Sinus surgery has truly evolved over the years.
With recent advances in technology, including the nasal endoscope, sinus surgery is now commonly performed entirely through the nose.
The most common reason for doing endoscopic sinus surgery is “chronic rhinosinusitis”, or more commonly “chronic sinusitis”.
Chronic rhinosinusitis is a general term for inflammation (swelling) of the nose and sinuses that does not improve sufficiently with medical treatment.
Steven Lyon, MD is here to discuss sinus surgery and how Stoughton Hospital can help you have a better quality of life.
Sinus Surgery: Nothing To Fear
Featured Speaker:
Steven Lyon, MD
Steven Lyon, MD specialty is Otolaryngology. Transcription:
Sinus Surgery: Nothing To Fear
Melanie Cole (Host): Sinus surgery has truly evolved over the years. With recent advances in technology, sinus surgery has become much less invasive and much more high tech. My guest today is Dr. Stephen Lyon. He’s a board certified otolaryngologist at Stoughton Hospital. Welcome to the show, Dr. Lyon. Tell us about sinus surgery. What are the most common reasons for someone to consider sinus surgery?
Dr. Stephen Lyon (Guest): Well, there are a number of reasons for people to have sinus surgery and they include things like recurrent infections, incomplete breathing through the nose, having chronic sinus drainage and difficulty with the sense of smell. These are the sorts of things that people tend to come and present with. Once we make a diagnosis that confirms the underlying problem and were to differentiate a sinus problem from a nasal problem and understand what the contributors are for their symptoms, then we can go ahead and talk about what the best approach to management is. Now, sinus surgery, as you mentioned, has come a long way. I have people who come in frequently and talk about their aunt or their uncle or their neighbor or relative who had sinus surgery in years past and that’s a different beast, by and large. These days, we have made significant improvements and, for instance, packing which has been one of the dreaded problems that keeps people from even coming in sometimes, to see an otolaryngologist, has been something that I have virtually eliminated from the sinus surgeries that I do at this point. So, the thoughts about having the packing in for a day or two days or sometimes several days is something that is no longer a part of the surgery that I include for sinus surgery. Then, there are other developments that include things like stents that can be placed into the sinus that are analogous to stents that are placed in the heart and can hold various parts of the operated sinuses open and can deliver medication to those local areas so that we can work to reduce the amount of inflammation or swelling and damage to the sinus linings and allow them to recover. It’s that recovery of the lining of the sinuses in the nose and the mucous membranes following surgery that we work to develop and maintain because that’s really the key to overcoming the symptoms that people are bothered by so much when it comes to their nose and their sinuses.
Melanie: So, what treatments do you try, Dr. Lyon, before you do an endoscopic sinus surgery? Are there some first line of defenses if someone comes in and they’ve got rhinosinusitis or they’ve got chronic sinus problems and some of the symptoms you’ve described. What do you try first? People hear about steroids and nasal inhalants and all kinds of things.
Dr. Lyon: Well, again, much of that comes down to the specifics for the individual but, among those things, and one thing that is actually not a recent development but has been a recently refined approach is the use of nasal saline irrigation. There are irrigators that are available now that can help us manage these things up front and, hopefully, in many patients, have them treat their symptoms effectively without the use, eventually, of nasal steroids, reducing the use of things like nasal histamines because irrigation is capable of rinsing out the things that tend to irritate the nose but also is capable of rinsing out the things that your body produces—mostly the immune system—that causes much of the symptoms and problems and damage inside the nose. So, irrigation sounds like an older approach but has lots of refinements to make it simpler, easier, more comfortable and it remains a very effective approach. Sometimes we will add medications to that irrigation so that that can get up into the little nooks and crannies inside the sinuses. Of course, steroid sprays are very common, and those are a very important part of management of many nasal sinus allergy type problems because they also reduce the inflammation. The problem with nasal steroids is that they’re not really removing the trigger from the nose whenever it’s breathed in to cause the irritation, they’re just working to reduce the body’s response to that which is important. It’s important in relief of symptoms. One of the things that I find is that people don’t always use those sprays properly. So, we try to re-educate people in properly putting the spray into their nose and aiming it properly and not sniffing it all into the throat but working it back and forth after they’ve inhaled the spray so that it stays in the nose and does its job where it’s needed.
