearing of the eyes and nasal itching. Sinusitis does not. Most complaints start after contact with allergens such as dust, pollen and mold.
• When it comes to colds and flu; winter sneezing, malaise, nasal congestion and discharge that leads to infections. The reason is viruses. Improvement occurs by keeping body resistance high. But the bacteria that cause sinusitis. Without antibiotic treatment, there is no improvement.
Image of sick sinuses (left) and healthy sinuses (right) on sinus tomography
A series of images are taken by X-rays on computed tomography. Sinuses are scanned at intervals of 1 to 3 mm. The process usually takes from 5 to 10 minutes. It is not difficult. Pain is not felt. It is different from MRI taken in a confined space. For this reason, sinus tomography can be easily taken in patients with closed phobia. It used to be an expensive imaging method. With its spread, it has become more economical.
Although sinus tomography is important in the diagnosis of sinusitis, it has a gold value in actual sinusitis follow-up and surgery. It guides the surgeon in sinus surgery. In this way, the surgeon resolves problems in the blocked and problematic sinuses.
What is seen during the examination?
The most common finding in a patient with sinusitis is inflamed discharge in the nose, edema, discharge to the throat and sensitivity to the face. Appropriate examinations are performed in patients with such findings and suspected sinusitis. However, it should be kept in mind that sinusitis may be present without a very clear finding in the patient’s examination.
How can I be protected from sinusitis?
There are a few things that patients can pay attention to in order not to have sinusitis or to be treated easily. Measures such as not staying in the cold, not leaving the hair wet, the humidity and temperature of the environment they live in, being not even in the smoke of the cigarette, staying away from dust, smoke or other irritant substances that may cause allergies can be taken.
In what situations is surgery necessary?
Because acute sinusitis usually responds to medication, surgery is rarely needed. However, chronic sinusitis, nasal flesh or bone curvature (deviation), such as cases, or in cases of developing complications, sinusitis surgery is required.
What are the complications of surgery?
Bleeding is the most common problem in endoscopic surgery except anesthesia complications. This is sometimes severe enough to prevent the surgeon from working, and the main purpose of the surgery is to stop the bleeding. In addition, serious complications may develop because there are important organs around the nose and sinuses. In addition to serious problems such as damage to the eyeball and nerve by penetrating into the eye sockets, perforation of the brain membrane, penetration of brain fluid into the nose, injury to large vessels leading to the brain, and brain abscess, as well as some minor and later treatable complications.
What should I look after after surgery?
The most important issue after endoscopic surgery is the proper dressing. In sinusitis surgery, dressing means proper cleansing of the nose. You will need to go to your doctor once every few days and then less frequently. How many days it needs to be cleaned depends on the course of the surgery and the doctor’s preference. Your doctor will tell you the next interview time after each dressing. The patient may try to prevent adhesions and deposits by washing the nose with saline.
Will sinusitis recur after surgery?
The rate of recurrence of sinusitis has decreased considerably after endoscopic surgery. However, it can be seen that sinusitis is a problem again, especially in allergy patients. Allergy is more common in our society than expected.
What to expect from sinusitis surgery?
It is necessary to keep the expectations realistic about what will be achieved after sinusitis surgery.
So, what should we expect?
• Postoperative sinusitis frequency and duration should be reduced.
• It should be able to breathe more easily than the nose.
• There should be a significant improvement in quality of life.
• Complaints such as headache, nasal discharge, fatigue should be reduced.
ALL SCIENTIFIC STUDIES HAVE BEEN SHOWN BY 80% REDUCTION OF AVERAGE COMPLAINTS AFTER SINUSITIS SURGERY. This is satisfactory for most patients. Many factors determine how much you will benefit. It is important that you do not have any frustration after your initial consultation with your doctor about which complaints will improve and to what extent.
Sinusitis surgery will not improve your “allergy sin in sinusitis developing on allergic ground. You will need to continue to use allergy medications for discharge, itching, sneezing.
