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Melanie Cole (Host): The Saint Louis University Sinus Institute treats a wide range of sinus problems including nasal blockage, allergies, deviated septums, and more. My guest is Dr. Jastin Antisdel. He’s the Director of the Saint Louis University Sinus Institute. He sees adult and pediatric patients for allergy testing and treatment, sinus and nasal surgery, and all sinonasal disorders. Welcome to the show, Dr. Antisdel. Tell us a little bit about the Sinus Institute. What conditions do you treat, and what can people expect when they come there?

Dr. Jastin Antisdel (Guest): Well, thank you for having me. We treat a wide variety of sinonasal problems. I have to say that the most common thing we treat our patients with chronic sinusitis and then the acute sinusitis that can be associated with that, and then patients with nasal obstruction. That’s probably the main aspect of what we do. Now, we do have large patients with allergies, we have a large amount of patients with sinonasal skull-based tumors—so tumors in the eye or brain that we take out through the nose—then we also have a subset of patients that we treat in combination with the ophthalmologists that have some eye problems that we can treat through the nose. So that’s kind of our big groupings overall.

Melanie: Sounds like some very complicated issues. Let’s start with one that’s not quite so much: allergies. With so many seasonal allergies and then different allergies to pollen and things, what do you want to tell the listeners about allergies and how you can help them?

Dr. Antisdel: Well, primarily what we do is treat patients with inhalant allergies. So if our patients’ primary issues are sinonasal and eye as well, as they go throughout the year and it goes through the different seasons, these patients will often have specific times of year where they become much more problematic, either in the spring, when the plants bloom, or in the fall, when ragweed season comes, and it makes their sinonasal symptoms much worse. We offer a streamline approach to those patients that they can be seen and have testing in our offices, and then we adjust their medications, or, if necessary, can get then immunotherapy, whether that be shots that eventually they can give to themselves at home or drops underneath their tongue that they can give to themselves at home. So that’s primarily how we treat our allergy patients. In addition, at our institute, we are able to send them to the medical allergist for some of those patients that have severe asthma or food allergies or maybe immune dysfunction is part of it. So we can kind of offer each patient what’s most appropriately tailored to their specific allergic issues.

Melanie: Tell us what we can expect at an evaluation. Is this is a very uncomfortable thing, to be evaluated for sinus issues?

Dr. Antisdel: No. Most of our patients that come in and complain of sinonasal problems, we’re going to spend quite a bit of time just talking about what’s going on so we can get a general idea of what it is—a sinusitis patient or if they have allergy, it’s just an anatomic issue. Or maybe even they have a headache problem that doesn’t have anything to do with their sinuses. Now, depending upon what we’re thinking along those lines, patients are usually going to get a general head and neck exam, look in their mouth, their ears, their neck and such, but most of our patients will also get a little bit of a spray inside their nose. So that numbs it up a little bit, also shrinks the lining a little bit and allows us to get a real good look with a small telescope. We make a recording as we do that, so patients are then subsequently able to see the inside of their nose and have it explained exactly what the anatomy is and what exactly is going on. Patients tolerate that quite well. We haven’t had any patient that hasn’t made it through yet.

Melanie: That’s great. Now, how do you determine? So you’ve determined what’s going on with them, with their sinus issues, what they need, and then what? I know the treatments are depending obviously on what they have, but what kind of treatments do you offer?

Dr. Antisdel: Well, most patients, as they’re trying to determine the cause, it’s going to have one of several things happened. Sometimes it’s very clear that either they have polyps growing out of their nose or it’s very clear they don’t have sinus problem, it’s just a nasal problem. But many patients will be treated with some medications, such as a nasal steroid spray. Some patients will get antibiotics, some patients will get oral steroids, and then we’ll follow that up with a post treatment CT scan, which thus allows us to actually see inside of the sinuses and instead of just looking in the nose. That can help us evaluate if patients don’t improve with medications, and maybe those patients would then go on to need surgery. Other things that we may suggest to patients are to get the allergy testing, and so that takes about an hour and a half in our office where we do some kind of extensive amount of very simple testing of the skin to see how they respond. Those kind of second level of looking at the patient allows us to then advise them whether they just need medications or they need allergy treatment, or there are some patients that need to go on to have surgery to correct their anatomic issues.

