Sinus Surgery

When your Seattle otolaryngologist (ear, nose, and throat doctor) wants to schedule you for routine sinus surgery, you may wonder if there are alternatives. The thought of sharp, rigid instruments inside the nose and sinuses can bring up feelings of caution and anxiety. In rare cases, surgery must be done urgently and without delay. For uncomplicated sinusitis however, surgery is typically used when alternatives and drug treatments have failed. In this article, we’ll talk in plain language about two common surgeries that promise to reduce the severity of sinus headache and sinus congestion – Functional Endoscopic Sinus Surgery, or FESS, and balloon sinuplasty.

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Dr. Frank, editor, sinusninja.comGreg had a sinus infection with headache and extreme nasal congestion.

“So when are you going in for surgery?” The mid-50’s telecom sales rep looked up over his thickish black frames and said, “In six weeks. Because of my schedule, I couldn’t make it any sooner.” After hearing his story about work and family, I realized Greg was a busy guy. He just had no time to be sick. He also believed in checking out all of his options. Greg did an internet search for alternative medicine for sinusitis in Seattle and found Nova Sinus Center.

He had a sinus headache and congestion that blocked the air passages in his nose.

In fact, I could tell during the interview he was breathing mostly through his mouth. “What remedies and drugs have you tried?” I asked. “Well, to get rid of the nasal congestion I tried Sudafed® for about four weeks. I didn’t like the way it made me feel. Kept me up most nights and didn’t seem to be all that effective. I heard about saline irrigation using a neti pot so I tried that for awhile. It seemed to work for about an hour then the congestion would come back.” “And then you went to your family doctor?” I continued. “Nope, my insurance plan allows me to jump right to a specialist so I thought I’d go see an otolar -” he stumbled as he said it. “An oto-laryng-ologist,” I prompted. “Yes, an otolaryngologist here in Seattle.” “Sure,” I said, “that’s a reasonable course of action. So what did you and your doctor find out?” “We did a sinus CT scan there at Minor and James Medical and went over the results.” “Right,” I said. “Is this the copy of the report you gave me?” “Yep, they said the CT showed nothing too unusual. Just some cloudiness in the sinuses. They diagnosed me with chronic sinusitis.” “So I see you are on an antibiotic,” I said. “That’s right, Amoxicillin. They also wrote me a prescription for a steroid spray which I haven’t filled yet. Since it was nothing more than a sinus infection, I wanted to check out other options. If this were my heart or liver, I’d do any drug or surgery I could to fix the problem. But as long as I don’t have an obvious complication involving my brain, eyes, or skull bones, it seemed like overkill to treat this so aggressively. Before I knew it, I was at the front desk scheduling my endoscopic sinus surgery.”

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Sudafed® is a registered trademark of McNeil-PPC, Inc.

Greg had uncomplicated chronic sinusitis.

“Interesting story,” I said. “It seems your otolaryngologist is OK with you putting off your sinus surgery for a little while.” “Yep, we both figured that since I’ve been living with sinus pain and congestion for six years, another six weeks wouldn’t make that much of a difference.”

“First, I’m glad to hear it’s nothing too serious,” I said. “Next, I want to remind us that most sinusitis is troublesome, not life-threatening. Since you made a decision to look for sinus surgery alternatives, you’ve given yourself a chance to try a less aggressive, more natural approach.” “Absolutely,” said Greg. “I believe if given the right conditions, my nose and sinuses will correct the problem. When I get a cut on my hand, my natural healing mechanism kicks in and fixes the injury. I figured there must be a way to optimize those conditions.”

After an initial series of treatments and monthly maintenance, Greg feels 90% better and has deferred his sinus surgery indefinitely.

Greg completed five Sinus Ninja treatments in three weeks and is scheduled for his sixth. After treatment #5 he reported a 90% reduction in nasal congestion. He reports he is able to go on airplane trips without complications. Before, his sinus symptoms and blocked ears would worsen making his flight very uncomfortable. He is happy with the results and wonders if he will ever need sinus surgery. Greg also asks if the results are permanent or will he have to maintain treatment to “hold” his current symptom-reduced state. “Time will tell,” I said, “if your sinus ostia (outflows) have opened sufficiently. Our experience has shown that monthly treatments and a few lifestyle changes keep the ostia open and the respiratory cilia (hairlike sweeping mechanisms) motile.”

The end of this story? Greg has deferred his sinus surgery indefinitely. He never filled the prescription for his nasal spray and finished his one and only course of antibiotics. He looks forward to his monthly “maintenance” treatments and complains of only minor nasal stuffiness once in a long while. Since patient report is the “gold standard” measure of improvement of uncomplicated (not medically urgent) sinusitis, Greg has opted to continue monthly maintenance treatments. He is also working with us outside of his regular treatment appointments to identify hidden food allergies, improve his diet, optimize his wellness, and generally remove obstacles to permanent cure of his sinus problems.

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Functional Endoscopic Sinus Surgery (FESS)

Endoscopic sinus surgery is a simpler, less invasive approach to sinus revision.

Endoscopic sinus surgery is not a single procedure but rather a family of techniques to “revise” or correct disturbances of nose and sinus anatomy. It also describes how the surgeon enters the body. In this approach, it happens through the nostrils. Before the 1980’s, ear, nose, and throat surgeons would use “open” techniques cutting through the face and above the gumline under the upper lip. Today, these more complicated, invasive approaches are generally reserved for advanced sinus disease such as malignant (cancerous) tumors.

