Endoscopic Sinus Surgery: Ten Reasons to have Sinus Surgery

Endoscopic Sinus Surgery:  Ten Reasons to have Sinus Surgery


(bright xylophone music) – Hi, my name is Dr. Jeff Terrell, I’m an otolaryngologist at
the University of Michigan. I specialize in rhinology. I see patients every week in clinic that are being assessed for
whether they need sinus surgery or for the medical
management of sinus diseases. And I see a lot of patients
that need sinus surgery, and frankly, I see a lot
of patients that don’t need sinus surgery, and then
also, patients that have had sinus surgery that probably
didn’t need sinus surgery. So I’ve written a blog on one website called nosinusallergy.com, but I think I wanted to make
a YouTube video on it as well. And the topic for today is, 10 good reasons to have sinus surgery. And if you tune in, I hope
to very soon make a video which may be more
interesting to some of you, which is 10 reasons not
to have sinus surgery. So I’m gonna start off with number 10, and which may be less common, and then work up to number one, which may be one of
the more common reasons to have sinus surgery. Sinus surgery, also called
endoscopic sinus surgery now because we work with
instruments through the nose, which a small fiberoptic
scope, four millimeters, it’s attached to a camera,
and I can include some photos in this video as well
that I’ll overlay my talk. But one of the reasons to have
sinus surgery, my number 10, is recurring sinus infections in patients with an impaired immune system. So, first of all, what’s
an impaired immune system? There are these biologic
drugs you hear on TV Now, Humira for rheumatoid arthritis
or psoriasis, other drugs that suppress the immune system for people that have autoimmune disorders. Unfortunately, those drugs
also suppress your ability to fight infections, and
so some people on these immune modulators or biologic drugs will get sinus infections, and they have a hard time
clearing the sinus infection. Oftentimes, we have patients
stop their biologic drug to see if their immune system
can clear the infection. But if it doesn’t, we
sometimes treat these patients with surgery to open the sinuses. Another cause for sinus surgery, or reason for sinus surgery,
number nine in my list, is nasal polyps and severe allergies. These are patients without
asthma and nasal polyps, they have severe allergies,
and they get a nasal polyp. And a polyp is, I liken
it to like a grape. It’s a swollen, watery tissue that hangs from the tissues in the nose. There are things called
turbinates in the nose, polyps can form on these turbinates and sometimes block the nose. Not real commonly, we sometimes
even do that in the office if it’s just one polyp in
the nose blocking things, I do that quite commonly. But this is just people
with allergies and polyps, and I want to make sure
that’s different from people with nasal polyps and asthma. That’s a different group. Why don’t we do that now,
number eight is triad asthma. (phone rings) Triad asthma is, there are
three things in the triad. It’s usually adult onset
asthma, nasal polyps, and aspirin or Motrin sensitivity. So, these are patients that
frequently are quite healthy, and they develop some nasal
obstruction, oftentimes first, then they may have a
decreased sense of smell, and these are the polyps
that are forming in the nose. And then, these patients
will develop asthma. So that’s the polyps and the asthma. The third thing is aspirin sensitivity. So one day, these patients
will take aspirin or Motrin, or a nonsteroidal anti-inflammatory drug, and that will cause them
to have an asthma attack. Sometimes quite severe. So if you have nasal polyps, asthma, and aspirin sensitivity,
and the nasal polyps are quite large, that’s a
common reason for sinus surgery, at least in Michigan, and
some areas of the country have more or less, but that’s a
common reason for sinus surgery. Those patients, oftentimes their nose is completely obstructed with polyps. Number seven is called
an antrochoanal polyp, there’s the maxillary sinus,
it’s called the antrum, sometimes a large cyst
will form in a sinus. It’ll fall into the nose. It’s called an antrochoanal polyp when it blocks up the nose. These are not very common, but
it’s an absolute indication for surgery because people
are pretty miserable when the polyp blocks one nose. Number five would be a fungus ball. It’s not very common, but
occasionally, people can inhale some mold or fungus that can
get trapped in the sinuses. When we look at CT scans, we
can oftentimes see the fungus. It looks different, it’s a lighter color gray in the sinuses. I can see if I can add a photo of that, and the fungus oftentimes
gets trapped in the sinus. The sinus has a very small opening. The fungus ball is
larger than the opening. That’s again, typically,
