Chronic sinusitis affects millions of people every year.  Some people with chronic sinus problems can’t get relief with medications, no matter what they try.  They may need to consider having sinus surgery to get some relief.  

Sinus surgery can help enlarge the sinus openings.  The goal is that the larger sinus openings will allow the sinuses to drain more easily.  The larger openings can also make it easier for medications to get into the sinuses.  All of this can then help the sinuses function better.

ENT doctors now perform two main types of procedures to treat chronic sinus problems. One is traditional endoscopic sinus surgery and the other is balloon sinuplasty.

Endoscopic sinus surgery is also called functional endoscopic sinus surgery (or FESS for short).  Surgeons have performed endoscopic sinus surgery over the course of 30+ years.  With endoscopic sinus surgery, the surgeon uses a little endoscope through the inside of the nostrils to look for the little openings into the sinuses.  The doctor then uses different surgical tools to enlarge the narrow sinus openings under direct visualization.

Balloon sinuplasty has been used for about 10 years.  With balloon sinuplasty, the doctor inserts a balloon into the nostrils.  They aim the balloon into the sinus opening.  They then inflate the balloon to try to stretch the sinus opening.  There has been a big increase in the number of patients having balloon sinuplasty over the last five years.

At our office, patients sometimes ask which type of procedure is better for them.  We typically find that traditional endoscopic sinus surgery is the better option for most of our patients.  Here are some reasons why:

Endoscopic sinus surgery is more precise and effective at opening the sinuses 

The goal of the sinus surgery is to enlarge the openings into your sinuses.  With endoscopic sinus surgery, small tools are used to enlarge the sinus openings.  The surgeon removes small amounts of material around the natural opening of the sinuses. The endoscope has a little camera so that the surgeon can see and enlarge that the opening.  The surgeon can also make the opening as large as they may need to for the type of sinus problem you are having.

Balloon sinuplasty stretches the sinus openings.  That can stretch the sinus opening, but stretching can only open the sinus so much.  The surgeon typically cannot see the location of the sinus opening as precisely with balloon sinuplasty.

For someone with very narrow sinus openings, the endoscopic sinus surgery will be able to enlarge the openings more effectively.

Endoscopic sinus surgery makes it easier to monitor your sinuses after surgery

Patients with chronic sinusitis issues can still have some sinus issues in the years after sinus surgery.  To diagnose and treat issues after sinus surgery, it is helpful for your doctor to look inside the sinuses.

A nasal endoscope is used to look inside the nose and sinuses of patients with chronic sinus problems.  After endoscopic sinus surgery, your doctor will typically be able to look directly into the sinus openings and see inside the sinuses.  They can do things like monitor the healing after surgery, monitor long term sinus inflammation, diagnose future sinus problems, and get samples of infected mucus from the inside of the sinuses.   If you have an infection, the doctor can take a sample for cultures.  This can then help treat future sinus infections more precisely. With the culture results, the doctor can select the correct antibiotic for the specific bacterial strains that may be causing a particular sinus infection.

After balloon sinuplasty, the opening into the sinus is typically not large enough to allow the doctor to look inside with a nasal endoscope.  Your doctor usually won’t be able to suction mucus or infected material from the inside of the sinus.  This can make it harder to monitor, diagnose, and treat sinus issues on a long term basis.

Endoscopic sinus surgery allows nasal sprays and nasal flushes to get inside the sinuses more effectively

Many patients with chronic sinus problems need to use some day-to-day treatments to keep the sinuses healthy after surgery.  Maintenance treatments can help keep the sinuses healthy.  

The larger sinus openings after endoscopic sinus surgery allow for nasal sprays and nasal irrigations to get inside the sinuses more effectively.  

The openings after balloon sinuplasty are smaller, making it more difficult for sprays and irrigations to enter the sinuses.

Endoscopic sinus surgery can be used to treat all of the sinuses

There are four sinuses on each side of the nose and face.  The names of the different sinuses are: the maxillary, ethmoid, sphenoid, and frontal sinuses.  With traditional endoscopic sinus surgery, a surgeon can enlarge the opening into each one of these sinuses.

With balloon sinuplasty, the doctor can stretch some, but not all, of the sinus openings. There is no balloon to treat problems with the ethmoid sinuses.  

The ethmoid sinuses have much smaller air pockets than the other sinuses.  They are often very prone to getting plugged, so they’re an important area for treatment if someone is having sinus surgery.