It is difficult to predict to what extent the sense of smell will improve in patients with odor problems due to sinusitis. Odor loss can be permanent if the disease has destroyed the nerve endings. There is no diagnostic method to determine this beforehand.
What is Endoscopic Sinus Surgery (FESS)?
The aim of endoscopic sinus surgery is to open the obstructed sinus canals. For this purpose, the endoscope, called the endoscope, is used. Under the endoscopic image, sinus canals are opened with special instruments under the guidance of computed tomography.
During endoscopic sinus surgery, the surgeon’s goal is to remove any diseased tissue that blocks the sinuses and causes infection. Ideally, the elimination of the obstructive tissue allows permanent opening of the previously blocked sinus canals.
The important point here is that the surgeon should avoid taking the diseased tissue to normal tissue or possibly to normalize when the inflamed sinus heals. The more unnecessary tissue is removed, the longer it takes to heal and the greater the risk of complications. It is usually at the discretion of the surgeon to decide which tissue to remove and which to release. The principle that I like to follow is the principle of doing as little as possible but as much as necessary.
Today’s surgeons have access to various additional instruments in the operating room. Whether or not to use these tools is a matter of personal preference. These:
Microdebriders: A small tube with a shaver at one end and a suction device at the other. When the surgeon operates the device with a pedal on his foot, the small tube shaves diseased tissue, the shaved tissue is automatically sucked into the tube. I love and use microdebrider in polyp sinusitis.
Lasers: Lasers are used in medicine to vaporize tissue. Many surgeons frequently used it during the first years of endoscopic sinus surgery. However, it was seen that it affected the wound healing negatively because it was removed by burning and not cutting the tissue. Today, laser is rarely used in endoscopic sinus surgery.
Image-guided surgery: A method to be used especially if you have advanced problems. It is an instrument that should be used if the nose anatomy due to disease or previous surgery is impaired. In normal cases, prolonging the operation time can be considered as a disadvantage.
Endoscopic sinus surgery is an operation that lasts approximately 1 hour. If there are additional problems such as deviation of the septum, concha hypertrophy (nasal flesh enlargement), it is mostly. Duration can be up to 1.5 hours. Endoscopic sinus surgery and nasal aesthetic surgery can be performed simultaneously. In this case, the time will be longer. Although surgery can be performed with local anesthesia (limited anesthesia), I prefer general anesthesia. So I’m working more comfortably as the patient feels nothing.
Unlike other surgeries, it is important that the hospital is equipped with advanced devices in terms of endoscopic equipment.
Endoscopic sinus surgery has been used for the last 20 years. Previously, surgery called cadwell luc. With this operation, instead of opening the obstructed sinus canal, a window was opened to the sinus through the mouth. Of course, this window would be blocked after a while. The patient would again deal with sinusitis. With the effect of this negative situation, a coldness has developed among the people against the sinusitis interventions. However, it should be kept in mind that the philosophy of endoscopic sinus surgery is completely different from the old methods and therefore the results are satisfactory.
Now the surgery is over. You can look forward to better breathing and less catching sinus infections. But before you reach this point, you need to know what awaits you during the recovery period:
Sputum mixed with blood: This condition lasts for 3 weeks after surgery. This condition, which is watery for the first week, manifests itself as a dried crust. This is completely normal.
Nasal congestion: You have had surgery to improve your nasal congestion, but your nose is still clogged after surgery. Don’t let this contradict you. In the first days, the obstruction is completely normal. This is due to the intranasal crust and edema after surgery. Day by day you will feel the relief of your breath.
Headache may experience pain similar to sinusitis pain for several days after surgery. You can get painkillers for this condition if necessary. This is normal and will go away in a few days.
Fatigue: The first few days of anesthesia and fatigue due to surgery may be seen. This is also completely normal.
So, in what situation should you be on alert?
