Sinusitis is an inflammation of the sinus lining commonly caused by bacterial, viral, and / or microbial infections; as well as, structural issues such as blockage of the sinus opening (ostium). If the ostium becomes swollen shut, normal mucus drainage may not occur. This condition may lead to infection and inflammation of the sinuses.
What are the common symptoms of sinusitis?
Common symptoms include:
Facial pain, pressure, congestion or fullness
Nasal obstruction or blockage
Discharge of discolored mucus from the nose
Discolored post-nasal drainage
Loss of smell
What types of doctors treat sinusitis?
Many types of doctors treat sinusitis, including general and family practice physicians, pediatricians, and allergists. However, if a patient has chronic sinusitis or does not respond to medical treatment, he or she may be referred to a specialist - an Ear, Nose, and Throat (ENT) physician, or otolaryngologist.
How is sinusitis treated?
Two approaches have emerged for treating sinusitis patients:
Endoscopic surgical interventions
Sinusitis is treated initially with medical therapies. Usually antibiotics or topical nasal steroid sprays are given to reduce mucosal swelling, fight infection, and relieve obstruction at the sinus opening (ostium). These therapies are often effective in reducing sinusitis symptoms. However, for many other patients, these medications are inadequate and sinus surgery may be the next step in finding relief.
Surgery may be indicated for those patients whose symptoms and ostial obstruction persist despite medical therapy. With the advent of FESS (Functional Endoscopic Sinus Surgery), sinus surgery has evolved from open and invasive procedures to less invasive surgical techniques. Along with this evolution, many endoscopic tools have been developed to further assist and help improve FESS techniques. These tools include an array of devices such as the microdebrider and the sinus balloon catheter.
What is "sinuplasty"?
"Sinuplasty" is the term that is sometimes used to refer to the Relieva Balloon Sinuplasty™ devices that your surgeon may chose to use during your FESS procedure.
What is "Balloon Sinuplasty™"?
Watch Sinuplasty Video >>
The words, “Balloon Sinuplasty™,” when used together, describe the use of a sinus balloon catheter to surgically repair the sinus ostia during a FESS procedure. FESS is a minimally invasive surgical procedure to open up air cells and sinus ostia (openings) in patients suffering from chronic sinusitis. FESS involves the insertion of an endoscope into the nose for a direct visual examination of the openings into the sinuses. Using the endoscope and a combination of surgical tools, e.g., curettes, forceps, powered micro-debriders, powered shavers, and / or sinus balloon catheters, surgeons enlarge the patient’s sinus openings to clear passageways in order to restore normal sinus ventilation and drainage.
What are the Balloon Sinuplasty™ devices?
The Balloon Sinuplasty™ devices are FDA-cleared, endoscopic, catheter-based tools specifically designed to be used in sinus surgery. The Sinus Balloon Catheter is gradually inflated to gently restructure the previously blocked nasal passage, maintaining the integrity of the sinus lining and restoring normal sinus drainage and function.
Does surgery with the Balloon Sinuplasty™ technology work?
Clinical studies have indicated that using Balloon Sinuplasty™ technology is safe and effective in dilating sinus openings.
Are the Balloon Sinuplasty™ devices safe?
While use of any surgical instrument involves some risk, clinical research has indicated the Balloon Sinuplasty™ technology to be safe.1 Furthermore, balloon catheter technology has been used successfully in other medical procedures such as balloon angioplasty for the heart.
How long does it take to recover from a typical surgery using the Balloon Sinuplasty™ system?
Because the system is minimally invasive it is typically used in an outpatient setting. While recovery time will vary from patient to patient, many people can return to normal activities within 24 hours after surgery.
Does surgery with Balloon Sinuplasty™ devices limit my treatment options?
No. Balloon Sinuplasty™ devices are endoscopic tools used within FESS and may be used with other medical therapies. They do not limit future treatment options for patients with progressive disease.
Are Balloon Sinuplasty™ devices right for me?
If you suffer from sinusitis, and medical therapy has not been effective in relieving your symptoms, you may be a candidate for surgery using the Balloon Sinuplasty™ devices. Talk to your doctor about whether use of these FDA-cleared, endoscopic, catheter-based tools are right for you.
Balloon Sinuplasty ™ technology is a FDA-cleared, endoscopic, catheter-based system for patients suffering from sinusitis. The technology uses a small, flexible, Sinus Balloon Catheter to open up blocked sinus passageways, restoring normal sinus drainage and function. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.