Endoscopic sinus surgery treats conditions like nasal polyps more effectively

Many patients with chronic sinus issues have nasal polyps.  Surgery for nasal polyps usually involves removing polyps and enlarging the openings into the sinuses.  

Endoscopic sinus surgery is very effective at removing polyps and at creating wide sinus openings.  Patients with nasal polyps usually have severe sinus inflammation.  Using maintenance medications to treat the inflammation is an important part of keeping the sinuses healthy.  The larger openings help medications get into the sinuses.  Nasal sprays or medicated nasal sinuses can enter the sinus areas after endoscopic sinus surgery.

Balloon sinuplasty may stretch the sinus openings, but a sinus balloon cannot remove nasal polyps.  The openings after balloon sinuplasty are typically smaller than with traditional endoscopic sinus surgery. The smaller sinus openings make it harder for medications to get into the sinuses after balloon sinuplasty.

We hope that answers some questions about the differences between endoscopic sinus surgery and balloon sinuplasty. It’s important to remember that different treatments are right for different situations.  If you are having chronic sinus issues, seeing a good sinus surgeon is a good starting point as you try to determine the best treatment options for your particular issues.

If you are interested in an appointment for evaluation of your sinus issues at our New Jersey or New York office, please contact us by phone or by requesting an appointment online.  

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With the freezing cold temperatures we have been having recently, it’s hard not to think about how the cold weather might affect our chances of getting sick. Well, a recent study looked at this very topic.

Researchers at Yale looked at the effect of temperature on a common virus that causes colds. In the study, the researchers looked at the immune response to the rhinovirus. The rhinovirus is the most common cause of the common cold. Using mouse cells, the researchers studied the effect of temperature on viral replication.

The study found that there was a weaker immune response to the virus at lower temperatures. This weaker immune response may allow the virus to replicate more aggressively. This, in turn, could lead to a higher chance of developing a viral infection.

So, there may be some scientific basis to the old adage of keeping warm to avoid getting sick.

A cold can lead to nasal stuffiness, nasal drainage, facial pressure, and a general feeling of misery. In most situations, a cold goes away on its own. Sometimes, though, a cold is just the beginning. A cold can help create conditions that might make a bacterial sinus infection more likely. In some situations, lingering infections and inflammation can lead to chronic nasal and sinus problems like chronic sinusitis.

Here is an interview with one of the study’s authors conducted by Science Friday:

Here are some additional links about the study: Article by Science Friday. Summary News article on Yale website. Article abstract in PNAS.

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Dr. Parul Goyal, from Syracuse Otolaryngology, gave presentations this week at the International Rhinologic Society Meeting in Dubai, United Arab Emirates.   The meeting was the largest Rhinology conference held in the Middle East, featuring speakers and participants from all over the world.  The aim of the meeting was for surgeons to learn and share knowledge about the treatment of problems affecting the nose and sinuses.

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Many patients suffer from chronic nasal congestion.  There are many problems in the nose that can cause nasal congestion.  Problems that can lead to nasal congestion include a deviated septum, enlarged turbinates, and narrow nasal valves.  Patients who suffer from chronic problems with nasal congestion sometimes benefit from surgery.

Drs. Goyal and Suryadevara both specialize in nasal surgery.  Dr. Goyal is a Rhinologist who focuses on surgery involving the structures inside the nose.  Dr. Suryadevara is a Facial Plastic Surgeon who focuses on external nasal reconstruction.  The two surgeons frequently work together on patients with complex problems affecting the nose and sinuses.  In addition to performing surgery, both doctors teach other physicians about the types of surgery used to treat patients with nasal congestion.  The two have also published research studies about surgery to treat nasal valve problems.

The nasal valve is typically the most narrow portion of a patient’s nose.  In patients who have chronic congestion, this area can be particularly  narrow.  In their courses, Drs. Goyal and Suryadevara described how physicians can diagnose and treat patients who have narrow nasal valves.  Both doctors point out that the best way to diagnose problems in patients with nasal congestion is to carefully examine the nose.  They do that by looking at the shape, size, and strength of the structures on the inside and the outside of the nose.  For the inside of the nose, using a tool called an endoscope can be very helpful.  After finding the narrow areas, surgeons should target surgery to an individual patient’s problems.

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Dr. Lindsay Sobin

Dr. Parul Goyal

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Dr. John Craig

Dr. Amar Suryadevara

Dr. Parul Goyal

Cover of the January-February 2014 issue of AJRA featuring picture from article by Drs. Craig, Goyal, & Suryadevara

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