Sinusitis is an inflammation of the mucosal lining of the sinuses caused by infection (bacterial, viral, or fungal), allergy, irritants (cigarette smoke), and immune deficiencies. Sinusitis is classified by duration such as acute (less than 4 weeks), sub-acute (4 to 8 weeks), and chronic (over 12 weeks). Patients may present with a variety of symptoms including chronic nasal congestion, difficulty breathing through the nose, post nasal drainage, facial pressure and headaches sometimes leading to migraines, dental pain, coughing, and worsening of asthma and bronchitis. Comfortable diagnostic endoscopic examination of the nose and throat is performed with local anesthesia (and a piece of candy for the bad taste). When appropriate, cultures and sensitivities are obtained to identify the cause of the infection. In this manner, appropriate antibiotic and antifungal agents are selected for optimal care. Allergies are aggressively controlled with oral and nasally inhaled pharmaceutical agents that are jointly identified by the patient and Dr. Craig as providing optimal control of allergy symptoms. When indicated, referral is made for consideration for allergic immunotherapy/desensitization therapy. For chronic sinusitis and recurrent acute sinus infections, CT scan imaging of the sinuses is obtained using stealth technology that can be used for possible computer-guided surgery. These images obtained after two to four weeks of aggressive allergy and infection treatment are carefully reviewed with the patient. Further medical and surgical options, including the possibility of computer-guided endoscopic sinus surgery are discussed.
Functional Endoscopic Sinus Surgery (FESS)
Functional Endoscopic Sinus Surgery with computer guidance is an outpatient surgical procedure that is performed on the sinuses usually under general anesthetic. Patients with persistent chronic sinusitis, nasal polyps, or recurrent sinusitis despite aggressive medical treatment are potential candidates for this procedure. In these patients, the normal sinus openings may be chronically congested due to infection and allergy and they may be anatomically narrow. Computer-guided endoscopes and instruments are used to permanently enlarge the normal openings through which the sinuses drain into the nose. There is no external swelling or bruising after surgery and no nasal packing is required so that the patient is breathing through the nose immediately after surgery. If there is moderate to severe nasal septum deviation, this may be straightened concurrently to optimize the nasal airway and this also improves sinus function.