Gain Access to the Sinus.
To gain initial sinus access, our sinus guide catheter is introduced into the nasal cavity to target the sinus ostia under endoscopic visualization. Our sinus guidewire or our sinus illumination system is introduced through the sinus guide catheter and gently advanced into the target sinus.
Inflate Balloon Across Ostium. The sinus balloon catheter is introduced over the sinus guidewire or sinus illumination system and positioned across the blocked ostium. The position of the sinus balloon catheter is confirmed and the balloon is gradually inflated to open and remodel the narrowed or blocked ostium.
Deflate and Remove Balloon. The sinus balloon catheter is then deflated and removed, leaving the ostium open allowing the return of sinus drainage. There is little to no disruption to mucosal lining.
The Benefits in Using the Balloon Sinuplasty™ Technology
Safe and Effective
While use of any surgical instrument involves some risk, clinical studies have indicated the Balloon SinuplastyTM system to be safe and effective in relieving symptoms of sinusitis.
The technology uses small, soft, flexible devices that enter entirely through the nostrils. These devices gently open blocked sinus openings, and in many cases, without tissue or bone removal.
Because in many instances no tissue or bone is removed when using this technology, there may be reduced bleeding associated with the procedure. As a result, the need for uncomfortable nasal packing may also be eliminated.
Improved Recovery Time
While recovery time varies with each patient, many people can return to normal activities within 24 hours.
Does Not Limit Treatment Options
This technology is an endoscopic tool and may be used with other medical therapies or sinus surgery techniques. It does not limit future treatment options if you have progressive disease.
Chronic Sinusitis (CRS) is typically treated with medications such as antibiotics, pain relievers, and steroid nasal sprays. For a time, patients typically feel better, but then the sinusitis symptoms return. In these cases, ENT physicians sometimes recommend traditional sinus surgery involving removal of bone and tissue – which is effective but may also lead to considerable post-operative pain and bleeding.
Faced with pain and recovery time associated with traditional sinus surgery, many Chronic Sinusitis patients forego treatment.
Less Pain, Quicker Recovery
Now your doctor has a new way to break the CRS Cycle without extensive surgery. It’s called FinESS™ Sinus Treatment. It’s a simple treatment that offers lasting relief from sinusitis symptoms.
Unlike extensive sinus surgery, FinESS does not require the removal of delicate bone or sinus tissue. It is a quick, virtually painless procedure that may be performed using local anesthesia. Recovery time is short with many patients resuming normal activity the same day.
Instant Relief, Lasting Results
FinESS Sinus Treatment is a less-invasive simple procedure that provides immediate relief and lasting results. FinESS safely reopens blocked sinuses behind the cheeks and the eyes using a small balloon similar to those used to open blocked heart arteries.
Because FinESS™ Sinus Treatment keeps sinus passages open, the procedure offers lasting, long-term relief from the problems associated with Chronic Sinusitis.
Are You Eligible for FinESS?
FinESS Sinus Treatment is designed to treat the symptoms most commonly experienced by many Chronic Sinusitis sufferers. Your physician
will determine if you are eligible for FinESS Sinus Treatment.
FinESS™ may be used to treat certain conditions affecting the sinuses behind your cheeks and eyes. Your physician
will need to determine if your condition is one that may benefi t from FinESS. Possible side effects include, but are
not limited to damage to a tooth or to the bone around it or to the bones around the sinuses, post-operative
pain and swelling of your face, nose and cheek, allergic reactions to anesthesia or other medications
administered during the FinESS procedure, excessive bleeding inside your nose or in your mouth, or infection.
Your condition may not respond to this treatment.
Image Guided Sinus Surgery
InstaTrak® ENT Image Guided Surgery
Having Sinus Surgery With The InstaTrak® System
The InstaTrak System is an image guided surgery system (IGS) that enables the surgeon to interactively visualize, on a computer monitor, the position of surgical instruments as they move through a patient's sinus anatomy.The InstaTrak System utilizes the patient’s preoperative CT scan and electromagnetic tracking technology to provide positional feedback of instrument location within the patient's sinuses. The InstaTrak System's computer compiles the patient’s image data from the CT scan and renders three orthogonal views of the sinus anatomy - axial, coronal and sagittal.
