Sinus Issues Addressed at Ears, Nose, and Throat of ENT Tulsa | Balloon Sinuplasty
Here at Ears, Nose, and Throat of ENT Tulsa, Dr. Scott Cordray has a special interest in treating sinus disease. This can be medical or surgical such as his pain-free balloon sinuplasty – however, when medical treatment fails this may involve surgery, which can be performed in the office. What is sinus disease? Sinus disease is essentially inflammation, set up in the mucosa or skin of the nasal and sinus passages that creates obstruction. The inflammation results in swelling of the tissues that cause obstruction of these natural drainage pathways of the sinuses. Bacteria and mucous now trapped in a warm dark cavity is a set up for infection.
With obstruction of the sinuses pressure can no longer be equalized. If the pressure inside of the sinus does not change compared to the outside, it will set up negative pressure causing pain and headaches. Allergies are the most common cause of inflammation and swelling of the nasal and sinus tissues in sinus disease. Although the above has been taught for years, we now know this is largely an immunologically mediated process. New treatments are on the horizon based on treating the immune system which Ears, Nose, and Throat of ENT Tulsa is following closely. For now, we offer our patients suffering from sinus problems but are not responding positively to medication pain-free balloon sinuplasty performed right in our office.
Other causes such as viruses and autoimmune disease can set up an inflammatory response that again causes swelling and obstruction of the sinuses which leads to infection, pain, and pressure. It also can lead to the inability to smell. The inability to smell or anosmia is associated with the tissue swollen inside the nose which will not allow the odiferous particles to go all the way up to the superior aspect of the nose where the olfactory nerve is located. The particals must reach the upper aspect of the nasal cavity for us to smell and detect different odorous items – issues that have been experienced by our patients who elected to employ our in-office painless balloon sinuplasty procedure..
What are the symptoms of sinus disease? We’ve alluded to this above, primarily pain and pressure over the sinuses. The sinuses are located above the eyes, between the eyes and below the eyes on either side of the nose. Another symptom of a sinus infection is pus coming out of the nose. Fever is also common with an acute or current infection.
Another issue can be nasal obstruction, nasal congestion, and inability to breathe out of the nose. One common complaint that Dr. Cordray gets at Ears, Nose, and Throat of ENT Tulsa is that if a patient lies on their left side at night then the left nostril will completely swell shut or if they lay on their right side then that side of the nostril will swell shut. This is what we refer to as dependent edema. Edema meaning swelling. Obviously, it depends on which side you’re lying on. It will cause swelling of those structures called turbinates in the nose which cause this issue. Treatment is a nasal steroid like Flonase. If this does not work, there is a very simple, in office, painless balloon sinuplasty procedure that can be performed.
What medicines can be used to help you with sinus disease? If it is an acute or current infection, antibiotics are given. Our Academy has officially recommended Augmentin which has Amoxicillin in it. If you’re allergic to penicillin then you should not take it. However, that is the drug of choice for sinusitis. There are other choices of antibiotic that can help. Nasal steroids and decongestants also are the mainstay of medical treatment. There are many side effects that one needs to be aware.
The most significant side effect with a decongestant is elevated blood pressure or hypertension with continued use. Actually, Dr. Scott Cordray, an ENT Tulsa specialist and painless balloon sinuplasty provider, has seen it occur with the use of just one or two pills of a decongestant such as Sudafed. Decongestants can cause prostate swelling especially in elderly men. Swelling of the prostate can make it difficult to urinate. Also, a significant issue in young healthy females is irritability, sleepiness and agitation.
Antihistamines are also part of the mainstay of treating allergies, which can indirectly treat sinus disease. If it’s the older type of antihistamine (i.e. Benadryl / Palgic) they can make you sleepy. The newer antihistamines such as Allegra do not cross the blood-brain barrier; therefore will not make you sleepy. In a study a couple of years ago, Claritin was shown to be almost as effective as a placebo. Typically, at Ears, Nose, and Throat of ENT Tulsa, we do not recommend Claritin for the treatment of allergy and sinus disease. Note, Dr. Cordray does have an occasional patient that Claritin works very well and seems to be the one that works best. Newer drugs are on the horizon that addresses the immune system as mentioned above. These are referred to as biologics.
Biologics directly affect the immune system to a very significant degree and have very promising effects. Right now, they are very expensive and are not FDA approved or covered by insurance companies.
What should you do if these medicines fail? For example, let’s say you’re taking nasal steroids and antibiotics but you continue to have pain, pressure, headaches, and recurrent sinus infections. If that goes on longer than 12 weeks, you’re very likely to be a great candidate to open the sinuses to allow them to aerate and allow the bacteria and mucus to come out of the sinus via our in-office painless balloon sinuplasty procedure. As long as the sinuses are obstructed you will continue to have the above symptoms not matter how much medicine you take. Here at Ears, Nose, and Throat of ENT Tulsa, we note the indications for surgery would be nasal congestion, pain, pressure, headache and anosmia or inability to smell or hampered ability to smell for more than 12 weeks despite medical treatment.
If symptoms have not responded to the medicines above the next step is to obtain a CT scan (CAT scan) of the sinus or computerized tomography. We used to refer to this as a cat-scan or computerized axial tomography. We now refer to it as CT because we have sagittal and coronal views not just axial views. Once the CT is completed, we can sit down and review the results to see if your sinuses are obstructed. If you have mucosal thickening (skin that lines the inside of the sinus) or other abnormalities then you may be a good candidate for balloon sinuplasty. One of the advantages that Dr. Cordray has here in the Ears, Nose, and Throat of ENT Tulsa office is that we can get the CT completed on the very same day because we have a CT scanner in our office. This allows Dr. Cordray to sit down with you and review the CT images together so we can continue right on with a treatment plan. This is dependent on the insurance as some require authorization before the CT can be obtained. He might note the other advantage of an office CT scanner is that it will give one third of the radiation that a hospital or outpatient scanner will give.
Sinus and nasal surgery can be performed in the office at Ears, Nose, and Throat of ENT Tulsa; however, there are some patients that do better using a general anesthetic. That can be because of the extent of the disease or just the patient’s preference.
An in-office procedure does not require any injection. Cotton is placed in powerful numbing medicine that is placed just inside the nose. Dr. Cordray of Ears, Nose, and Throat of ENT Tulsa starts at the very front of the nose and work back to the opening of the sinuses as the numbing medicine works. In this way the patient does not experience any pain. This is like any procedure where more medicine needs to be used on some patients. That being said Dr. Cordray certainly has had patients that have experienced pain and more medicine was added to make them comfortable.
Anxiety about the procedure is considered normal. Relaxing medicine and pain medicines are given an hour prior to the procedure to reduce concern and increase the comfort of our patients undergoing this procedure at Ears, Nose, and Throat of ENT Tulsa.
In addition to painless balloon sinuplasty procedur, other surgical issues can also be performed in the office at Tulsa ENT. Deviated nasal septum, nasal polyp removal and treatment of nasal congestion can easily be treated in the office without having to use a general anesthetic. Although this sounds crazy, Dr. Scott Cordray has conducted hundreds of cases in his Ears, Nose, and Throat of ENT Tulsa office with the experience to back up those claims.