1) Bleeding: It is very rare after sinusitis surgery. This is an important condition if plenty of fresh red blood comes through the nose within 3 weeks after surgery. Don’t panic. However, try to reach your doctor as soon as possible. If out of reach, contact a nearby health facility
2) Infection: The infection at the operating site is manifested by fever and yellow-green discharge. You may need to use additional antibiotics.
What should you pay attention to after surgery?
Stay away from movements that will cause rapid blood flow to us for a few days after surgery. Such movements may cause bleeding. Heavy lifting, buckling, heavy effort.
You don’t have a special diet after this surgery. Everything is free except alcohol smoking. I especially emphasize smoking alcohol. While smoking delays healing, alcohol will increase the intranasal swelling.
The next day of surgery, the bath was released provided it was not too hot. You should wait 1 month for hammam and sauna
You start driving after 2 days. However, you must wait at least 10 days for air travel.
When will you know that you have benefited from the surgery?
It will take some time for you to fully recover your nose functions after surgery. This varies from person to person, but is an average of two months. You may need some patience to see the positive results of the surgery.
In all cases, if the right surgery has been performed, most people will patiently realize that sinus surgery is a significant improvement.
Is there any possibility of an undesirable condition during sinusitis surgery?
Although very rare, serious undesirable conditions can be seen during sinusitis surgery. These include decreased vision, rupture of the membranes and associated cerebrospinal fluid through the nose, and damage to vital vessels.
Balloon Sinoplasty called sinusitis surgery is a method developed in order to avoid such complications. There is no possibility of serious adverse events in this technique.
I’ve had sinusitis surgery and I’m still having problems, what should I do?
If you have had surgery and are having problems, there may be many reasons. If these reasons are found and solutions are created, a life without sinuses will await you. Old and ineffective surgical techniques may have been used.
Before 1991, endoscopic sinus surgery was not used. There was a surgery called Cadvel surgery. With this operation, only the maxillary sinuses in our cheeks were intervened. A window would open into the sinus through the mouth. If there is a curvature of the middle cartilage of the nose, it is corrected and sometimes the reduction procedure in the nasal flesh is added to this. The other sinuses were untouchable. Because it was possible to interfere with the other sinuses by making cuts on the face and this meant a serious scar. As the other sinuses were not intervened, the problems persisted and the patient still had complaints of sinusitis despite surgery.
The first thing to do is to have a tomography for the sinuses. Thus, it is possible to achieve full recovery by eliminating the remaining problems from the first surgery. Surgical interventions in this situation are usually short, buffer-free, simple interventions.
Inadequate or no intervention in some sinuses during surgery:
This happens from time to time for many physicians interested in sinusitis. We often encounter this condition in patients with frontal and sphenoid sinusitis. Surgical intervention in these two sinuses carries various risks. Sometimes the physician may not make adequate and necessary intervention to avoid these risks. This may be manifested as sinusitis which is not fully corrected and the complaints continue.
Cerrahi Balloon Synoplasty ’is the gold key in the treatment of frontal and sphenoid sinusitis where such surgical intervention has a small risk. It is applied as an effective and reliable method without complications and will solve your problem.
Inability to detect problematic sinusitis:
The patient with chronic sinusitis whose complaints did not diminish with antibiotic treatment was determined by the latest CT examination to determine the fullness in certain sinuses, following a minor surgery for the sinus with fullness and not interfering with the other sinuses. resistant infections may occur.
This is not a rare scenario. At the beginning of modern endoscopic sinus surgery, it is based on not touching the structures that do not cause problems. While this seems to be very logical, the patient mentioned in the above scenario is likely to have cooled during the CT scan while detecting sinuses with the focus of chronic infection during CT examination, but also the presence of areas that cause postoperative problems.
To avoid this situation, not to fall into this trap I did; CT is not a surgical procedure.