Melanie: What types of surgery do you do there at the Sinus Institute?

Dr. Antisdel: Well, we operate actually at three locations, in two different hospitals and one surgery center, and almost everything we do is through the nose. Myself personally, I do open up the sinuses for if they have sinusitis or have polyps, or septoplasty, which is where we straighten the septum. The septum is the part of the nose that divides it into two halves, and can be pushed to one side of the other and block the nose; shrinking the turbinate, which are the airflow controllers of the nose, and that can allow better air to get through. And as I mentioned previously, some patients who have tumors or eye problems, we’ll do essentially a sinus surgery to allow us to approach the brain or the eye from below. So that’s kind of a general idea of the main things that we do.

Melanie: What are the general healing times? What is healing like after a surgery like that? People think, Dr. Antisdel, about sinus surgeries and they think that they’re going to have bruising and black eyes and swollen sinuses. What really happens?

Dr. Antisdel: Well, I think that that is from what traditionally happens in patients when they were having sinus surgery 15, 20 years ago. Things are remarkably different. We weren’t able to see very well because what we were doing is using a headlight and looking into patients’ noses through that small nostril and then reaching instruments in. That’s kind of a very crude technique compared to what we’re able to do today. By having endoscopes or telescopes that look into the nose and magnify it and then especially designed instruments that don’t pull out the lining of the nose that’s not supposed to be removed—and really, the natural structures stay behind as much as possible and we don’t go into the eye—patients don’t get black eyes or bruising. I think most patients are surprised when they come back when they tell me that they took less pain medicine and they thought they were going to, that they could breathe through their nose better immediately. In general, the horror stories from the past are pretty much over. We don’t pack people’s nose with packing that has to be removed. They may have some small plastic splints just to hold their septum correctly, but really, it’s so much easier than it used to be in the distant past. Patients, typically, what I tell them is they’re going to take off of work or school for about a week, and that’s just to allow them some time to get over the anesthesia, give their nose a little bit of time to heal, and just to be ready to go back kind of at the full bore.

Melanie: Doctor, tell us about your multidisciplinary team that you’ve got there at Saint Louis University Sinus Institute and how together you’re working to help the patients with all of these different issues you’ve been discussing.

Dr. Antisdel: Well, we have specialists within our own department that do a little bit different things, where some of us focus more on the inside of the nose, some of us focus on the outside of the nose, and some of us focus a little more on the cancers and those sorts of things. Additionally, we have our allergy nurse, and then we have several neurosurgeons and ophthalmologists, rheumatologists, medical allergists, all these people that we work together with constantly. You are all on the same medical records, which allows us to streamline our communication with each other, and we’re all on first-name bases and phone number anytime to quickly communicate about a patient and allow their care to move along quickly and have the patient feeling as good as they can as quickly as possible on the least amount of medication and moving forward with their life and improving their quality of life.

Melanie: Dr. Antisdel, just the last minute that we have, tell the listeners why they should come to see you at the Sinus Institute for their issues.

Dr. Antisdel: Well, there’s a lot of choices in the Saint Louis region, but if you want to come to the place that has had the longest history, we’ve had a fellowship training rhinologist longer than anywhere in the city and we’ve had that continuously. At the university, you are going to come to a place that isn’t choosing the treatments for how it affects the physician but more how it affects the patient, and we are going to administer you in any specific direction of what your type of treatment should be according to our preconceived notions. But with each patient, we tailor exactly what that patient needs, give you the options, and we work together to choose what’s best for you.

Melanie: Thank you so much, Dr. Jastin Andistel, Director of the Saint Louis University Sinus Institute. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physicians Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks for listening.