Melanie: Dr. Lyon, people think of sinus surgery and they think of very uncomfortable, painful type surgeries. Do you use anesthetic? Do we feel you going in through our nose? Most surgeries people think of, they’re out for them, but are people in twilight? Is there an anesthetic used? Are we feeling what you’re doing?
Dr. Lyon: Absolutely not. The vast majority of patients who have sinus surgery are under anesthetic, both local anesthetic which we use to make it so that they don’t feel what’s going on in the nose, even if they were awake and a general anesthetic so that they’re actually sleeping, in addition, during the procedure. So, they have no awareness that anything is going on. Adding the local anesthetic that we use allows the anesthesiologist to not have to give them quite so much general anesthetic medication because we can make it so that the anesthesia is lighter and the anesthesia people and surgeons will know that the people won’t be feeling anything because we’ve numbed up all the sinuses on the inside of the nose. So, the surgery itself is something that the patient doesn’t have to worry about in terms of comfort because they don’t feel or recall any of that going on. Then, the post-op care—which is something that has been a source of discomfort for patients in the past—has really, I think, come a long way because of the use of nasal irrigation after the surgery. Also, when I was able to remove packing from my approach to doing sinus surgery, it made a dramatic change. People understood that having packing in your nose after surgery is the most uncomfortable part of the surgery.
Melanie: Absolutely. That’s what so many people hear and think about now. So, in general, and we only have a few minutes left. In general, are these surgeries a permanent solution? If you go in and open up the sinuses and, I know it depends on the type of surgery you do, but is it something that generally needs to be re-done at some point later down the line?
Dr. Lyon: That is a very good question. The answer is that the durability of sinus surgeries’ effect has to do with two things. It has to do with the severity of the underlying problem. It has to do with the way that that patient’s nose and sinuses are managed after the surgery. For people who have more significant damage, inflammation and swelling to the lining of the sinuses and nasal cavity. If they maintain the nasal irrigation at a level that we determine by looking in the nose that’s appropriate for the underlying problem, then we can maintain those people in a way that we’ve really never been able to do in the past. We not only fix the issues surgically but maintain those so they get excellent long-term control of that underlying disease. If patients have severe disease and they expect that the surgery alone is going to give them a permanent fix, then it’s more likely that they’re going to have to have repeat procedures because there are two aspects, really—two aspects to managing these things successfully. One is creating the surgical access and the surgical drainage and the second one is managing what is really a medical problem—the body’s immune response in the nose that causes the inflammation that essentially leads to the abnormal mucous production, the recurrent infection, the headaches, the stuffiness—really all the things we’ve come to know as chronic sinusitis and nasal sinus problems.
Melanie: So, in just the last minute here, tell patients and listeners, really, your best advice about your sinuses and why they should come to Stoughton Hospital for their care.
Dr. Lyon: The first and most important thing is to make sure that they have the proper diagnosis. Many people have a label of sinus problems but it’s much more difficult than you might think to establish whether the problem is primarily a nasal problem or a sinus problem or simple headaches or a variety of other issues. So, first, we work through the diagnosis and understanding the diagnosis because it doesn’t matter how good the surgery is or how good the treatment is because if it’s being given for the wrong diagnosis, you don’t feel better. Part of the reason that people have ongoing symptoms is because the underlying problem isn’t well-understood. We start by trying to understand what the underlying problem is, what the contributors are to that problem and then come up with a management plan to address each of those problems. That’s really the key. Then, plugging them into whatever the treatment’s going to be. For some people, surgery is going to be necessary. For many people, there are other ways of managing it that will successfully address the problem and if it’s not a chronic problem or if it’s not an identifiable nasal problem, we can frequently identify what the problem is and direct them to treatment that can give them relief of what their actual underlying problem is. So, really, that getting into an expert, getting a proper diagnosis, getting a plan, that’s really the most important first step to getting care and getting the effective treatment.