The electromagnetic tracking system correlates the movement of surgical instruments to the CT images. Two electromagnetic sensors provide positional information on the preoperative CT images displayed on the monitor. One sensor is attached to the instrument and the other is located on the InstaTrak headset. The patient wears the headset during the preoperative CT scan and surgical procedure. The headset enables automatic registration, which is the process of correlating the patient's medical images to the patient's actual anatomy. The electromagnetic sensors attached to the instrument and headset are registered to show the position of the instrument tip with respect to the CT images of the patient.
The surgical instruments act as pointers that allow the surgeon to visualize, localize and navigate through the patient's sinuses during the procedure. The tip of the instrument is displayed on the InstaTrak System monitor as a set of crosshairs in the axial, coronal and sagittal planes, allowing the surgeon to visualize critical structures such as the cranial bone and orbit.
Preparing for Surgery:
During the preoperative CT scan, the patient wears the headset, which is placed on the bridge of the nose and on the external ear canals. Once the CT scan is obtained, the headset is removed and the images are transferred to the InstaTrak System.
During surgery the System’s monitor is positioned for optimal surgeon viewing. Electromagnetic sensors are attached to the headset and the surgical instrument. The headset is again placed on the patient and automatic registration occurs instantly correlating the CT images with the patient's anatomy. The patient's CT images are then displayed on the InstaTrak System's monitor. During the surgical procedure the System plots the precise movement of surgical instruments and correlates them to the patient's medical images.
FUSION™ ENT Image Guided Surgery
Image-guided systems are essentially like GPS (global positioning satellite) systems for the anatomy of your head. These systems are used to aid the surgeon in the confirming the location of critical structures when the interior of the nose and sinuses is distorted by unusual anatomy or prior surgery.
To use the image-guidance navigation system, a CT scan of the sinuses, is performed using a specific navigation system protocol. For some systems, a special mask or markers are placed on your face during the scan to serve as reference points. The CT scan is transferred to a disk, which is then loaded into the image-guidance computer.
During surgery, a detection array or a mask is placed on the patient's head. The CT scan images loaded into the system are then calibrated to the patient's anatomy using set pre-set reference points, which may be the mask or markers or specific anatomic points on the face. The position of the sinus surgery instruments can then be tracked by the computer by integrating the information detected from the patient's pre-set reference points and comparing it to the information on the CT scan map.
Designed for sinus surgery and advanced ENT applications, Medtronic's surgical navigation system will enhance your confidence and ability to perform more thorough and challenging procedures. Providing 3-Dimensional visualization enables you to locate and avoid critical structures, such as the optic nerve and brain, while safely navigating your way to the diseased area.
Functional Endoscopic Sinus Surgery (FESS) Procedure Solutions & Benefits
When patients with sinusitis do not improve after repeated courses of antibiotics and reasonable trials of the other medications used to treat sinusitis, the otolaryngologist may recommend undergoing FESS. The recommendation will also be based upon the physical examination, nasal endoscopy and CT scan findings. The decision to perform surgery should be made only after carefully considering the risks and benefits.
There are several advantages to FESS over the open sinus procedures that preceded it. To begin with, the ability to see within the nose and sinuses is much improved. Open sinus procedures often required facial incisions with resulting visible scars and lots of nasal packing. With FESS, there are usually no visible signs that surgery has been performed since the surgery is almost always done completely through the nostrils. Recovery is usually faster and there is usually less postoperative pain and bleeding. Nasal packing is used infrequently in FESS.
The primary advantages to using our navigation solutions for FESS include:
Procedures are much less invasive than open surgical operations that were once standard
Precision is greater, resulting in lower risk to the patient
Patient discomfort is minimal
Procedure recovery time is shorter
Endoscopic Sinus Surgery
Who Qualifies for Endoscopic Sinus Surgery?
Patients with chronic sinus problems documented by x-ray who do not respond to medical therapy are candidates for endoscopic sinus surgery. Symptoms of sinus disease can include facial pain, above or below the eyes or in the temples, fullness or pressure, blocked nasal breathing, persistent nasal odor, postnasal drainage or drip, and occasional headaches. Occasionally sinus problems can cause hoarseness due to drainage or cough. Patients with polyposis almost always have sinus disease because polyps block sinus drainage. However, many of these symptoms can occur in the absence of sinus disease. Allergy and chronic nasal congestion are examples of problems causing symptoms similar to sinusitis, but not helped by endoscopic surgery. Your doctor is capable of deciding whether or not you have sinusitis.
