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Traditional and New Treatment Options for Chronic Sinusitis
By Joe Kuderko, MD
Sinuses are air-filled structures within our facial skeleton. Some sinuses we are born with, and others — like the frontal sinus — form as we mature into adulthood. It is often, inaccurately, thought that sinuses aren’t known to do anything, but here’s what we do know: The sinuses make our facial skeleton lighter because they’re filled with air instead of bone. This reduces the load on delicate neck vertebra and on what our body has to carry around. They also serve to protect the brain and eyes from injury, as they crumple on impact — much like the body of a car — to absorb the force of a traumatic blow to the face or forehead.
The maxillary sinus within your cheeks has an unusual drainage system, it’s not like a window in a house (open or shut), but more of a one way stream carrying mucus from the sinus into the nose. The nose has a surplus of germs while the sinus is clean. A wayward germ that gets into a sinus can hitch a ride out on top of the sinuses mucus blanket. At first their ride is more of a joy ride going into the nose, but later it gets more serious as the mucus is swallowed and the germs destroyed by the acid bath of the stomach. A liter of this mucus is washing your sinuses clean daily, every day. Nasal rinses with saline make this system more effective and are worthwhile preventive measure to reduce sinus infection.
If you take carbon particulars, essentially small bits of ash, spray them into a living maxillary sinus and watch with a sinus endoscope you’ll see the little mucus brushes of the sinus going to work. A bunch of tiny ash specks organize themselves into lines and march up and out of the sinus in toy soldier fashion. The drainage route isn’t much bigger than the tip of a pen and is located about an inch and a half from the floor of the sinus into the nasal wall. This is what we can see and measure.
What we can’t see is that the environment within the sinus itself is rich with a gas called nitric oxide, many thousands of times more potent than anywhere else in the body. Nitric oxide sounds a lot like nitrous oxide but doesn’t make you laugh as the dentist yanks out your tooth, it’s a different gas. Nitric oxide has a number of properties that we are just beginning to appreciate. It is antibacterial, antiviral and anti-fungal. More, your sinuses maybe the nitric oxide "pump" for your respiratory tract, it is being actively investigated right now.
When a sinus becomes colonized with germs, tissue lining the sinus swells and blocks the outflow tract, placing bacteria in a good spot to multiply. Most of the time, the body’s defense system, possibly with the help of an antibiotic, can reverse this process and restore normal function. Sometimes it can’t and that’s when the infection becomes chronic, leading to one sinus infection after the next or an infection that never leaves. At this point, your primary care doctor may choose to refer you to an ear, nose and throat specialist.
As sinus surgeons we respect the design of the sinuses and we’re developing ways to adjust them for improved function without impairing their abilities to work for our bodies. We view chronic sinusitis as much as a medical problem as it is a structural or surgical problem. In order to clear up nagging sinus pressure, morning headaches, a stuffy nose, post nasal drainage, cough and bad breath we consider a number of factors and treatments. It may be that you just need a longer round of antibiotics, nasal rinses, steroids, or a mucolytic.
If necessary, a CT scan of the sinuses can provides a blue print of your sinus anatomy, revealing whether they are infected or clear. If the sinuses are clear, we will investigate environmental factors that may aggravate your condition — for example cigarette smoke or the presence of pets in one’s home. Very often, a patient’s situation can be improved; if not, surgical intervention may be the most effective option.
Sinus surgery historically has been no picnic, involving blood loss and significant discomfort, not to mention the risk of altering the sinus’s function. (Remember those adjacent structures like your brain and eyes that the sinuses are so good at protecting?) Perhaps most disheartening is that sometimes it doesn’t work. That’s why surgery has traditionally been reserved for the worst of the worse sinus situations — when someone is so miserable that he or she is prepared to roll the dice.
North Memorial offers a new treatment option, called Balloon Sinuplasty", that permits a more delicate reconfiguration of the sinus drainage routes. It’s a surgery, performed on an outpatient basis, typically under general anesthesia, in which a flexible wire navigates the sinus outflow tract, a balloon is placed over the wire within the sinus duct and inflated with solution compressing the surrounding bony channel. It improves sinus drainage by dilating the channel, and preserving the important lining tissue within the duct returning your sinus to normal function.
Balloon Sinuplasty has been available for about three years and has helped thousands worldwide. It has been found to be uncommonly safe especially for a newer surgical procedure; over 250,000 sinuses have been treated with fewer than five adverse events. Patients often return to work and life as usual within a day or two of treatment. There is rarely need for nasal or sinus packing, and there is minimal post-operative pain.
It is a major step forward in the treatment of chronic sinusitis and can provide an option to improve your situation with a minimum of risk and down time. Moreover, this procedure is much more respectful of your sinus anatomy and function and less likely to convert one problem into another. Our premise as physicians is first and foremost to do no harm, and Balloon Sinuplasty is new champion of this core belief in dealing with chronic sinusitis.
This new technology may be an option not only for those who experience severe, unrelenting sinusitis but for people who have several infections a year, experience frequent sinus headaches or have lingering colds lasting for weeks and are just plain worn out. You may be a candidate for this innovative, new technology. Talk to your doctor, and visit http://www.balloonsinuplasty.com for more information.
Joe Kuderko, MD, is an ear nose & throat specialist on North Memorial’s medical staff. He practices at Oakdale Ear, Nose & Throat Clinic in Robbinsdale, phone (763) 520-7840.
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