Common Sinus Procedures Performed
Prior to the widespread use of fiber optics, examination of the nasal cavity relied on a limited view of the anterior portion of the nose, which would often miss important findings in the posterior nasal cavity.
Nasal Endoscopy is a technique in which the physician examines the nasal cavity in the office setting with a rigid or flexible endoscope. This allows excellent visualization of all nasal structures and of the nasopharynx (the junction between the nose and the throat). In these areas many abnormalities can be found which are frequently responsible for nasal and paranasal sinus disease. A posterior nasal polyp, a posterior nasal septal deviation, enlarged adenoids, or an infection near the opening of the sinuses would be easily be missed if a nasal endoscopy is not performed.
Nasal endoscopy is essentially painless and free of complications. It is normally performed following the use of a topical anesthetic (no injection needed). It has become an essential step in the initial diagnostic evaluation of a patient who has nasal or sinus complaints. It is also very important in the follow-up of patients who have had surgery, allowing for easier nasal cleaning and faster recovery. In these patients it frequently decreases the need for radiologic studies as the paranasal sinuses can be seen through the endoscope.
(Now available at St. Joseph Hospital Nasal & Sinus Center) is a minimally invasive procedure that occurs in our outpatient environment. It utilizes a needle electrode to emit radiofrequency energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring) and base of tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).
Endoscopic Sinus Surgery
Endoscopic sinus surgery is a procedure that is performed to improve the natural drainage of the sinuses. It was popularized in the United States about ten years ago and has developed into the standard for most surgeons performing sinus surgery. Like a Nasal Endoscopy, a rigid endoscope is used during the procedure to improve the visual field for the surgeon during surgery. The surgeon then removes the diseased area and opens the natural openings into the sinus cavities to improve natural drainage. It usually takes one to two hours and is done on an outpatient basis. The pain is minimal although there are a few days of discomfort while packing is in the nose. Most people feel better three to five days after surgery and are able to return to normal activities within a week. It should be noted that all sinus surgeries, when possible should be performed when the infection is at a minimum, with good light, good visibility so the surgeon can visualize the nasal cavity clearly. Sinus surgeries do sometimes need revisions and at these times the recently developed InstaTrak technology is invaluable. Surgery is performed only when medical therapy has failed.
Image Guided Sinus Surgery
The St. Joseph Hospital Nasal & Sinus Center is one of few facilities in California to offer a new, three-dimensional computerized image guidance system for sinus surgery. Developed with Gulf War missile-tracking technology, The InstaTrak System provides a critical element previously missing in sinus surgery--depth perception. To surgeons who must work deep inside the nasal cavities, within millimeters of delicate areas of the eyes and brain, the new system allows the sinus surgeon to navigate the sinus cavities with an added margin of precision and safety.
Before surgery, the patient undergoes a CT scan. During the CT scan the patient wears a special InstaTrak headset, which is placed on the bridge of the nose and the external ear canals. The headset is used with the CT scan to create a three-dimensional "road map" of the patient's sinus anatomy. During surgery, the surgeon uses a special device tipped with electromagnetic sensors to register, or create, an exact correlation between the sensor location and the "3-D" CT scan image of the sinuses. In essence, this special technology provides increased accuracy to the physician letting the physician know where and how close they are to important
structures within and surrounding the sinuses. This new computerized technology guidance system raises the standard of care for sinus surgery to the next level, and it's available right now at the St Joseph Hospital Nasal & Sinus Center. St. Joseph Hospital Nasal & Sinus Center is one of few facilities in California to offer a new three-dimensional computerized image guidance system for sinus surgery. Developed with Gulf War missile-tracking technology, The InstaTrak System provides a critical element previously missing in sinus surgery--depth perception. To surgeons who must work deep inside the nasal cavities, within millimeters of delicate areas of the eyes and brain, the new system allows the sinus surgeon to navigate the sinus cavities with an added margin of precision and safety.
Laser Turbinate Surgery
Laser turbinate surgery is designed to reduce the size of your turbinates (structures in your nose that can cause congestion). This surgical procedure is designed to be quick and painless, with no general anesthesia and no downtime. This procedure is done in a laser lab with topical anesthesia and usually takes about 15-20 minutes. CO2 and KTP lasers are the most common used for this procedure. The procedure usually takes about an hour. There is no packing required in the nose and you could return to work the same day. After surgery, there is very minimal discomfort other than a little congestion for about a week. For those who want some relief from chronic congestion without significant downtime, or are just frightened by a complicated surgery, this may be the best treatment. Turbinate surgery is designed to reduce the size of your turbinates (structures in your nose that can cause congestion). This surgical procedure is designed to be quick, painless, no general anesthesia and no downtime. This procedure is done in a Laser Lab with topical anesthesia and usually takes about 15-20 minutes. CO2 and KTP lasers are the most common used for this procedure. Patients are only at the Surgery Center for about an hour. There is no packing required in the nose and you could return to work the same day. After surgery there is very minimal discomfort other than a little congestion for about a week. For those who want some relief from chronic congestion without significant downtime, or are just scared of a complicated surgery this may be the best treatment.
Headaches caused by sinus disease are so rare that they are the least likely cause of a headache. Those rare headaches caused by sinus disease are mild, and are almost always associated with unmistakable changes in secretions, massive swellings and losses of sensation over the face. The sinuses are in no way affected by tapping on the face or forehead. Unusual facial tenderness has nothing to do with the nose or sinuses. The advertising programs of the cough and cold industry have done the public a great disservice by exaggerating, for sales purposes, the probability of sinus disease as a cause of headache.
People who suffer from frequent severe headaches usually will be found to have a mixed headache syndrome. The mix includes muscle tension and contraction, causing a 'Charlie Horse to the muscle and face, head and neck. This component produces most of the tenderness patients often believe points to the sinuses.
A second major element is tempero-mandibular joint syndrome (TMJ) from clenching the teeth in severe pain. This contributes to the tenderness and headaches on the side of the head.
The most important element of the mix is the vascular headache. These intense headaches arise in the blood vessels in the brain. They can be located anywhere on the head...even the face or teeth! They are often accompanied by nausea, and are relieved by sleep. They can be triggered by several foods, hormonal fluctuations, and some are convinced, certain weather conditions. Vascular headaches seemed to be caused by abnormalities in brain chemistry. There is a strong inherited element. They are the major cause of severe headache misery. Migraine headaches are just one example of this kind of headache. These occasionally cause nasal swelling and wetness...(which misleads people into thinking the nasal symptoms were pointing to the cause, rather than the effect). In some headache sufferers, the nasal swelling causes a crowding and pinching in the nose, which in is experienced as face pain...adding to the misery. Occasionally this component can be reduced or eliminated by nasal or sinus surgery.