Seeking Sinus Relief

You have holes in your head — and that’s a good thing. Sinus pockets give resonance (umpf) to your voice, while filtering the air you breathe.  

The filtering process occurs as mucus — a protective body fluid — travels and drains through your sinuses. But painful pressure and congestion can build behind your eyes, nose and other facial areas when the sinuses become inflamed by asthma or allergies. A cold virus, fungus or bacteria can also infect your sinuses, according to William Brown, M.D., an ear, nose and throat specialist (ENT) affiliated with Baptist Health and the Medical Arts Surgery Center at South Miami.

If you suffer from sinusitis, you’re not alone. The condition affects about 37 million people in the U.S. and accounts for 2 percent of all office visits to primary care physicians, according to the National Institutes of Health.

Treatments can range from allergy shots, antibiotics or surgery, depending on the underlying cause of your sinus problem. Even a small balloon can provide effective treatments for those with chronic sinusitis, says Francisco Pernas, M.D., an ENT, affiliated with West Kendall Baptist Hospital and other Baptist Health facilities.

What’s the link between allergies and sinusitis?

If your sinuses are chronically inflamed or infected, it’s important to rule out allergies as an underlying cause. As a first step, an allergy test can determine if you are allergic to dust, pets, pollen or other substances.  “We can desensitize you to the allergy and get rid of the chronic swelling,” Dr. Brown says.

Congestion linked to allergies can be controlled by medication, nasal sprays, topical medicine or a customized mix of allergy medicine and anti-inflammation steroids.

What are the other treatment options for sinusitis?

When conservative allergy or cold treatments fail to reduce inflammation and congestion, your physician will take a mucus culture to identify and treat the source of infection. Depending on exam results, your doctor will recommend a week or two of stronger antibiotics or steroids.

Additional steps are needed if medication is not effective, and you suffer from intense or recurring cases of sinusitis.  In that scenario, you doctor will recommend a CT scan to identify which sinus passages are blocked. Additionally, a tiny endoscopic camera — inserted through your nose — can help your physician identify polyps, anatomical problems or obstructed passages.  Some obstructions and polyps can be removed through minimally invasive procedures.  Reconstructive surgery may be necessary to correct major structural problems in the sinuses or nasal areas.

How is the balloon procedure used for blocked sinuses?

ENTs have borrowed and modified coronary angioplasty, a procedure in which an interventional cardiologist dilates a small balloon attached to a catheter to open blocked arteries.  

ENTs use balloon sinuplasty to offer relief. After the inflamed areas have been identified through either a CT scan or endoscopy, a small and flexible balloon catheter is inserted and dilated to reshape sinus passageways

“You’re dilating a natural opening to make it large enough,” Dr. Pernas says.

How are stents used as a sinus treatment?

Once again, techniques used to clear blocked coronary arteries have been adapted to treat congested sinuses. To open a blocked artery, a cardiologist often uses a small mesh tube called a “stent.”

Likewise for nasal passages, an ENT surgeon will expand blocked sinuses with stents coated with anti-inflammatory steroid medicine.

This process offers two forms of relief to chronic sinus sufferers. The stent —with a spring mechanism — opens and expands the congested sinus passage. Time-released medicine reduces the inflammation.  A stent can be administered with balloon dilation, and both procedures are considered minimally invasive surgery.

What are the benefits?

Dr. Brown says the benefits to the patient include:

• Reduced need for oral steroids after the operation.
• Diminished need for surgical interventions.
• Shorter recovery period than with that of more traditional forms of sinus surgery.

Who is the ideal candidate for balloon or stent treatments for the sinuses?

Dr. Pernas says you may be a candidate for either of those procedures if you suffer from chronic sinusitis, reoccurring chronic nasal obstruction/congestion, uncontrolled allergies, or chronic sinus headaches.

“Obviously, your nose and sinuses are connected to other areas of your face, including the ears and throat,” Dr. Brown says, adding that inflamed sinuses could be the culprit behind a chronic sore throat, earache and post-nasal drip.

Tags: allergies, asthma, diagnostic procedures, health & technology, sinusitis