Sinus Disorders and Endoscopic Sinus Surgery

When a patient with sinus problems is seen for the first consultation, 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 other causes of facial pressure and headaches, and whether he has received exhaustive medical treatment. Depending on this review, the patient and Dr. Zemplenyi will decide whether the patient is a candidate for further medical therapy versus consideration of surgical treatment. Often, a CT scan of sinus will be ordered to better evaluate the involved anatomy. Aggressive medical treatment is tried first before surgical therapy is offered. Allergic evaluation may also be needed.

Sinus disorders represent one of the most common of all medical problems, affecting about forty million individuals annually in the United States. Normally, sinuses are air-filled cavities that are 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) that line the sinus cavities. The mucus passes through narrow openings that become narrowed further by recurrent irritations or infections. Sinusitis results from blockage of the normal channels of drainage. The sinuses become filled with secretions or pus under pressure. Symptoms of acute sinusitis consist of facial pain and pressure, green or yellow drainage, and nasal congestion. The 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 consists of obtaining an accurate history, examination including fiberoptic endoscopy to view the nasal passages, and a CAT scan of 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, a consideration is given to surgical treatment. The goal of surgical management is to decrease the frequency of episodes of sinusitis and to provide resolution of symptoms on a more permanent basis. If successful, surgery results in a marked decrease in 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 using a fiberoptic telescope which is inserted into the nasal passage. No incisions are made from the outside and no scars result. Microscopic instruments are used to carefully remove and debride thickened tissues that block the sinus openings and thus prevent the normal functioning of sinuses. Dr. Zemplenyi usually does not pack the nose in order to make the overall postoperative discomfort minimized. Small, dissolvable sponges are sometimes left to stent the middle meatal space. Thus, the patient experiences no discomfort before and during the surgery, and only mild discomfort in the post-operative period. Narcotic medications and Tylenol are used 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. The success rate with this surgery is high. It is exciting to know that most individuals who are plagued by sinus problems can be effectively treated, either medically or surgically.