It is wise to change the philosophy if a second operation is needed after repeated events. In the first sinus surgery, the goal should be to solve the patient’s problems with minimal procedures, which works in most patients. However, the aim of the second surgery should be to ensure that the third surgery is not needed. In line with this philosophy, in the second surgery, although I change according to the patient’s history and anatomical structure, I perform surgical procedures on all sinuses that I suspect and simple.
Inadequate wound healing:
Wound healing may be insufficient despite complete diagnosis and perfect surgery. This is more common after surgery with active nasal infection (flu). It may also occur in patients with very small nose anatomy.
It is necessary to help wound healing with dressings in the office environment.
Failures due to personal factors:
• Existence in dry environment,
• Exposure to polluted air,
• Not paying attention to personal care and hygiene (not drying the hair after bathing, staying in the wind, etc.)
• Diabetes or other conditions that lower body resistance.
Such situations reduce the patient’s benefit from surgery no matter how successful surgery is performed.
It is necessary to control the other diseases together, to try to optimize the ambient air, to quit smoking and to take care of personal care.
What is Balloon Sinusoplasty (Synoplasty)?
Drug therapy is very effective in the early period. Surgery may be required in chronic sinusitis that do not respond to persistent drug treatment. Purpose of surgery; is to open the sinus paths. Thus, the aeration of the sinuses is provided. Infection regresses and disappears in the vented sinus. We can do this with endoscopic sinus surgery as well as with balloon sinusoplasty technique.
It is the process of opening the narrowed sinus holes with Balloon Catheter. The logic is the same as angioplasty used to open the occluded heart vessels.
What are the advantages of balloon sinusoplasty?
The tissue that lays the nose has many tasks. Heats the air we breathe, humidifies, filtrer.vs. In all nasal surgeries, these tissues can be damaged more or less. The idea of how to open the sinus mouth without damaging the tissues has resulted in the technique of balloon synoplasty. In this technique, a balloon is placed in the problematic sinus mouth with the help of a catheter. The balloon is then inflated with serum.
The swelling balloon expands the obstructed sinus mouth.
Therefore, no useful tissue inside the nose is damaged.
There is no incision in the nose and no bleeding.
No buffering is required after the procedure.
You can return to daily life the next day.
How Much Healing After Balloon Sinusoplasty (Synoplasty)
Balloon synoplasty is a minimally invasive method. Although it is done in hospital, it does not require overnight stay. Although it varies from patient to patient, normal activities can be started on the same day.
Who Can Perform Balloon Sinusoplasty (Synoplasty) Technique?
This technique can only be done by a qualified ENT specialist. Routine is not a ubiquitous intervention. The experience of the physician is indispensable if this procedure is not necessary.
Balloon Sinusoplasty (Sinoplasty) Technique Used in the Treatment of Hanig Type Sinusitis?
Balloon sinoplasty technique is used in chronic sinusitis, especially frontal, maxillary, sphenoid sinusitis and ethmoid sinusitis. Endoscopic sinus surgery should be preferred in polyp sinusitis.
Is there any age limitation in Balloon Sinusoplasty (Sinoplasty) Technique?
Yes, in order for this technique to be applied, it is necessary to have a patient profile suitable for this treatment and to have completed 17 years of age.
Does treatment with the Endoscopic Surgery Method create any problems in applying this technique?
In order to perform the balloon synoplasty technique, endoscopic surgery should not be used before.
You mentioned that there is a new treatment method, how and where did you get this training?
Prof. I studied at Levin from San Francisco.
You said that balloon sinoplasty (synoplasty) is a new method. DO YOU HAVE PUBLISHED SCIENTIFIC ARTICLES ABOUT THIS SUBJECT?
Yes there is.
Those interested can find the article details below.
The following are clinical publications related to the clinical application of Acclarent TM’s innovative technologies. Please check back for regular updates.
Safety and Feasibility of Balloon Catheter Dilation of Paranasal Sinus Ostia: A Preliminary Investigation
Christopher L. Brown, M.D., William E. Bolger, M.D.
