Relief for One of the Most Common Health Problems – Sinusitis

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Melanie Cole (Host): Sinusitis affects 37 million people each year and is one of the most common health concerns. Many people misdiagnose themselves with allergies or a cold and it actually might be sinusitis. This is Melanie Cole sitting in for Deborah Howell today and my guest is Dr. Jesse Tan. He's an otolaryngologist and Chief of Surgery at Long Beach Memorial. Welcome to the show, Dr. Tan. Tell us, what is sinusitis?

Jesse Tan, MD: Hi Melanie, thank you very much for having me this morning. Sinusitis is a general term for inflammation of the sinuses. And as you mentioned, it's a problem that affects millions of Americans every year. And it includes a conglomeration of symptoms including things like nasal airway obstruction, facial pain and pressure, headaches, post-nasal drips, drainage out the nose, chronic sinus infections. So a lot of these symptoms many people will have over the course of a year. So it's a catch-all term for all of these types of symptoms.

Melanie Cole (Host): So there are a couple of different kinds of sinusitis, Dr. Tan. So what are the differences between acute and chronic? And how might somebody know that what they have is not just a cold?

Jesse Tan, MD: Yeah, that's a great question. Acute sinusitis is one of those instances where a patient has a one-time attack of either the facial pressure and pain and the drainage or headache, and then they go ahead and get treated by the doctor with a course of antibiotics or other medical therapy and then the condition resolves and doesn't come back for a long time. In contrast, chronic sinusitis refers to that condition where patients just have these ongoing symptoms for months or for years where they're always chronically congested or have chronic headaches, lots of drainage every day or multiple sinus infections. And those cases we consider it chronic. If we're going to go really medical about it, anything that lasts for more than three months as far as symptoms are concerned, we'll consider that chronic. Or if the symptoms just seem to occur over the course of months or years on a longer term basis, then we'll call those patients chronic sinus sufferers and at which point we try to look for more definitive therapies for them.

Melanie Cole (Host): So you mentioned that the treatment options for acute sinusitis might be a course of antibiotics or some other medical course of treatment. So when you've determined that it's chronic and it's going on, what are some of the treatment options available?

Jesse Tan, MD: Yes, that's great. So the general treatment for chronic sinusitis is first we'll try them on several courses of antibiotics. So we'll treat them for their acute attacks and that usually involves three, four or more courses of antibiotics. In addition, we'll put them on steroid nasal sprays which helps decrease the inflammation and congestion in the sinuses in an attempt to get them to open up. Sometimes we'll also add allergy medicine or decongestants. And then in the really severe cases, we'll actually give the patients a course of oral steroids. So all of this is in an attempt to unplug the sinus and get their chronic condition resolved. Now if that continues on despite all these medical therapies, the next step usually is to get a CT scan of the sinuses and see if there's an anatomic blockage in the sinus itself that's not responding to the medical therapy. And in which case, if that CT scan shows some abnormality, at that point we start considering some type of endoscopic sinus surgery for them.

Melanie Cole (Host): And what are those types of surgery? If they've had the CAT scan and you determine that this is something that might be needed, what's involved?

Jesse Tan, MD: Yes, the traditional sinus surgery which has been done for decades involves placing the patient under general anesthesia, and then we go in and straighten out any deviated septum that we see inside the nose. Then that's proceeded by a traditional operation where we go in and open up the sinuses and clean out any disease, inflammation, polyps, or other abnormalities that are seen in the sinuses. The traditional operation involves using cutting forceps to widen what we call the ostia of the sinus or the opening of the sinus, and then suction forceps and other sharp cutting instruments to actually open up the sinus cavities itself. Now that typical operation was associated with more bleeding, and especially more discomfort for the patient after surgery because we had to use cutting tools to get the sinuses open. So that was the traditional sinus procedure that was typically done in the past.

Melanie Cole (Host): Now what about balloon sinuplasty? How is that different? Is it minimally invasive? How is it different than the traditional surgeries you've been discussing?