and absolute indication, a very reasonable indication,
to do sinus surgery, because the fungus won’t come
out through a small opening. Similarly, there’s something called allergic fungal sinusitis So this is fungus that gets in the sinus, but then you get this
incredible inflammatory or allergic response to it
that causes nasal polyps, and either the fungus or
the polyps can actually push bone and erode bone and thin bone. So sometimes it pushes towards the eye, or pushes out the eye, or pushes backwards towards the brain. Again, a CT scan, and an ENT doctor that is somewhat experienced
should recognize this. Sometimes they don’t. But this is allergic fungal sinusitis. And we see this because there’s areas of a lighter color fungus, the nose gets plugged up with polyps, and you see the nasal
polyps in the CT scan, and some expansion and
erosion of the walls. So that’s allergic fungal
sinusitis, that’s number four. Number three, if there’s a
foreign body in the sinuses that keeps getting infected. Again, this is not very common, but it’s an almost an absolute indication. Some people have jaw surgery, trauma, plates, pieces of plastic. Sometimes a tooth fragment
will be pushed up to the sinus. And, when that sits in the sinus, it forms kind of like a
splinter or a foreign body. It keeps getting infected. And so, this is not very
common, but when it does occur, it usually is something that needs surgery to get out that foreign body. Recurring sinus infections
that don’t clear with antibiotics is another common cause for needing sinus surgery. Number two on my list. And actually, I think most of the time when people have recurring
sinus infections, it’s either due to allergies
or they’re just exposed to, I call it germ warfare. They get a lot of colds. Those are the two most common causes. Usually if you treat the
allergies or try to avoid getting colds by hand washing
and those sort of things, usually you can avoid doing sinus surgery. But occasionally people do get
recurring sinus infections. I tell them to watch
out for a tooth abscess that can cause sinus infection. It’s not on my list, but
whenever anybody gets a recurring sinus infection,
particularly in this sinus, we do look for an abscessed tooth. Probably should be my
number 11 on the list. So that was number two. Number one is chronic
bacterial sinus infections that have failed all
medical interventions. So by that I mean, somebody
that’s had two or three courses of antibiotics, and the infection with a
yellow-green nasal discharge and nasal blockage, maybe some pressure, keeps coming back or never improves. Oftentimes in the clinic,
we’ll culture these patients to find the best antibiotic,
but even the best antibiotic sometimes doesn’t
work, and the sinus needs to be opened and drained. We see this with dental
infections as well, when a tooth root gets infected, and then the sinus gets infected, and it’s hard to clear
some of those infections. Sometimes, the sinus fills
up with very thick, you know, pus, actually, and it’s
so thick and sticky, it just can’t work its way out. It just keeps getting infected. Kind of like an abscess. And to treat an abscess in
the skin or anywhere else in the body, first you have
to open it up and drain it. In the sinus, we wash it out and then treat it with antibiotics. So those are the top 10
reasons for sinus surgery. I hope you’ll consider
tuning in ’cause probably as many of you need to
know the top 10 reasons to not have sinus surgery. (bright xylophone music)

7 Comments

  • Samantha Hicks says:

    I had an asthma attack after taking darvocet I sneezed and it threw me into such a severe attack. My heart stopped and I ended up on the ventilator.

  • Joy Thorpe-McCarter says:

    How do I contact this doctor? I have Triad Asthma in which he spoke about.

  • OlymPigs2010 says:

    …another thing that can cause Chronic Sinusitis is Hypothyroid also known as Low Thyroid.Hypothyroid lowers the body's temperature making areas like the Sinuses more susceptible to the growth of various Infectious agents!

  • Mike Smallwood says:

    Go watch my very informative video about my sinus surgery experience.

  • Laura Eager says:

    My reasons for having sinusitis was recurring infections not responding to medical therapy and blocked frontal sinuses in my CT scan for my second surgery.

  • Giovanni Foulmouth says:

    I got polyps but no asthma nor allergies and I'm scheduled for surgery.

  • Lynette B says:

    Maybe I missed this, but what about a recently discovered large maxillary cyst in someone with sleep apnea, that has already undergone turbinate reduction sugery along with deviated septum surgery corrrection. Turbinates are growing back. Has suffered with sinusitis and fairly bad allergies for 47 years.
    Thank you

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