Melanie: Thank you so much. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to StoughtonHospital.com. That’s StoughtonHospital.com. This is Melanie Cole. Thanks so much for listening.
Sinus Surgery: Nothing To Fear
Melanie Cole (Host): Sinus surgery has truly evolved over the years. With recent advances in technology, sinus surgery has become much less invasive and much more high tech. My guest today is Dr. Stephen Lyon. He’s a board certified otolaryngologist at Stoughton Hospital. Welcome to the show, Dr. Lyon. Tell us about sinus surgery. What are the most common reasons for someone to consider sinus surgery?
Dr. Stephen Lyon (Guest): Well, there are a number of reasons for people to have sinus surgery and they include things like recurrent infections, incomplete breathing through the nose, having chronic sinus drainage and difficulty with the sense of smell. These are the sorts of things that people tend to come and present with. Once we make a diagnosis that confirms the underlying problem and were to differentiate a sinus problem from a nasal problem and understand what the contributors are for their symptoms, then we can go ahead and talk about what the best approach to management is. Now, sinus surgery, as you mentioned, has come a long way. I have people who come in frequently and talk about their aunt or their uncle or their neighbor or relative who had sinus surgery in years past and that’s a different beast, by and large. These days, we have made significant improvements and, for instance, packing which has been one of the dreaded problems that keeps people from even coming in sometimes, to see an otolaryngologist, has been something that I have virtually eliminated from the sinus surgeries that I do at this point. So, the thoughts about having the packing in for a day or two days or sometimes several days is something that is no longer a part of the surgery that I include for sinus surgery. Then, there are other developments that include things like stents that can be placed into the sinus that are analogous to stents that are placed in the heart and can hold various parts of the operated sinuses open and can deliver medication to those local areas so that we can work to reduce the amount of inflammation or swelling and damage to the sinus linings and allow them to recover. It’s that recovery of the lining of the sinuses in the nose and the mucous membranes following surgery that we work to develop and maintain because that’s really the key to overcoming the symptoms that people are bothered by so much when it comes to their nose and their sinuses.
Melanie: So, what treatments do you try, Dr. Lyon, before you do an endoscopic sinus surgery? Are there some first line of defenses if someone comes in and they’ve got rhinosinusitis or they’ve got chronic sinus problems and some of the symptoms you’ve described. What do you try first? People hear about steroids and nasal inhalants and all kinds of things.
Dr. Lyon: Well, again, much of that comes down to the specifics for the individual but, among those things, and one thing that is actually not a recent development but has been a recently refined approach is the use of nasal saline irrigation. There are irrigators that are available now that can help us manage these things up front and, hopefully, in many patients, have them treat their symptoms effectively without the use, eventually, of nasal steroids, reducing the use of things like nasal histamines because irrigation is capable of rinsing out the things that tend to irritate the nose but also is capable of rinsing out the things that your body produces—mostly the immune system—that causes much of the symptoms and problems and damage inside the nose. So, irrigation sounds like an older approach but has lots of refinements to make it simpler, easier, more comfortable and it remains a very effective approach. Sometimes we will add medications to that irrigation so that that can get up into the little nooks and crannies inside the sinuses. Of course, steroid sprays are very common, and those are a very important part of management of many nasal sinus allergy type problems because they also reduce the inflammation. The problem with nasal steroids is that they’re not really removing the trigger from the nose whenever it’s breathed in to cause the irritation, they’re just working to reduce the body’s response to that which is important. It’s important in relief of symptoms. One of the things that I find is that people don’t always use those sprays properly. So, we try to re-educate people in properly putting the spray into their nose and aiming it properly and not sniffing it all into the throat but working it back and forth after they’ve inhaled the spray so that it stays in the nose and does its job where it’s needed.