Jesse Tan, MD: Yes, I found that the balloon sinuplasty procedure which we've been doing here at Long Beach Memorial for the last several years is a significant advantage over the traditional endoscopic sinus surgery. The reason is instead of using the cutting instruments and suction and drills to get the sinus cavities open, we now use these balloon catheters in which we thread a guide wire into the sinus itself. And then once that guide wire is in the sinus, we advance a balloon over the wire itself into the sinus opening and into the sinus itself. Then we go ahead and dilate that balloon to several millimeters of width and that actually cracks open the opening into the sinus therefore causing the opening to stay permanently more open because the bone has actually been cracked and the bone remodels in a more open position therefore the opening in the sinus stays open permanently. And then once that opening has been established or widened, then we'll go ahead and flush the sinus out with high volume irrigation to get whatever mucus, polyps or other mucosal thickening that's in there to flush out of the sinus. And I should say that leads to an equivalent result as far as what we're going to do to get the sinus open. But the good part is there's a lot less discomfort after the surgery because we haven't used any cutting instruments. There's a lot less bleeding, and then perhaps more importantly from a functional standpoint, there's less scarring in the sinus. So that the sinuses open, but because we've done it in a very gentle way, there's less likelihood for that sinus opening to scar down again and cause recurrent sinus symptoms.

Melanie Cole (Host): So that actually leads to my next question, Dr. Tan, is this a permanent fix? Is it something someone might need to come back again and have done, or are there adjunct treatments after this surgery that you might continue on so that this doesn't still reoccur?

Jesse Tan, MD: Yes, that's a very common question that my patients ask me. They say, after this surgery, what are the chances that this will need to be redone again? And the answer to that is it really depends on the patient and their sensitivity to the environment and allergies. If a patient comes to me and just has isolated sinus disease, let's say a polyp in there or some blockage in the sinus that needs to be opened up, and we go ahead and open it up, in general those patients will just need one surgery to fix the problem and the sinus stays open after that. The patients who are a little bit more problematic are those who have chronic allergies or chronic sensitivity to things in the environment. So I can go in and clean out that whole sinus and it can look pristine and totally clean at the end of the operation. But if that patient has severe allergies or something in the environment that causes that sinus mucosa to get inflamed again and swollen, then there is definitely a chance that the patient would need a repeat procedure down the line after that disease reaccumulates from their predisposition to whatever sensitivity they have in the environment. So we always tell our patients that most patients will need just one surgery, but if they have some condition that they're very sensitive to things in the environment, yes there is a chance that the procedure would need to be done again in the future. And at that point, we also do an adjunct consultation with an allergist so that we can try and pinpoint which antigens or things in the environment are causing their symptoms, and then the allergist will try and minimize the reaction to those stimuli so that the problems don't surface again.

Melanie Cole (Host): Dr. Tan, we only have about a minute and a half left or so. Tell us where patients can go to find out more information and give us your quick best advice for maybe prevention, something they can do at home to avoid some of those triggers that might lead to this inflammation.

Jesse Tan, MD: Yes, I am a Long Beach Memorial physician, so we generally refer any patients who are seeking help with their sinuses to our general phone number which is 1-800-MEMORIAL. And at that point the operator can direct the patient to the appropriate doctor or clinic that they can see in order to get their sinus symptoms fixed. And I'm sorry Melanie, what was your second question?

Melanie Cole (Host): Just your best advice for some things that patients can do at home, avoiding triggers.

Jesse Tan, MD: Yes. So if patients realize that they are allergic or they have sensitivity to things in their house or in certain environments, avoidance is always the best treatment. So we recommend things like HEPA filters, changing your carpet, cleaning the house regularly. Taking allergy medicines when needed to help reduce and avoid those allergens that are causing the patient's symptoms. It's helpful sometimes to see an allergist too if patients have chronic symptoms like sneezing, watery eyes, change in their nasal drainage when they're around certain environments, then that way the allergist can help pinpoint what is causing the problem so that they can advise the patient, you know, just remove this particular stimuli from your environment or take this particular medication or perhaps allergy shots to help decrease the reactivity of that patient to that stimuli.

Melanie Cole (Host): Thank you so much, Dr. Jesse Tan, otolaryngologist and Chief of Surgery at Long Beach Memorial. You're listening to Weekly Dose of Wellness. For more information, you can go to memorialcare.org. That's memorialcare.org. This is Melanie Cole. Thanks so much for listening.