Simply put, sinus surgery is not the right treatment for all patients. When it is performed, the procedures can vary considerably, even among patients presenting with similar histories and symptoms.
Advances in Sinus Surgery
Traditional sinus surgery, which was developed in the 1950s, focused on draining or removing infection from the sinus cavities. This usually meant surgically opening the sinuses, often through direct incisions on the face, scalp, or in the mouth above the upper teeth. Not only did these procedures often fail to treat the underlying causes of sinus blockage and subsequent infection, they were rather invasive, resulting in prolonged recovery periods.
In the 1970s, Austrian otolaryngologist Walter Messerklinger, a professor in Graz, Austria, discovered that sinus disease was usually due to areas of blockage in the osteomeatal complex, the small channels through which the sinuses drain into the nose. He further observed that gently clearing or unblocking this narrow area, using nasal endoscopes and delicate surgical techniques, would promote normal mucus drainage and restore sinus health.
The introduction of the microdebrider in the early-1990s helped to popularize this approach. This electrically powered instrument can shave away and remove diseased tissue, one thin layer at a time, leaving healthy tissue unharmed. The microdebrider encourages gentle dissection of the tissues and does not damage the healthy anatomy as is common with traditional instruments. Quick healing usually follows this gentle surgical technique.
Another major advancement in sinus surgery occurred with the introduction in the mid-1990s of an approach known as Image Guided Sinus Surgery. During the procedure, the surgeon interacts with 3-dimensional CT images on a powerful computer system, attached to the patient via a headset. With this perspective, the surgeon can positively pinpoint areas of disease as well as maintain ideal positioning of surgical instruments in the patient’s complex and delicate sinus cavities providing a real-time surgical road map. This image guided technique can dramatically improve surgical accuracy, leading to more consistent results, and shortened operating and anesthesia time.
A new technique, balloon sinuplasty, uses inflatable balloon tipped catheters to dilate narrowed sinus openings, without removal of any tissues. This is similar to the procedures used in cardiac catheterization and appropriate in certain cases.
New, innovative approaches to sinus care are constantly developed. As a result, it is not uncommon for physicians who do not specialize in sinus care to have rather limited access to and knowledge about the latest treatment options. This information lag can cause occasional confusion for physicians and patients alike concerning the best course of treatment for any one patient’s condition.
Indeed, New York Sinus Center physicians treat many patients who have failed previous medical and surgical therapy. For example, in instances where antibiotics were prescribed, the treatment course may have been too short, leading to immediate relapse, or the antibiotics were prescribed without the guidance of bacterial culture tests, leading to the wrong drugs being tried with limited or no efficacy. As a result, the opportunity to eradicate sinus infection and prevent chronic sinusitis is, unfortunately, frequently missed.
Minimally invasive, targeted surgical techniques are now widely recognized as the most effective, least discomforting and least invasive approach to remedying sinus disease. The New York Sinus Center has been using these advanced tools for more than a decade to pinpoint disease in patients with focal, localized blockage. We consistently find these technologies invaluable in the surgical treatment of patients who have extensive disease, such as massive nasal polyps and allergic fungal sinusitis, as well as in cases where previous surgeries may have caused scarring and other forms of tissue damage.