Melanie: Dr. Lyon, people think of sinus surgery and they think of very uncomfortable, painful type surgeries. Do you use anesthetic? Do we feel you going in through our nose? Most surgeries people think of, they’re out for them, but are people in twilight? Is there an anesthetic used? Are we feeling what you’re doing?
Dr. Lyon: Absolutely not. The vast majority of patients who have sinus surgery are under anesthetic, both local anesthetic which we use to make it so that they don’t feel what’s going on in the nose, even if they were awake and a general anesthetic so that they’re actually sleeping, in addition, during the procedure. So, they have no awareness that anything is going on. Adding the local anesthetic that we use allows the anesthesiologist to not have to give them quite so much general anesthetic medication because we can make it so that the anesthesia is lighter and the anesthesia people and surgeons will know that the people won’t be feeling anything because we’ve numbed up all the sinuses on the inside of the nose. So, the surgery itself is something that the patient doesn’t have to worry about in terms of comfort because they don’t feel or recall any of that going on. Then, the post-op care—which is something that has been a source of discomfort for patients in the past—has really, I think, come a long way because of the use of nasal irrigation after the surgery. Also, when I was able to remove packing from my approach to doing sinus surgery, it made a dramatic change. People understood that having packing in your nose after surgery is the most uncomfortable part of the surgery.
Melanie: Absolutely. That’s what so many people hear and think about now. So, in general, and we only have a few minutes left. In general, are these surgeries a permanent solution? If you go in and open up the sinuses and, I know it depends on the type of surgery you do, but is it something that generally needs to be re-done at some point later down the line?
Dr. Lyon: That is a very good question. The answer is that the durability of sinus surgeries’ effect has to do with two things. It has to do with the severity of the underlying problem. It has to do with the way that that patient’s nose and sinuses are managed after the surgery. For people who have more significant damage, inflammation and swelling to the lining of the sinuses and nasal cavity. If they maintain the nasal irrigation at a level that we determine by looking in the nose that’s appropriate for the underlying problem, then we can maintain those people in a way that we’ve really never been able to do in the past. We not only fix the issues surgically but maintain those so they get excellent long-term control of that underlying disease. If patients have severe disease and they expect that the surgery alone is going to give them a permanent fix, then it’s more likely that they’re going to have to have repeat procedures because there are two aspects, really—two aspects to managing these things successfully. One is creating the surgical access and the surgical drainage and the second one is managing what is really a medical problem—the body’s immune response in the nose that causes the inflammation that essentially leads to the abnormal mucous production, the recurrent infection, the headaches, the stuffiness—really all the things we’ve come to know as chronic sinusitis and nasal sinus problems.
Melanie: So, in just the last minute here, tell patients and listeners, really, your best advice about your sinuses and why they should come to Stoughton Hospital for their care.
Dr. Lyon: The first and most important thing is to make sure that they have the proper diagnosis. Many people have a label of sinus problems but it’s much more difficult than you might think to establish whether the problem is primarily a nasal problem or a sinus problem or simple headaches or a variety of other issues. So, first, we work through the diagnosis and understanding the diagnosis because it doesn’t matter how good the surgery is or how good the treatment is because if it’s being given for the wrong diagnosis, you don’t feel better. Part of the reason that people have ongoing symptoms is because the underlying problem isn’t well-understood. We start by trying to understand what the underlying problem is, what the contributors are to that problem and then come up with a management plan to address each of those problems. That’s really the key. Then, plugging them into whatever the treatment’s going to be. For some people, surgery is going to be necessary. For many people, there are other ways of managing it that will successfully address the problem and if it’s not a chronic problem or if it’s not an identifiable nasal problem, we can frequently identify what the problem is and direct them to treatment that can give them relief of what their actual underlying problem is. So, really, that getting into an expert, getting a proper diagnosis, getting a plan, that’s really the most important first step to getting care and getting the effective treatment.
Melanie: Thank you so much. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to StoughtonHospital.com. That’s StoughtonHospital.com. This is Melanie Cole. Thanks so much for listening.