Sinuses are air-filled spaces embedded in the facial bones in the nasal cavity. It has various functions such as reducing the weight of the skull, creating a barrier against shocks and moisturizing the intranasal area by creating regular secretions. Sinusitis is the infection of the sinuses around the nose cavity. Infections that emerge in short-term are called acute sinusitis. The infections which are repetitive and continue longer than 3 months are called chronic sinusitis. Acute sinusitis acts as an upper respiratory tract infection and can be treated in similar ways which are used in this infection. Chronic sinusitis requires medication besides surgical therapy. The diagnosis is made through the patient’s story, nasal endoscopic examination and radiological investigations. Computed Tomography (CT) is the most useful technique in radiographic examinations. Patients’ complaints are similar as in a severe flu, such as headache, facial pain, nasal congestion, cough, fatigue and coryza. In acute and some chronic sinusitis 10-14 days of appropriate antibiotic treatment may be sufficient. In chronic sinusitis treatment, we need to eliminate the causes of chronicity. In order to achieve this, surgical treatment is often the most convenient way.

During the past 15 years, a great progress has been recorded in surgical treatment of chronic sinusitis. A surgical procedure is applied which does not harm intranasal mechanism and nasal mucosal structure. The experience and knowledge of the surgeon is very important in this technique known as Functional Endoscopic Sinus Surgery (FESS). In this surgery practice, sinuses are achieved with the aid of an endoscope by working in nose. Sinuses are cleaned without damage to the surrounding tissue and natural channels are re-opened for enabling the physiology to gain its regular functions after the operation. Because it protects the sine function and foresees the correction of altered physiology, the results of endoscopic surgery are very successful. Sinusitis problem is solved at a great rate by an operation which is performed with the aid of special microsurgical instruments and endoscopes showing the finest detail of sinuses and nose. Functional Endoscopic Sinus Surgery is difficult to doctors while it is an easy operation to patients. Doctors who will perform the operation must have all technical equipment, the knowledge and experience. This surgery can be performed under local or general anaesthesia and is completed in a period of 1-2 hours. Post operation period passes very easy and patients can return to their daily activities due to absence of a large buffer that completely covering the nose. Patients are generally discharged on the first day of the operation and are being treated as outpatients. Patients are monitored after the buffer is removed within 1-2 days and they can return to work at the 5th day. After the 3-week of early follow-up period, patients are taken into a long term follow-up.

Sinuses

Sinuses are air-filled spaces embedded in the facial bones in the nasal cavity. They help the nasal physiology. Although some parts of these sinuses are present at birth, some parts are evident in the childhood. These sinus forms include maxillary, ethmoid, frontal and sphenoid sinuses.

Sinusitis

Sinusitis is an infection of the air spaces around the nose cavity called sinuses. Infections that emerge in short-term are called acute sinusitis and infections which are repetitive and continue longer than 3 months are called chronic sinusitis. While acute sinusitis act as an upper respiratory tract infection and can be treated in similar ways, chronic sinusitis requires medication besides surgical therapy.

Diagnosis: The diagnosis is made through the patient’s story, nasal endoscopic examination and radiological investigations. Computed Tomography (CT) is the most useful technique in radiographic examinations.

Symptoms: As seen in a severe flu, headache, facial pain, nasal congestion, cough, fatigue and coryza are the main symptoms of a sinusitis.

Medication: In acute and some chronic sinusitis 10-14 days of appropriate antibiotic treatment and some medications are used to correct the swelling in the nose. In chronic sinusitis treatment, the most convenient way is the surgical treatment against the causes of chronicity. In order to achieve this, surgical treatment is often the most convenient way. Medication alone will not be sufficient.

Surgical Treatment (Endoscopic Sinus Surgery)

During the past 15 years, a great progress has been recorded in surgical treatment of chronic sinusitis. A surgical procedure is applied which takes into account the working mechanism (physiology) of nose and sinusitis formation mechanism and utilizes the technology. The experience and knowledge of the surgeon is very important in this technique known as Functional Endoscopic Sinus Surgery (FESS). Old techniques that do more harm than benefits should be abandoned, although they are still applied. In this surgery practice, sinuses are achieved with the aid of an endoscope by working in nose. Sinuses are cleaned without damage to the surrounding tissue and natural channels are re-opened for enabling the physiology to gain its regular functions after the operation.

What are the results of operations?

Because it protects the sine function and foresees the correction of altered physiology, the results of endoscopic surgery are very successful. Sinusitis problem is solved at a great rate by an operation which is performed with the aid of special microsurgical instruments and endoscopes showing the finest detail of sinuses and nose.

Is the surgery easy?

