Ep. 20: Several Sinus Surgery Types That Make a BIG impact
Today’s episode will conclude my sinus infections series by discussing several sinus surgery types that may be needed to improve health. I have already discussed basics about sinuses, sinusitis diagnosis, and treatments as well as some of the scary, and life-threatening complications that can occur; however, when treatments do not work, surgery may be the answer.
Many different surgical procedures can be performed to improve sinusitis. Although they are not all directly performed on the sinus cavities, some different of these sinus surgery types can make a huge difference in your health.
When do we consider sinus surgery?
I generally discuss sinus infections in terms of the type of the problem that is causing blockage of the drainage site. The two types of problems I look for are FUNCTIONAL blockages and PHYSICAL blockages.
I define functional blockages as something that causes swelling as a result of a specific problem, like an allergy or a cold.
After combining medical treatments like nasal saline washes, various allergy treatments, and antibiotics if needed, I sometimes find that I cannot completely get rid of the sinus infections symptoms. Consequently, I become concerned that despite aggressive medical care and treatment of functional swelling, there may be a physical problem.
I then order xrays or perform a nasal endoscopy to see if there is a problem that remains present all the time. This can be any type of physical narrowing of the nose or sinus drainage site. Because medications cannot change a physical blockage, surgery may be considered.
What should you expect from sinus surgery?
This is such an important question! Regardless of the type of surgery that I perform, patients are always hopeful that they will no longer have any problems. I cannot emphasize enough how important it is to talk to your surgeon to fully understand the goal of surgery.
MANY SURGERIES DO NOT STOP THE PROBLEM FROM COMING BACK! Maybe I should not have written that in capital letters, but I hope it drew attention to an important take-home message.
In terms of chronic sinus infections, all surgery is designed to improve the ability of the sinus cavities to drain. If you have allergies or other medical problems, you will STILL need medical treatments to keep the swelling from blocking up the space that surgery created.
I discussed this exact situation when I posted about ear infections and ear tubes. Surgeons create an improved drainage site which now may allow medical treatments to be successful. Sometimes the surgery is performed directly on the sinus drainage sites; however, it may simply need to be done to improve the nasal drainage.
Sinus surgery types that may improve chronic sinusitis
The adenoid is a lymph node found at the back of the nose; consequently, it swells when it tries to fight off infection. Usually, once the infection or inflammation goes away, the adenoid returns back to normal.
However, chronic nose problems may lead to chronic swelling of the adenoid which may lead to blocking nasal drainage. When the nose does not drain properly, mucus remains in the nose longer; therefore, additional swelling may occur which can lead to blocking the sinus drainage site.
If these cases, removing the adenoid may improve a chronic stuffy nose and reduce sinus infections.
I have previously described the nose structure in great detail and highlighted the nasal septum. The septum normally divides the nose into two sides that are equal in size; however, if the septum becomes crooked, sinus drainage may be blocked.
Surgery to straighten a crooked septum can be done alone or with traditional sinus surgery. Once again, the importance of surgery is to create more room so the nose and sinuses drain more effectively.
Turbinates are structures in the nose that swell up to warm and filter air breathed into the nose. Most of us have had a stuffy nose where one side of the nose is blocked more than the other. That swelling is caused by a turbinate.
When chronic nose problems happen, the turbinates may stay swollen all the time and block drainage. Surgery to reduce enlarged turbinates can be done in many different ways; however, it is unusual for me to perform this surgery by itself in kids. Adults often can tolerate this procedure in an office setting, but kids usually need general anesthesia.
Many times, this surgery in kids is done at the same time as removing the adenoid or sinus surgery.
Nasal polyps grow because of chronic inflammation in the nose and sinus. When they are small, polyps may not cause symptoms and may be treated with nasal steroid sprays. However, larger polyps often need surgery, which can be combined with sinus surgery.
Actual Sinus Surgery
True sinus surgery is performed on the sinus cavities to open blocked drainage sites and to remove mucus or swollen tissue inside the sinuses.
Over the years, sinus surgery has changed from extensive surgeries with incisions made on the face to now being a fancy endoscopic surgery with a relatively easier recovery. Back in my training days, we often could only do surgery on one side of the face at a time because it took many hours and often required blood transfusions. We have traveled a long way in 30 years!
I like to think about sinus surgery in 3 categories as listed below. (listen to the podcast for important details)
- Temporary Procedures
- Sinus Irrigation–(flush mucus out of sinus)
- Nasal Antral Window–(create new sinus drainage site)
- Old School infrequent Techniques
- Caldwell Luc–(open the front of the maxillary sinus and clean it out)
- Frontal sinus obliteration–(open front of forehead, clean infection and close sinus)
- Functional Sinus Surgery: The current standard
- Telescopes used to open natural sinus drainage sites
- Instruments removed bone and tissue
- Balloon opening drainage site — (no bone or tissue removed)
- Sometimes guided by xrays
Bottom line, chronic nasal inflammation, regardless of cause, should be aggressively treated to reduce the risk of developing chronic sinusitis. When medical management fails, surgery may be needed. AND THEN, aggressive medical management will be needed to prevent sinusitis from worsening again.
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