Most people who have proven sinus disease do not need surgery, but can be treated medically using antibiotics, nasal irrigations, nasal hygiene, nasal steroid sprays, or perhaps allergy treatment. Your doctor can best decide appropriate medication.
Surgery may be necessary if medical therapy is not successful. Usually this is due to an infected or inflamed area does not clear up with antibiotics or returns when antibiotics are stopped.
What is Necessary to Find Disease Which is not Responsive to Medical Therapy?
Previous records of care, especially sinus X-rays or CT scans, are very helpful. During your visit a full head and neck examination will be performed with special attention to your nose and sinuses. It may be necessary to perform a CT scan of the sinuses to further evaluate sinus disease and to act as a surgical map pointing to disease that needs removal.
If surgery is necessary, surgery will be scheduled as an inpatient or outpatient depending on your overall health. Your doctor may recommend using a special computer guidance system during surgery to increase the safety of the procedure in difficult situations. This usually requires an additional CT scan of the sinuses wearing a special headset. If you are given a headset, please bring this with you on the day of your surgery.
What is Endoscopic Sinus Surgery?
Endoscopic sinus surgery differs from conventional intranasal surgery in that is stresses careful diagnostic work-up to identify precisely the cause of the problem. Sometimes an office exam with an endoscope or CT scan may identify disease that ordinarily would not have been found.
The principle of endoscopic surgery is that when the underlying cause of disease is found, that problem is corrected eliminating more extensive surgery. Secondary problems will usually resolve when the primary problem is corrected. This usually requires continuous medical therapy antibiotics, nasal irrigations, and nasal sprays after surgery to improve this reversible disease with less surgery. Usually the main area of obstruction is the ethmoid sinus into which all other sinuses drain. The nasal linings do not function properly for several months while adjusting to the new anatomy after surgery. This necessitates vigilant nasal hygiene and sporadic medical therapy.
The advantage of endoscopic sinus surgery is that, in general, less surgery is needed, normal tissue is preserved and precision surgery can be performed without nasal packing. The result is faster healing and less discomfort postoperatively.
Sinus surgery is most commonly done under general anesthesia. Any patient undergoing outpatient surgery should understand that hospitalization might be necessary if any problems occur. Usually nasal packing is not required, but return visits are necessary after surgery to clean the sinus cavities and monitor the healing process. Please take your prescribed pain medication prior to your postoperative visits to make the cleaning procedure more comfortable. These visits are routinely scheduled every 7-14 days until the nose is healing well and then less frequently. You will participate in your care by taking prescribed medications and irrigating your nose with salt water at least four times per day. If packing is required, you will return in a few days after surgery for removal.
Occasionally further endoscopic surgery may be necessary for disease which recurs. Endoscopic sinus surgery, while a marked improvement in the treatment of sinus disease, does not always cure everyone. Some patients, especially those with nasal polyps may have recurrent disease.
What are the Complications, Risks and Alternatives of Endoscopic Surgery?
In general the complications and risks of endoscopic surgery are the same as those for conventional intranasal sinus surgery, however, because of better visualization and special instrumentation, the risks of surgery are reduced. Nevertheless, each patient should be aware of the potential complications.
Bleeding is a possibility in any nasal or sinus surgery because of the extensive blood supply. Occasionally significant bleeding may occur requiring termination of the procedure and nasal packing. This usually requires hospitalization for observation. Blood transfusions are rare, as is the need for subsequent surgery to control bleeding. However, certain precautions are necessary, such as the avoidance of all anti-inflamatory medication (aspirin, Ibuprofen, and Naproxen, Motrin, Advil, Aleve, Lodine, Mobic, etc) for two weeks prior and for three weeks after surgery. Tylenol, Celebrex, Bextra, and Vioxx are not a problem.
Failure to Cure the Problem of Recurrent Disease
Disease may not be cured by endoscopic surgery or may recur at a later time. While endoscopic surgery reduces the chances of this occurring, a risk of persistent or recurrent disease is possible which may require subsequent intervention.
Postsurgical blood-tinged drainage or clots may occur up to one to two weeks after surgery. This is not abnormal and will clear. Blowing of the nose should not be attempted for three weeks after surgery.
Risk of Anesthesia
Although this procedure may be performed under local anesthesia, most patients prefer general anesthesia. Although usually safe, general anesthesia has some risks and complications. This may be discussed with your anesthesiologist.