Functional Endoscopic Sinus Surgery is difficult to doctors while it is an easy operation to patients. Doctors who will perform the operation must have all technical equipment, the knowledge and experience. This surgery can be performed under local or general anaesthesia and is completed in a period of 1-2 hours. Post operation period passes very easy and patients can return to their daily activities due to absence of a large buffer that completely covering the nose.

How long does it take to recovery?

Patients are generally discharged on the first day of the operation and are being treated as outpatients. Patients are monitored after the buffer which does not cover the face is removed within 1-2 days and they can return to work at the 5th day. After the 3-week of early follow-up period, patients are taken into a long term follow-up.

The body’s immune system is a mechanism which recognizes the one belongs to itself and create self-defence against non-owned foreign ones. When a foreign object is detected it activates the necessary cells to secrete some chemicals if this object is encountered previously by the immune system. Sometimes this reaction may be an excessive manner. These released chemicals (such as histamine) cause some symptoms in the body.

Allergens: The allergens that cause allergies can be received through respiratory tract or orally with food. The most common allergens are pollens, grasses, house dust mites (mite), chemicals in the air due to air pollution, allergens that taken through the animal hairs and foods.

Symptoms: nasal congestion, runny nose, itching and sneezing are among the most common symptoms. Besides, the following symptoms such as itching and watery eyes and headache and facial pain due to the swelling of the nasal tissue usually occur.

Diagnosis: A complete ENT examination is done with especial observation of the conditions of the nasal tissue. Endoscopic examination of nose must be made good. Further examination is made on the patients who considered allergic rhinitis.

Tests: The most important test in the diagnosis of allergic rhinitis is the skin test. In this test, small doses of known allergic substances are given to the patient’s skin and it is observed whether there is an excessive reaction to them. It is a process which takes about 30 minutes. In addition, measurement of serum immunoglobulin levels in the blood can also give an idea about it.

Treatment: First, changes and cleaning in the environment for cutting of contact with the allergen forming the allergy must be performed. In particular, mites must be fought because they are one of the most common reasons of allergy and cause complaints along year. To achieve this, hairy and wool goods must be removed from bedroom and, it should be cleaned with a special vacuum cleaner and special detergents that destroy mites.

The drugs used in the treatment are directed at the prevention or suppression of allergic reactions. Allergic rhinitis is taken pretty good results with steroid nasal sprays used in recent years and can be used long-term.

Another method is vaccine therapy which also known as immunotherapy. In allergic rhinitis, treatment with vaccine usually does not provide same results as it obtained in other types of allergies. Because of the low success rate and long, laborious and costly nature of this method prevents it to be the first choice of treatment.

Surgical treatment: Surgical treatment of patients with allergic rhinitis is generally aimed at reducing symptoms (correction of a deviated septum and turbinate hypertrophy) or correcting other associated problems (such as sinusitis, nasal polyps). Correcting these problems will both reduce complaints and make the issued medicines more effective in nose.

Sinusitis treatment with balloon synoplasty which is a recently introduced technique all over the world and is successfully applied to appropriately selected patients with chronic sinusitis in our country is also started to be implemented by Dr. Emre İlhan.

Sinusitis which means inflammation of the sinuses is a common health problem that affects about 15 million people every year in Turkey.

Its prevalence is higher than rheumatism high blood pressure and it impairs the quality of life more than diabetes and heart failure. So much that; it does not only impairing for the quality of life in terms of physical and functional, but also it emerges as a serious psychological disease that affects humans. In terms of national economy, the money spent on the treatment of sinusitis can reach to serious amounts. For example, a recent study conducted in the United States showed that the cost of medication in each year is over $ 8 billion. In our country the situation is not much different.

The reason of sinusitis is blockage of the sinus holes. When these holes are re-opened, sinusitis completely recovers. Clogged holes can be opened in three ways.

1. With the help of medication,
2. Functional endoscopic sinus surgery
3. With the help of a balloon catheter

Medication is very effective in the early stages. In chronic sinusitis which does not respond to persistent medication surgery may be necessary. The purpose of the operation is to open clogged sinus roads. Therefore, it enables the ventilation of the sinuses. Ventilated sinus infection subsides and disappears. We can do this via endoscopic sinus surgery as well as balloon synoplasty technique.

What is the Balloon Synoplasty?

It is a procedure which opens narrowed sinus holes with the help of a BALLOON CATHETER. The logic is the same as ANGIOPLASTY used for opening congestive coronary vessels.

What are the advantages of Balloon Synoplasty?

The tissue covering the interior surface of the nose has many tasks. It warms, moisturizes, filters etc. the air we breathe. All surgery performed inside the nose may damage to the tissue more or less. The balloon synoplasty technique was emerged from the idea how the sinus opening can be opened without damaging the tissue. In this technique, a balloon is placed in the entrance of the problematic sinus with the help of a catheter. The balloon is then inflated with serum.

