Transcription:
An Innovate Surgery for Those Suffering From Chronic Sinusitis

Bill Klaproth (Host):  Do you have difficulty breathing through your nose, cold like symptoms that won’t go away, facial pain, maybe even headaches, or all of the above?  Then,  you may have a condition called “chronic sinusitis”. Now, there are a number of innovative sinus surgeries for those suffering from chronic sinusitis and here to tell us more is Dr. Antony Sanders, a physician at Schneck Medical Centre who specializes in otolaryngology which are diseases and disorders of the ear, nose and throat or, as it’s called ENT.  Dr. Sanders, thank you for being on with us.  So, let’s start the beginning. Can you tell us more about chronic sinusitis? What is it?

Dr. Antony Sanders (Guest):  Chronic sinusitis is an inflammation of the nose and sinuses.  It's a very common problem. We see an awful lot of it in Southern Indiana. It is associated with allergies sometimes, and frequently just chronic infection in the sinuses that won’t go away on themselves.  With that, people tend to have a variety of symptoms that are sometimes debilitating where they have headaches, facial pressure, fatigue, just feel lousy, their general sense of well-being is poor.  They may have a stuffy nose, nasal drip, sore throat, ear pain or pressure and, in general, just kind of miserable with it.

Bill:  And who do you see this most in?  Or, who is most at risk to get this?

Dr. Sanders:  Well, actually, it affects pretty much all age groups. We see it across the spectrum of age.  People who have allergies tend to be more prone to it. People who smoke to it tend to be more prone to it also.  It also has the tendency to run in families.

Bill:  So, when is the time to see the doctor?  We all get colds and people with allergies, when is it time to come see you?

Dr. Sanders:  Well, most people, if they get a cold, the symptoms will last for a week or 10 days and go away on its own.  If you have persistence symptoms, then it’s time to see the doctor.  Generally, people who have this oftentimes will try over the counter medications and they may get some relief, sort of like taking an aspirin for a headache.  On the other hand, if your symptoms persist, then it’s time to see somebody to have it looked into or treated more aggressively.

Bill:  How do you diagnose this when someone comes to see you?

Dr. Sanders:  Well, their history is the most important factor, when they have a story that has the symptoms involved that we just discussed.  There are also physical findings such as a crocked nasal septum or swollen and inflamed lining of the nose but as far as the taking of the next step of diagnosis we usually do it with a CT scan of the sinus or a nasal endoscopic examination where we look up inside the nose with a tiny little fiber optic scope to see if there's infection draining or structural problems.  Then, allergy testing is also useful in people who are chronic nasal and sinus suffers.

Bill:  Okay and through medical advances, there are new ways to treat chronic sinusitis. Can you tell us about those new innovated procedures?

Dr. Sanders:  Yes. Procedures are for people who have persistent symptoms and failed medical treatment, so you probably would have been on several antibiotics at least prior to taking that next step.  But, probably the newest and least invasive of the procedures is something called “balloon sinus dilatation:.  What that is, is under anesthesia, in the office, we insert a little balloon catheter into the opening that’s under the sinuses and dilate that so they drain better.  Frequently, people will get infection in their sinuses which can’t drain and it’s like having an abscess. The antibiotics tend to travel just into the bloodstream which is the lining of the sinus and they don’t penetrate well enough to get to the infection to kill it off and so drainage is an important part of the treatment.  If you can’t get the sinus to drain and the infection has to be transported out, then you have a tendency to have early recurrence or persistent symptoms.  So, that's what balloon sinus dilatation does. It allows the sinuses to drain better and fight off the infection the way it’s intended to.  Also, in the office we can do things to improve airway in the same setting. This is about a 10-minute procedure with practically no recovery. People are usually back to work the next day.

Bill:  That sounds great.  When you say “balloon sinus dilatation”, I'm envisioning an angioplasty. You put, basically a balloon up the nose and inflate it and it clears the passageways?  Am I close on that?

Dr. Sanders:  No, that’s exactly what it is and I think that’s probably where the concept came from.  An angioplastiest decided that, “Heck, we can do that to sinuses and get them to work better,” and, in practice, it works very well and avoids bigger procedures as a result.

