INTRODUCTION The nasal cavity is separated into two nasal cavities by a midline partition (nasal septum). Paired frontal sinuses, ethmoid sinuses, maxillary sinuses, and a partitioned sphenoid sinus located at the base of the skull drain directly or indirectly into the nasal cavity. These sinuses bony cavities are filled with air and lined with a mucus membrane; they serve to lighten the skull, protect the brain from head injury and improve vocal resonance. If the nose is injured, the septum is frequently deviated resulting in difficulty breathing and obstruction of the sinus drainage pattern. The nasal cavity has paired mucus membrane covered folds (turbinates) that help cleanse, warm, and moisten air to prepare it for the lungs. Abnormal turbinate function can cause airway obstruction and a stuffy nose. Septoplasty, surgical correction of a deviated septum and turbinate reduction can be corrected by the surgeons at Ear, Nose and Throat Associates.
Otolaryngologists treat diseases of the nose and sinuses medically and surgically. Common diseases include allergic rhinitis, nasal polyposis, acute sinusitis, chronic sinusitis and cancers of the nose and sinuses.
ALLERGIC RHINITIS Forty-five million Americans suffer from a recurring disease called allergic rhinitis, also commonly known as "hay fever". Common symptoms caused by allergies are itchy eyes, sneezing, nasal stuffiness, nasal congestion and drainage, or headache. Some people experience hearing changes, scratchy sore throat, hoarseness and/or cough. Less common symptoms include dizziness, facial or throat swelling, and even respiratory problems, like asthma. Some allergy sufferers experience symptoms all year long and others find certain seasons cause allergy attacks. Symptoms are controlled best when multiple management approaches are used simultaneously. Minimizing exposure to allergens, using medications, and desensitization with allergy shots are all helpful in controlling allergy symptoms.
Acute sinusitis may be the result of chronic allergic rhinitis, non-allergic rhinitis, or frequent upper respiratory infections. If there is sufficient inflammation of the sinus membranes to cause obstruction of the natural drainage ports into the nose, then bacterial colonization can follow leading to subsequent acute sinusitis. Symptoms can include facial pain and swelling, green or yellow discharge, persistent stuffiness and headache. Acute sinusitis is treated with antibiotics and other supportive medications including nasal sprays and mucous thinners. Your ENT physician will make the diagnosis of sinusitis by your clinical history and using sophisticated tools like a fiberoptic nasal endoscopy to directly visualize the nasal anatomy.
CHRONIC SINUSITIS Chronic sinusitis can result from persistent allergic rhinitis, recurrent unresolved acute sinusitis, or structural blockage. If chronic sinusitis is severe enough, it will require surgery. Surgery can be as limited as a nasal polypectomy; however, usually endoscopic sinus surgery is required. ENT surgeons in our practice specialize in endoscopic sinus surgery. Patient preoperative preparation for sinus surgery includes obtaining a sinus computer tomography CT scan or preferably a landmark CT scan. Mills and Peninsula Hospital, as well as other facilities perform these specialized CT scans. Also, the Medtronics LandmarX Navigation System is used in the operating room, allowing for pinpoint accuracy in identifying disease tissue and normal anatomy. This technology greatly decreases the risk of complication in the critical areas adjacent to the sinuses, such as the eyes and brain.
NASAL POLYPS Nasal polyps can be the result of allergic rhinitis or recurrent infection. They sometimes can be controlled by topical nasal steroids. Frequently, polyps require surgical removal under general anesthesia.
CANCER Cancers of the internal nose and sinuses are very rare, yet cannot be missed. Diagnosis involves office-based nasal endoscopy and computer tomography identification. A multidisciplinary approach to diagnosis and treatment is usually required. This may include surgery, radiation and chemotherapy.
Medtronics LandmarX Navigation System
The Medtronics LandmarX Navigation System allows the surgeon to perform image-guided endoscopic sinus surgery. A special CT scan of the sinus is done pre-operatively, and entered into the computerized system. The system is then used during the surgery to confirm the position of the surgeon’s instruments at all times. The CT images and direct views from the endoscope are visualized throughout the procedure.
The surgeons of the Ear, Nose and Throat Associates of San Mateo utilize the LandmarX image-guidance system for many of their endoscopic sinus surgeries. The surgeon views the anatomic landmarks using endoscopes. Additionally, the navigation system confirms the positions of the surgeon’s instruments by superimposing them on the CT scan images. This is especially helpful in cases of revision surgery, unusual anatomic structures or nasal polyps, all of which can make visualization of the normal sinonasal structures more difficult.
Image-guided surgery can make surgery quicker and safer for the patient.