So what actually happens during endoscopic sinus surgery? Sharp, rigid instruments are introduced through the nostrils under the guidance of video produced from a tiny camera at the end of an endoscope. An endoscope is a long tubelike device used to look inside body cavities. Watching what’s happening on a TV screen, the skilled surgeon removes what he or she believes to be irreversibly diseased tissue. What gets revised or removed is guided by the surgeon’s experience and what he or she sees, or has seen on previous diagnostic endoscopy and CT scan.

While there are many names for the specific procedures and techniques, some common revisions and removals include septoplasty (straightening a deviated septum), polyp and cyst removal, turbinoplasty (shaving down enlarged parts of the nasal passages), removal of invasive “fungus balls,” and removal of soft tissue and bone with intent to enhance sinus airflow and mucous outflow. Once inside the nose and sinuses, a surgeon may decide to do any of these revisions. The specific endoscopic procedure that removes soft tissue and bone in a standardized sequence is called FESS, or Functional Endoscopic Sinus Surgery.

FESS is an acronym – a word made from the first letters of each term describing the surgery

“SCUBA” is also an acronym. It means “Self Contained Underwater Breathing Apparatus.” Other common acronyms are NASA, FEMA, and the title of the well known Swedish pop group ABBA (immortalizing the names of the group’s members – Agnetha, Bjorn, Benny, and Anni-Frid).

“F” stands for “Functional.” Ultimately, the goal of any surgery is to preserve the body’s normal anatomy and function. The therapeutic intent of FESS is to remove irreversibly diseased tissue and open the natural, “functional” outflows of the sinuses.

“E” stands for “Endoscopic.” This term makes it clear that the surgical approach is less invasive than “open” techniques used before the early 1980’s and uses a thin scope and smaller instruments.

“S” stands for “Sinus.” Modern technology makes endoscopic surgery the “standard of practice” for many procedures. This term specifies the sinuses making the nature and location of the procedure clear.

The second “S” stands for “Surgery.” Make no mistake: FESS is surgery. While often done in outpatient settings – that is, at the “doctor’s office” – this term reminds us that a fully equipped operating room and surgical staff are needed to perform the procedure. Nurses, assistants, and an on-call anesthesiologist assist one or more surgeons as they snip, bite, suction and stand ready to replace any blood lost.

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Balloon Sinuplasty

Balloon sinuplasty is hailed as a safe, minimally invasive “alternative” to endoscopic surgery.

When a coronary (heart muscle) artery is blocked and can no longer deliver a sufficient blood supply, balloon angioplasty is one surgical option. A thin wire catheter is introduced into the heart muscle artery through a larger artery in the thigh. A balloon-like device is then slipped over the wire and inflated at the point of blockage. LDL cholesterol, platelets, and calcium deposits are magically “pushed aside” allowing improved blood flow through the diseased vessel. A wire mesh stent (sometimes medicated) is often left behind to keep the artery open.

It didn’t take long to adapt and market this technology as an alternative to FESS. A company called Acclarent, Inc. located in Menlo Park, California was the first to develop and secure FDA clearance for Balloon Sinuplasty™ in 2005. The problem for most uncomplicated chronic sinusitis is stenosis (narrowing) of the sinus outflows. It makes sense that the same basic technology used for opening the arteries of the heart would work in the mucus outflows of the sinuses.

For a technology so elegant, balloon sinuplasty has yet to reveal its drawbacks. While Acclarent, Inc. touts short term success, sustained cure is doubtful in the long term. It is well known that “pushing aside” blockages in a diseased tissue is like parting the Red Sea. Eventually, the waters recede. Even with angioplasty stents – which surprisingly are not used in Acclarlent’s “first generation” version of balloon sinuplasty – the coronary vessels routinely close back up. A second, third, and even fourth angioplasty is often needed to recover patency of the vessel.

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Does my sinus problem require immediate surgical consult?

Most sinus problems are troublesome, not life threatening.

However, symptoms may arise that point to more advanced sinus disease. Just like any doctor, your naturopathic physician at Nova Sinus Center is trained to detect obvious complications of sinusitis. If one of more of the following signs are observed during your initial visit, we will advise that you leave our office and arrange a consult with an ear, nose, and throat surgeon right away:

Red Flag Symptoms

Increasing severity of symptoms

Eyelid swelling, redness, and eye socket pain

Drooping eyelid

Loss of eye movement

Vision changes

Pupil fixed or dilated

Symptoms spreading to both sides of face

Development of severe headache

Personality or mental changes

Soft swelling over the bones of the face

Nasal polyps occurring in one nostril, and/or occurring with nosebleed or colored discharge: these are suspicious and require removal and biopsy to check for malignancy (cancer)

I’d like to schedule a Sinus Ninja treatment for uncomplicated sinusitis

Like many interventions in medicine, the alternative treatment referenced on this site is an empirical one. That is, we “try it” to see if it works. No promise of result is implied or intended.

This site is not intended to provide medical advice or to be a substitute for proper diagnosis and treatment by a qualified health care provider. If you have concerns about your condition, seek medical help right away.

Sinus Ninja ™, SinusNinja.com ™, An Ancient Weapon for Sinusitis ™,  REST ™, Respiratory Care Suite ™, Respiratory Suite Treatment ™, A NEW way to treat sinus trouble ™, Give your nose a REST ™, and Sneeze, Sniffle, Snore? ™ are all trademarks of Nova Sinus Center, LLC / Frank Aversano, ND.

Nova Sinus Center ™, The Nautilus Newsletter ™, and The Nose in the News ™ are all trademarks of Nova Sinus Center, LLC / Frank Aversano, ND.

© 2012 Frank Aversano, ND / Nova Sinus Center, LLC  Trademarks

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