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Monday Medical: Advances in sinus surgery

Susan Cunningham
For Steamboat Pilot & Today

If you have chronic sinus infections or challenges with breathing and airflow, sinus surgery may help.

But if the idea of sinus surgery conjures up fears of a painful recovery, know that the field has greatly advanced.

“Over the last decade with the advances of 3-D image guidance and balloon technology, sinus surgery has become more successful and much easier to recover from,” said Dr. Jason Sigmon, an otolaryngologist at UCHealth Ear, Nose and Throat Clinic in Steamboat Springs.

There are several conditions that may be best treated through sinus surgery:

  • Structural problems that impact breathing and airflow: “These patients have problems breathing through their nose in general, especially at night when lying down or during the day when exercising,” Sigmon said. “They may or may not have infections.”
  • Nasal polyps: These noncancerous growths inside the sinuses or nasal passages are soft and painless, but if they get too large, they can block nasal passages, causing breathing problems, loss of smell and frequent sinus infections. Medications can help shrink or even eliminate nasal polyps, but sometimes, they need to be surgically removed.
  • Deviated septum: For people with this condition, the nasal septum — the thin wall of bone and cartilage that divides the nasal cavity in half — is off center or crooked. That can make it difficult to breathe and can result in congestion and nasal blockage. Medication can help open the nasal passages, but surgery is needed to correct the condition.

While these issues can impact people of all ages, they typically begin to cause problems in the teenage years.

“Our best understanding is that patients have sinus and nasal function that’s a little compromised, in part, due to genetics and, in part, due to developmental anatomy,” Sigmon said. “These areas can develop in a way that makes them more likely to trap infections or air flow.”

Someone who has a sinus infection or head cold once a year, but gets better with over-the-counter or prescription medications, likely doesn’t need further evaluation. But more chronic or serious sinus or breathing issues may be reason to see a specialist.

“If you have sinus infections and symptoms two or three times a year, year after year, or previously responded to medications, but now it seems like those therapies aren’t working, that could be an indication that it’d be helpful to see a specialist,” Sigmon said.

During an evaluation, Sigmon will look at the nose with a scope or camera, or do a CT scan or X-ray to identify problem areas in sinuses. Structural issues may also be seen on dental X-rays.

“If a patient fails medical management — nasal rinses, steroid sprays, antibiotics — then we may consider surgery,” Sigmon said.

Patients sometimes have the misconception that nasal surgery is very painful and still involves “nasal packing,” in which gauze-like material is placed in the nasal cavity to reduce bleeding. But surgery is much different than it was 10 to 20 years ago.

“Now, we use balloon catheters to open the sinuses,” Sigmon said. “It’s similar to the technology used in heart procedures to open blood vessels.

“And we use 3-D image guidance, an advanced system in which we load a patient’s x-rays and CT scans into a machine to create a three-dimensional image that we use to navigate in surgery. That allows for safer surgery that’s more effective and involves a much faster recovery.”

The surgery is an outpatient procedure, and after a two- to three-day recovery, patients can be back to work and regular life.

While surgery is always a last resort, it can make a big difference for people suffering from chronic issues.

“The long-term benefit of correcting an issue permanently versus continuing to medically manage it is a driving factor of doing surgery,” Sigmon said. “Sometimes, patients will get more complicated sinus infections over time, but with surgery, we can prevent these problems from becoming bigger issues.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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