• The inflating balloon extends the entrance of the clogged sinus.
• Therefore any part of beneficial intranasal tissue would not be harmed.
• There will be no bleeding due to absence of any cut in the nose.
• After the procedure, you do not need a buffer. Recovery is very fast.
• Just in the next day they can return to daily life.

How long the recovery takes times after Balloon Synoplasty?

Balloon synoplasty is a minimally invasive method. Although it is performed in the hospital, there does not require night in the hospital. Though it varies from patient to patient, most of them can start to normal activities at the same day.

Who can implement the Balloon Synoplasty technique?

This technique can only be implemented by otolaryngologist who has been trained. It is not a routine intervention applied everywhere. The experience of the doctor is very essential for this procedure.

In what types of sinusitis treatments the Balloon Synoplasty is used?

The balloon synoplasty technique is used in chronic sinusitis, particularly frontal, maxillary, and sphenoid sinusitis types. Endoscopic sinus surgery should be preferred for etmoit sinusitis and polyps sinusitis.

Is there any age restriction in implementation of the Balloon Synoplasty technique?

Yes, in order to apply this technique, first of all, the person must be an appropriate patient profile for the treatment and must have completed the age of 17.

Does it make any problems for application of this technique to be treated previously with the endoscopic surgery method?

In order to implement the balloon synoplasty technique, patients should not be applied to the treatment previously via the endoscopic surgery method.

You mentioned that it is a new treatment method. So, how and where have you got this training?

I took the training in San Francisco from Prof. Levin who allowed the diffusion of this technique all around the world.

You mentioned that Balloon Synoplasty is a new method. Are there any scientific articles published on this subject?

Yes, there are.

Those interested can find below the article details.

 

The following are clinical publications relating to the clinical application of Acclarent TM’s innovative technologies. Please check back for regular updates.

Safety and Feasibility of Balloon Catheter Dilation of Paranasal Sinus Ostia: A Preliminary Investigation

Christopher L. Brown, M.D., William E. Bolger, M.D.

Annals of Otology, Rhinology & Laryngology April 2006, Vol. 115(4): 293-299;

Catheter Based Dilation of the Sinus Ostia: Initial Safety and Feasibility Analysis in a Cadaver Model

William E. Bolger, M.D., Winston C. Vaughan, M.D.

American Journal of Rhinology May-June 2006, Vol. 20, No.3, P. 290-294

Functional Endoscopic Dilatation of the Sinuses (FEDS): Patient Selection and Surgical Technique

Michael Friedman, M.D., Paul Schalch, M.D.

Operative Techniques in Otolaryngology June 2006, Vol. 17, 126-134

 

For those who want to reach more information;

www.acclarent.com

www.american-rhinologic.org addresses can be used.

Sinuses are air-filled spaces that located within the skull and links to the nasal cavity. These are:

• Maxillary sinus: There are 2 maxillary sinuses located in both cheeks. These sinuses are neighbours of eye and mouth and the tooth roots.
• Frontal sinus: There are 2 frontal sinuses located in the forehead. Important neighbours of these sinuses include the eye and the frontal part of brain.
• Ethmoid sinus: consists of many small air spaces in the nasal cave. Similar to frontal sinus, its neighbours include the eye and the frontal part of brain.
• Sphenoid sinus located in the nasal cave but in a deeper part of the skull. It is the neighbour of the skull base, optic nerves and the major arteries.

What are the tasks of the sinuses?

Sinuses together with nose are vital structures which determine the tone and character of the voice. Moistening and cleaning of the inhalation air are also their tasks. In addition, they reduce the weight of head because of their air filled structure.

Sinusitis is an inflammation of the tissue covering the inner surface of the sinuses. The most common symptoms are a headache or facial pain which similar to the symptoms appears after upper respiratory tract infections such as fever or flu. This pain can be mild or severe, it is constant, throbbing and sometimes can increase with tilting forward the head. The pain can also be felt in cheeks, teeth, eyes, behind the head or at the top of the head depending on the position of the inflamed sinus. However, there may not be any pain in chronic sinusitis. Furthermore, often inflammatory (yellow-green) runny nose, nasal congestion, nasal discharge and cough occur.

Symptoms of chronic sinusitis emerge more quietly such as reduced sense of smell and taste and increasing nasal congestion due to meat-growth formation in the nose (polyps).

If you have headache and facial pain starting and intensifying after flu, if you have intractable cough, nasal congestion and postnasal drip, if you have problems with smell;

ALWAYS CONSULT TO AN ENT SPECIALIST.