Elective surgery to facilitate drainage of the sinuses by widening the openings and removing excess mucus or diseased tissue is easier, faster and safer today than ever before. Modern advances in medical technology, specifically the endoscope (a thin fiberoptic tube inserted through the nostrils) and surgical lasers, allow for a minimally invasive procedure with less post-operative pain and shorter recovery time. Three-dimensional imaging provides the surgeon with real-time visualizations of the patient’s sinuses to avoid damage to neighboring structures such as the brain, eyes and arteries.
The decision to undergo surgery may be made when sinus infections recur or do not respond to medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) or to non-surgical procedures such as flushing. Pre-surgical testing includes nasal endoscopy, CT scan and allergy testing to determine the effect of allergies on the problems experienced.
Surgery is usually outpatient and may be performed in a hospital or surgical center with local or general anesthesia. Recovery time is minimal, with results appreciated within four to six weeks.
Sleep-disordered breathing describes a group of abnormal breathing patterns experienced during sleep, which may manifest as light or heavy snoring, pauses in breathing (sleep apnea) or complete airway collapse. People with obstructive sleep apnea syndrome stop breathing while they sleep, sometimes hundreds of times per night and sometimes for a minute or longer each time. The soft tissue at the back of the throat closes, blocking (obstructing) the person’s airway. A common warning sign of obstructive sleep apnea is snoring (especially snoring interspersed with gasps or lack of breathing), although the two are not always related. Because the brain and major organs are deprived of essential oxygen when breathing is disrupted, if left untreated sleep apnea can result in high blood pressure, cardiovascular disease, stroke, memory problems, weight gain, impotency, headaches, and daytime fatigue leading to job impairment and motor vehicle crashes.
There are many treatments available for sleep apnea and other sleep-disordered breathing problems. Snoring independent of sleep apnea can be lessened with changes in diet and weight loss and reduction of alcohol, tobacco and other drugs; if this fails, surgery of the soft palate may be elected. Traditionally, this involved a procedure called uvulopalatopharyngoplasty, which removes the tonsils, uvula and part of the soft palate to open the airway. Now, more advanced procedures such as Laser Assisted Uvula Palatoplasty (LAUP) and somnoplasty (radiofrequency ablation) are performed to stiffen the soft palate without the need for general anesthesia.
Before surgery is attempted, patients suffering from sleep apnea are given a breathing mask to wear at night that uses Continuous Positive Airway Pressure (CPAP), wherein air is forced past the obstruction for clear breathing. If this fails to correct the problem or if the patient is too uncomfortable to continue, surgical options may be considered, such as uvulopalatopharyngoplasty or a procedure using radiofrequency energy that shrinks the base of the tongue and the soft palate.
Nasal obstruction (stuffiness, congestion) affects millions of Americans. It arises from a number of causes, including a deviated septum (misalignment of the normally centered sheet of cartilage and bone which divides the nose into a right and leftpassageway); swelling of the mucosal covering of the turbinates (bony structures lining the inside of the nose) due to illness, allergy, infection or other irritation; sinus blockage; enlarged adenoids (masses of lymph tissue in the back of the throat); and aging.
Tests for nasal obstruction include nasal endoscopy and CT scans. If non-surgical methods such as nose sprays and decongestants prove insufficient to reduce chronic congestion, surgery may be elected.
Surgical treatments range from adhesive strips for minor blockages associated with aging, to in-office injection, freezing, radiofrequency, laser or cautery procedures for turbinate reduction, to an outpatient procedure called septoplasty. Septoplasty (called septorhinoplasty when it is combined with cosmetic improvements) involves the re-shaping of the cartilage and bone for improved air flow. Full enjoyment of results from septoplasty are usually experienced within a week or two when swelling is reduced and splints or packing are removed.