The sinuses are hollows in the facial bones filled with air and connected to the nose with narrow passages which allows the air to circulate and mucous to drain. When these passages become blocked (usually by swelling of the membranes that line them), recurrent or persistent sinus infection may result.
If the sinus infections recur frequently or if they do not respond to medications (antibiotics, decongestants, nasal steroid sprays, antihistamines etc.) or to non-surgical procedures such as flushing, the decision to undergo surgery may be made.
Pre-surgical testing includes a CT Scan of the sinuses, nasal endoscopy and sometimes allergy testing to determine the effect of allergies on the problems experienced.
Elective surgery to facilitate drainage of the sinuses by widening the openings and removing the diseased tissues is easier, faster and safer today than ever before. Modern advances in medical technology, specifically the endoscope (a thin tubing inserted through the nostrils) allows for a minimally invasive procedure with less possibility of pain and shorter recovery time. In some cases it is necessary to use three dimensional imaging that provides the surgeon with a three dimensional visualization of the patient's sinuses to avoid damage to the neighboring structures such as the brain, eyes and arteries.
Surgery is usually outpatient and may be performed in the hospital or surgical center under general or conscious sedation anesthesia. The recovery time is minimal with results appreciated within 4-6 weeks.
Procedures to Alleviate Nasal Obstruction
The septum is a thin wall that separates the nose in the left and right nasal passages. It consists of a thin plate of bone and cartilage. The septum can become deviated (bent) as a result of trauma or it may be congenital.
Septoplasty (also called septorhinoplasty, when it is combined with cosmetic improvements) involves the reshaping of the septal bone and cartilage for improved air flow.
Nasal turbinates are thin boney structures lined with spongy mucosal lining. They may be come hypertrophic (chronically swollen due to allergies and chronic sinusitis)
Turbinate reduction may be achieved using radio frequency waves applied to the turbinate via bipolar forceps or in some cases by actually trimming excess tissue. Allergy related mucosal swelling as well as other symptoms of allergic rhinitis such as (sneezing, running or itchy nose) may be relieved by immunotherapy (allergy treatment).
Recently, sublingual drops have been used with increased frequency as an alternative to allergy shots.
Enlarged adenoids (masses of lymph tissues behind the nasal cavity) are often the culprit of nasal obstruction, chronic sinusitis and otitis media in children hypertrophic adenoidal tissue may be safely and gently removed under general anesthesia.
Nasal Valve Reconstruction
Breathing can be compromised by constriction of the nostrils in an area called the nasal valve. That problem is often caused by weakening of the supporting cartilages due to aging or previous rhinoplasty. Nasal valves can be sometimes reconstructed with cartilage grafts.
Balloon sinuplasty is an FDA-approved advanced treatment option to relieve the symptoms of chronic sinusitis. This minimally invasive procedure uses a thin, flexible balloon catheter that is placed in the nose and gradually inflated to relieve blockages in the nasal passage by gently restructuring the bones in the nose. It restores normal sinus function while maintaining the lining of the sinus and keeps post-operative pain and bleeding at a minimum.
This procedure offers patients many benefits as an alternative to conventional sinus surgery. Some of these benefits include:
- Minimally invasive - The soft, flexible tube gently opens sinus openings and avoids damaging surrounding tissue or bones
- Safe - Balloon sinuplasty is regarded as a safe and effective procedure with no serious complications
- Faster recovery times - Many patients return to their regular activities within 24 hours
- Reduced bleeding - By not removing tissue or bone during this procedure, bleeding and other surgical side effects are often reduced
Balloon sinuplasty is performed under general anesthesia on an outpatient basis. The average procedure takes about three hours to perform, and patients can return home shortly after. After balloon sinuplasty, most patients can return to work and other normal activities within 24 hours.
Most patients enjoy significant relief from their sinus symptoms after undergoing balloon sinuplasty. Although the length of these results may vary, clinical information reports continued improvement up to two years after surgery.
While balloon sinuplasty is an effective treatment for relieving many sinus problems, it is important to note that not everyone can benefit from this procedure. Balloon sinuplasty does not treat ethmoid sinusitis or nasal polyps, and cannot be used on patients with extensive scarring within their sinus openings.
There are no serious risks or complications involved with the balloon sinuplasty procedure. It is FDA-approved for the treatment of sinus conditions and has been safely performed on thousands of patients across the world.
Surgery for Hoarseness
People with paralyzed vocal cords often have a breathy, weak voice. Some people, especially the elderly, develop atrophy (shrinking or thinning) of the vocal cords which has a similar effect on the voice. In such cases the vocal cords do not come together fully during talking. Swallowing also requires the vocal cords to come together to protect the airway. Therefore if the vocal cords do not move properly or are exceedingly atrophic, aspiration (food or liquid getting into the windpipe and lungs) may result.
Vocal cord medialization surgery can help to provide a stronger, more natural voice and help prevent aspiration. This can be accomplished by injection of a biocompatible material into the vocal cords to help push them together. This procedure is usually done under general anesthesia in the operating room but in carefully selected cases, it can be performed in the office under local anesthesia. Another procedure requires a small incision over the Adam's apple and placement of a small implant to push the paralyzed or atrophied vocal cords toward the midline. Both are short surgeries, easily tolerated and often with a great result.
The tonsils are masses of lymph tissue in the back of the throat that work with the adenoids and immune system to defend the body against invading bacteria and viruses. Occasionally the tonsils may become unhealthy or abnormal and cause more harm than good. They can become so enlarged that they cause breathing and swallowing problems such as snoring, disturbed sleep, chronic mouth breathing (possibly resulting in deformations of the teeth, mouth and face), bad breath, ear infections and hearing loss. Or they may become chronically infected harboring bacteria which causes frequent flare-ups of sore throats. Signs that you or your child may have tonsillitis (infected tonsils) include:
- Tonsils that are enlarged or redder than usual.
- Have a white or yellow coating.
- Swelling that causes voice change.
- Sore throat.
- Difficult or painful swallowing.
- Swollen lymph nodes (glands) in the neck.
In cases of chronic abnormal tonsil enlargement, tonsillectomy (removal of the tonsils) may be needed.