In the past, sinus surgeries were a nuisance but today’s endoscopic approaches to nasal and sinus disorders are less invasive, less painful, and yield great patient outcomes. In this episode of the Texas ENT Audio Blog, Dr. Ryan Reilan discusses the most common sinus disorders and the latest technology to get relief.
Shelby Stockton (00:00):
Welcome to the Texas ENT audio blog. I'm Shelby Stockton, and today I discussed sinus disorders with otolaryngologist, Dr. Ryan Neilan. We discuss the most common sinus disorders, how they're diagnosed, and treatment options. Dr. Neilan also educates us on the latest technology to help patients get relief. If you suffer from sinus disorders, this is the audio blog for you. Dr. Neilan, thank you very much for taking time out of your day to talk to me today.
Dr. Neilan (00:27):
Hello, my pleasure.
Shelby Stockton (00:29):
I have a few questions for you, mainly about sinus disorders. The first one is, what are the most common sinus disorders?
Dr. Neilan (00:38):
In our practice, we see a couple of different variations. One of the more common ones patients are usually aware of is what we call an acute rhinosinusitis, which is a sinus disease that's lasting less than four weeks. We diagnose it with symptoms like nasal blockage, congestion, discharge from the nose, post-nasal drip. Typically, these patients will also have either facial pressure or pain, and they even have a reduction in their smell. The other one that we see really commonly, and probably the one we treat the most commonly in our practice, is what we call a chronic rhinosinusitis. That's one that's lasted more than 12 weeks. These are patients that have had this ongoing. They've usually been to an urgent care or their primary care doctor and have already experienced some sort of treatment that's not worked for them or worked short term and has come back. These are patients that have similar symptoms from a complaint standpoint, as far as just discharge, obstruction pressure.
Dr. Neilan (01:49):
With chronic sinusitis, if it's been going on this long, we usually do a little bit more of a workup rather than just a normal exam. We usually do what's called a nasal endoscopy where we look around the nose with a camera. We're looking for signs of drainage from the nose or nasal polyps in the nose, signs of inflammation. Oftentimes, we'll often get what's called a CT scan, which is just some quick images of the inside of the sinuses looking for some of this inflammation.
Dr. Neilan (02:19):
We also have patients that have what's called a recurrent acute sinusitis where they're having these episodes that do tend to resolve completely within that four week period. But they're having four or more episodes a year. They'll feel well for a while, and then it just seems like they just fall back into another infection and the process continues. We also treat patients that have what's called allergic fungal sinusitis, which is an extreme version of chronic sinusitis with polyps. That's due to an allergy from molds that are in the environment. We also treat patients with a much rarer disorder that's called aspirin exacerbated respiratory disease, which is just a more aggressive polyp form of sinusitis.
Shelby Stockton (03:12):
Wow. How do you diagnose all these different sinus disorders?
Dr. Neilan (03:18):
A lot of it's clinically in their history and what they're telling us. A lot of it has to do with either the endoscopy or radiographic findings. Most of them really require both, require some sort of an objective data showing visual signs of the disease along with their symptomatology. There's some nuances to how the CT scans look. Some of those, particularly allergic fungal sinusitis, based on the imaging, you can get a feel for which patients are having that sort of a disorder.
Shelby Stockton (03:58):
What are some of the treatment options?
Dr. Neilan (04:02):
With the acute sinusitis, they're usually resolving with nasal steroids, nasal saline, sometimes antibiotics. The ones that we were really spending a lot of time treating are that group of the chronic sinus patients. We almost just always manage them medically first, and so a typical treatment regimen probably is about three to four weeks of medical treatment. This typically involves nasal saline, intranasal steroid sprays. Often, it will involve shorter courses of antibiotics, two to three weeks typically. Along, if they do have polyps, we will give them oral steroids as well. After a course of therapy, we have them come back and see number one, symptom-wise how are they doing? Are they feeling better? One of the things that people overlook with these chronic disorders is the patient's experiencing more than just the nasal symptoms of this. This tends to affect their energy level during the day. It tends to affect their sleep quality. We just assess how they responded to that therapy.
Dr. Neilan (05:14):
Usually at that time, we're getting some sort of follow-up either endoscopy or imaging to see, did we make the disease go away or not? Are they still having issues. For patients that have failed that three to four week medical regimen, those are patients that if they're having a lot of quality of life issues still tend to be candidates for surgery. Those surgeries can vary immensely just based on the disease burden. Patients with pretty mild disease with some mild anatomic changes may benefit from what we would call a balloon sinuplasty. That's performed in the office with them awake. Patients that have really bad polyps and very, very high mucosal disease burdens are people we usually end up taking to the operating room and really opening up their sinuses more.
Dr. Neilan (06:08):
When we're performing surgery on these patients, our primary goal is just to improve their quality of life. We want to try to reduce that mucosal disease burden. And then we want to be able to really open up those sinuses where postoperatively after surgery, we can give them nasal sprays and nasal rinses that can actually penetrate into those sinuses to continue to treat them and continue to try to reset their sinuses.
Shelby Stockton (06:35):
Is there any latest technology that's helping patients get relief?
Dr. Neilan (06:42):
The balloon sinuplasty is one of the bigger ones, and so it allows us to access some of those sinuses easier. It's a nice tool to be able to get into sinuses. The technology as far as surgical navigation, being able to in real time know where you are off of a CT scan, has helped increase the safety of sinus surgery and the speed at which it could be done. And then there are some recent studies looking at these endotypes, or just different molecular types of these sinusitis issues. Some of the companies have come out with what we call biologics, which are therapy infusions for some of these patients, especially in polyp patients that have failed medical therapy and maybe have even had a surgery or two and continue to have their polyps grow back, despite all of our best efforts. Some of these biologics may be paving the way for the future.
Shelby Stockton (07:49):
Wow. That's so interesting. Dr. Neilan, thank you so much for spending some time with us today.
Dr. Neilan (07:54):
Oh, you're so welcome. Thank you.
