Sinus Disorders & Endoscopic Sinus Surgery
When a patient with sinus problems is seen for the first consultation, nasal and sinus surgeon Dr. Zemplenyi needs to review the symptoms and type of treatment thus far received. It must be determined whether or not the patient really suffers from sinusitis or from other causes of facial pressure and headaches and whether exhaustive medical treatment has been received. Depending on this review, the patient and Dr. Zemplenyi will decide whether further medical therapy is warranted versus consideration of surgical treatment. Often, a CT scan of the sinuses will be ordered to better evaluate the involved anatomy. Aggressive medical treatment is tried before surgical therapy is offered. Allergy evaluation may also be needed.
Sinus disorders represent one of the most common medical problems, affecting about forty million individuals in the United States annually. Normally, sinuses are air-filled cavities lined by a thin tissue (mucosa) which produces mucus. The mucous blanket is propelled from the sinuses into the nose by beating of microscopic hairs (cilia) lining the sinus cavities. The mucus passes through narrow openings that can become narrowed by recurrent irritations or infections. Sinusitis results from blockage of these normal drainage channels. The sinuses then become filled with secretions or pus under pressure. Symptoms of acute sinusitis consist of facial pain, pressure, green or yellow drainage, and nasal congestion. Treatment consists of appropriate antibiotics for two to six weeks, anti-inflammatory nasal sprays, decongestants and mucous thinners. While most individuals respond to this medical treatment, some patients with sinus problems suffer from chronic or recurrent sinusitis. Accurate and appropriate diagnosis and treatment leads to great improvement or cure in many individuals. Dr. Zemplenyi has the expertise to establish an accurate diagnosis and to provide treatment choices that help most patients control their chronic sinus problem. The treatment includes obtaining an accurate history, examination including fiberoptic endoscopy to view the nasal passages and a CT scan of the sinuses. Medical treatment centers on avoidance of environmental irritants, tobacco, possible allergens, usage of anti-inflammatory sprays, and antibiotic therapy. Other common causes of facial pain such as common migraine and myofascial pain syndrome (the latter seen in patients with jaw clenching and teeth grinding) must be differentiated from symptoms of sinusitis.
If patients suffer from frequent and bothersome episodes of true sinusitis that interfere with their quality of life, surgical treatment may be considered. The goal of surgical management is to decrease the frequency of sinusitis episodes and to provide a more permanent resolution of symptoms. If successful, surgery results in a marked decrease in the use of medication, especially antibiotics. Functional endoscopic sinus surgery (FESS) reverses obstruction and restores effective drainage and ventilation (aeration) of sinuses. This outpatient procedure is performed under general anesthesia in our certified outpatient surgical facility. It is accomplished by viewing the nasal passages with a fiberoptic telescope and by using microscopic instruments to carefully remove and debride the thickened tissues that block the sinus openings. Since no incisions are made from the outside no scars result. Dr. Zemplenyi usually does not pack the nose in order to minimize postoperative discomfort. Narcotic medications and Tylenol are used as needed for the first 24 to 48 hours. Return to work is commonly possible in three to four days following the operation. Frequent irrigation of the nose and sinuses with salt water solution is necessary during the two to three week following surgery. It is exciting to know that most individuals who are plagued by sinus problems can be effectively treated, either medically or surgically.