Cerebrospinal Fluid Leak
Since the area just above the nose is the brain, there is risk of entering the thin wall separating nose from the brain. A thin clear fluid that surrounds the brain can then leak into the nose. This fluid can become infected and meningitis could occur. However, this complication is rare. If a leak does occur it may be able to be stopped during surgery. If not, it may close on its own. Surgery to close the hole is necessary if the leak persists. Better visualization often helps to reduce this complication even further. Any surgery involving removal of polyps or extensive sinus disease runs this risk.
Loss of Vision
Any extensive sinus surgery in the nose may result in loss of vision. While endoscopic guidance reduces this risk, blindness in one or both eyes could occur. Fortunately this complication is very rare. Temporary or prolonged double vision has been reported, but is also very rare.
You may note some numbness or discomfort in the front and upper teeth temporarily. Swelling, bruising, “black eye”, and lip numbness may also occur, but usually resolve in one to two weeks. Air may collect under the skin around the eye postoperatively. This rapidly resolves. Symptoms may return or in some cases worsen such as sinus pain or discomfort, increased nasal obstruction or discharge. Smell may be decreased or absent after surgery, but this is rare. Scarring may occur in the nose, but usually does not cause a problem. Occasionally, the scarring may need to be removed.
Alternatives to Surgery
Medical therapy if successful, is the treatment of choice. If unsuccessful, you may choose to tolerate the symptoms rather than have surgery. Besides endoscopic surgery, conventional sinus surgery is available. This should be discussed with your surgeon. Depending on the extent of the disease, treatment without surgery may lead to orbital complication (loss of vision), brain abscess or infection, loss of smell, and intracranial cysts or masses.
Coblation® of Turbinate Surgery
Coblation® Turbinate Reduction can provide a fast return to normal breathing for your pediatric and adult patients with turbinate hypertrophy. Coblation Turbinate Reduction, performed with the ReFlex Ultra® PTR Wand for pediatric patients or the ReFlex Ultra® 45 Wand for adult patients, is intended for the treatment of enlarged or hypertrophied turbinates. This procedure uses Coblation-Channeling® to simultaneously remove and shrink submucosal tissue. The unique action of Coblation technology creates channels by ablating tissue as the Wand is inserted into the turbinate. For tissue shrinkage, a submucosal necrotic lesion is created around the tissue channel. This dual therapy creates an immediate reduction in nasal obstruction, with a greater reduction during healing.
Submucosal lesions are created in 10-15 seconds versus the two or more minutes required for other turbinate reduction procedures. This makes Coblation Turbinate Reduction an ideal procedure for the office or the OR.
Septoplasty is surgery to correct any problems in the nasal septum, the wall inside the nose that separates the nostrils.
Most patients receive general anesthesia before septoplasty. This will make you unconscious and unable to feel pain. Some have the surgery under local anesthesia, which numbs the area to block pain. You will stay awake if you have local anesthesia. Surgery takes about 1 to 1 ½ hours. Patients usually go home the same day.
Your surgeon will make a cut inside the wall on one side of your nose.
The mucus membrane that covers the wall will be lifted up.
Then your surgeon will remove or move any cartilage or bone that is causing the blockage in the area.
After this, your surgeon will put the mucus membrane back in place. This membrane will be held in place by stitches, splints, or packing material.
The main reasons for this surgery are:
To repair a crooked, bent, or deformed nasal septum that blocks the airway in your nose. People with this condition usually breathe through their mouth and get infections on their nose.
To repair a hole in the nasal septum. This is called nasal perforation.
You will meet with your anesthesiologist (the doctor who will give you your anesthesia medicine and monitor your condition before, during, and right after your surgery. You will discuss your medical history to help determine the right amount and type of anesthesia to use. You may be asked to stop eating and drinking after midnight the night before the procedure.
Be sure you tell your doctor or nurse about any medicines you take, evendrugs, supplements, or herbs you bought without a prescription. Also tell your doctor if you have any allergies or if you have a history of bleeding problems.
You may be asked to stop taking any drugs that make it hard for your blood to clot 2 weeks before your surgery. Some of these are aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and some herbal supplements.
You will go home on the same day as surgery. After surgery, both sides of your nose may be tightly packed (stuffed with cotton materials) so you do not get nosebleeds. Usually this packing is removed 24 to 36 hours after surgery.
Most septoplasty successfully straighten the septum. Breathing often improves.