Annals of Otology, Rhinology & Laryngology April 2006, Vol. 115 (4): 293-299;
Catheter Based Dilation of the Sinus Ostia: Initial Safety and Feasibility Analysis in a Cadaver Model
William E. Bolger, M.D., Winston C. Vaughan, M.D.
American Journal of Rhinology May-June 2006, Vol. 20, No.3, P. 290-294
Functional Endoscopic Dilatation of the Sinuses (FEDS): Patient Selection and Surgical Technique
Michael Friedman, M.D., Paul Schalch, M.D.
Operative Techniques in Otolaryngology June 2006, Vol. 17, 126-134
Those who want to reach more information;
They can be found at www.american-rhinologic.org.
Sinusitis in children is characterized by dark nasal discharge and nasal congestion.
Children who can express themselves describe headaches. In severe and long-term cases, it can be manifested by sleep disorders and decrease in course success.
It usually occurs after an upper respiratory disease, such as the flu, and resolves quickly with antibiotic therapy.
The most common cause of sinusitis, which is not repeated despite frequent recurrence and long-term treatment, may be the overgrowth of adenoid vegetation in children, or the nasal flesh becoming a source of germ. If there is sinusitis due to nasal flesh 4-5 times a year, or if no sinusitis has ever disappeared, it is best to remove nasal flesh by surgery.
In the last 30 years, the prevalence of both allergic rhinitis and bronchial asthma has increased, especially in developed countries. It is generally accepted that patients with allergic rhinitis have a four-fold chance of developing bronchial asthma. In a prospective study that lasted 23 years, it was found that in high school years, young people with allergic rhinitis had 3 times more asthma problems than non-rhinitis patients. Despite all these epidemiological studies, it is not easy to say that the problem starts in the nose or allergic rhinitis plays a direct role in bronchial asthma in patients with respiratory allergy. Although most of the patients have a family history, definitive genetic evidence is not yet available. It has been shown that the mediators are secreted from immunoglobulin-E-linked mast cells, which are characteristic of allergic problems of the nose and lower respiratory tract, and the source of the resulting mast cells is histamine, arachidonic acid metabolites, quinine and tryptase release. Although the general clinical opinion is that bronchial asthma symptoms regress with rhinitis treatment, this effect has only been investigated with controlled clinical studies in recent years.
Epidemiological studies suggest that allergic rhinitis and bronchial asthma are frequently seen together. Some patients with allergic rhinitis have been shown to have non-specific bronchial hyperreactivity without bronchial asthma. In patients with allergic rhinitis with bronchial asthma, the use of intranasal corticosteroids, antihistamines with or without decongestants causes regression in bronchial asthma complaints. Although the pathophysiological relationship between the nose and the lower respiratory tract cannot be fully explained, several mechanisms have been described that lead to lower respiratory tract dysfunction in bronchial asthma in patients with rhinitis. Laboratory and clinical studies show that treatment of rhinitis (allergic or non-allergic) also improves the bronchial asthma clinic. Long-term, controlled studies should be planned in order to clarify the dark spots.
The general clinical experience is that rhinosinusitis also causes bronchial asthma and rhinosinusitis treatment and bronchial asthma complaints regress. Studies examining the relationship between rhinosinusitis and bronchial asthma are complicated by exacerbations and spontaneous remissions of both diseases. Studies may not be optimal because of the continuous improvement in the medical treatment of bronchial asthma and rhinosinusitis and the difficulties in objective detection of disease severity. Chronic rhinosinusitis, which causes bronchial hyperreactivity and exacerbates the symptoms of bronchial asthma, is reported to have lower airway complaints after treatment with sphenoethmoidectomy or endoscopic sinus surgery. Stammberger reported regression of bronchial asthma complaints following endoscopic surgery in 70% of patients with chronic rhinosinusitis with intrinsic asthma.