Causes and current treatments of sinusitis

June 6, 2000

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MsBelievin1: If a case was severe and chronic, would an operation be of any help to drain and clear the sinuses, and what procedure would it be?

Dr. Moses: Yes, once aggressive medical therapy has failed in treating the chronic sinusitis, it is at this point that I would schedule a CAT scan to evaluate the anatomy of the sinuses. Based on this evaluation, I then sit down and review the scans with the patient and discuss the options. Every patient is unique, and there is not a 'cookie cutter' type surgery that will cure everyone. However, there are some basics. The premise with surgery is to open the narrow channels leading from the sinuses to allow a much easier flow. This targeted surgery will allow for drainage of the sinuses, even at times when the patient's normal channels would have narrowed. To clarify the types of operations, the standard of care today is an endoscopic sinus surgery technique which involves operating through the nose with an endoscope, using instruments through the nose to open these narrow channels. There is rarely any bruising or swelling on the face. Newer techniques, using image guided surgery, have allowed surgeons to operate on areas that were much more difficult to reach, still utilizing the approaches through the nose. These techniques, then, prevent the surgeons from having to cut above the eyes or on the face to remove disease.

Silky: Can you tell me how this new technology of 3D imaging works?

Dr. Moses: Thank you for asking! I was one of the original investigators in Philadelphia before I came to Houston, involved in 3D image guided surgery. The technique involves the patient obtaining a CAT scan with a headset that looks like a headband, prior to the surgery. Those images are then stored in a computer. On the day of the surgery, the patient is brought into the operating room and the same headset is placed on the patient's head. At that point, the headset is registered in space relative to the patient's head and that position is correlated with the images that were obtained before the surgery from the CAT scan. This allows movement of instruments inside the nose and sinuses, and gets a 3D view of the position of those instruments relative to the patient's anatomy in real time.

Mom: If a child suffers from sinusitis and has surgery, will they need to repeat this when they grow older?

Dr. Moses: Pediatric sinusitis is a completely different problem. Often, children suffer from sinusitis from other sorts of diseases. They can suffer sinusitis from large adenoids, cystic fibrosis, or other problems limited to childhood diseases. If and when a child is considered for sinus surgery, a very careful approach must be taken during the surgery. There are many centers of growth in the face adjacent to areas affected in the sinus surgery. These could affect the growth of the child's face. There have been studies done in pigs, looking at this exact question, and they did find a change in the bony anatomy, but no external cosmetic difference between the two sides of the face. In direct answer to your question, pediatric sinus surgery often requires a follow-up surgery for debrisment several weeks after the initial surgery. If the child is in a category where they also have asthma, polyps, or aspirin sensitivity, they fall into a high risk class for recurrent sinus problems, and this would have to be followed very carefully through the child's adolescent and adult years.

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