Bill:  Well, this sounds great. It’s done on outpatient and usually they’re back to work the next day.  So, how long does this last, then?  Is this a cure or a way to get it in check for a number of months?  Tell us about the efficacy of the balloon sinus dilatation.

Dr. Sanders:  The results so far have been very encouraging. The balloon sinus dilatation has been done for a number of years now and the results tend to be lasting with it.  People who get a good result are usually staying healthy..

Bill:  That’s terrific.  So, once you do this, how do you determine “I'm going to give someone this or a more traditional form of treatment for dealing with chronic sinusitis”?  How do you determine who gets what?

Dr. Sanders:  People who tend to have really bad structural issues that we can’t deal with in the office, we may be more inclined to recommend a more traditional surgery.  People with extensive nasal polyps, which is an inflammatory condition of the lining of the nose tend not to respond as well to the balloon sinus dilatation.  Sometimes, it’s, unfortunately, insurance driven. Certain insurers don’t recognize that as a viable procedure even though there’s excellent literature and tons of clinical experience now that suggests that it’s a very good alternative. But, sometimes the insurance drives it as well.

Bill:  When we talk about traditional forms of treatment, what is the most common way to traditionally treat sinusitis?

Dr. Sanders:  Well, there's a procedure called “endoscopic sinus surgery” which means basically opening the sinuses, rebuilding the opening so they drain properly and removing any infection that’s there.  That’s the most common procedure done for chronic sinus infections. It has been around for probably since the early 1980s.  It has replaced, the old fashioned sinus surgery. It tends to be done through the nostril with no incisions, no bruising, no swelling, out-patient surgery. It usually takes about an hour to do.  Most of the time the pain afterwards isn't bad and it has a success rate in excess of 90%.

Bill:  What is the recovery?

Dr. Sanders: Most people have some restriction for about a week afterwards:  no lifting, straining or nose blowing.  We also have people use saline nasal irrigations which help to keep the sinuses clean and wash away any clogs or crusts.  For the most part, people are up on their feet, functioning, can drive a car, bathe, shower, and pretty much do whatever they want to short of no weight lifting or heavy activity like that.

Bill: Okay. So, it sounds like, that is a very effective way of treatment as well but that the balloon dilatation sounds like the gold standard now and that’s the one you want because  it seems like there’s a lot less recovery time with that?

Dr. Sanders:  Well, that’s certainly what I would choose if I was in that position because it’s minimally invasive, practically no risk involved and pretty highly effective.

Bill:  Well, if that’s the one you would choose, that’s the one we would choose then.  If you want it, we want it.

Dr. Sanders:  Well, if that doesn’t work for you, you really haven’t burnt any bridges. You just go on to more invasive options at that point.  

Bill:  Okay. That sounds good.  Dr. Sanders, is there anything else we should know about  chronic sinusitis that we haven’t asked you?

Dr. Sanders: Well I think, probably the important message is that people really don’t have to suffer with this.  There have been quality of life surveys done that suggest that chronic sinusitis is more debilitating than congestive heart failure, so it is a miserable problem to have.  But there are, now, many good solutions--sometimes medical, sometimes surgical--and the surgical ones we have are often solutions that are easy to do with minimum down time.  So, I guess I would encourage people who suffer from this problem to realize that it’s not something you have to deal with. There’s a very excellent chance we can help you with that problem.

Bill:  So, the message from Dr. Sanders is, if you’re suffering from this, don't wait and put it off and delay, go see your doctor.  Is that the overall message?  There's no reason to live with this?

Dr. Sanders:  That's right. That's right and I think the treatment has come a long way.  A lot of people come in and tell me they’ve heard horror stories from the past but I think it’s a new day as far as sinus treatment goes.

Bill:  Dr. Sanders, last question.  Why should someone choose Schneck Medical for their ENT care?

Dr. Sanders:  I think at Schneck Medical Center, we have first of all, a hospital that is nationally recognized for excellence.  The people who work there are your neighbors, friends and relatives and the care is exceptional. I think as far as the sinus portion of it goes, you see a tremendous amount of that. Our volumes are high. Outcomes are excellent.  I think that you probably couldn’t do better going anywhere else in the States.

Bill:  Dr. Sanders, thank you so much, we appreciate it.  For more information, visit schneckmed.org, that's schneckmed.org.  This is Schneck Radio, I'm Bill Klaproth. Thanks for listening.