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If you have a question about chronic sinusitis or Balloon Sinuplasty, please complete the information below and it will be submitted to Howard Levine, MD.

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Recent Expert Answers

Q: Will Balloon Sinuplasty help someone with a badly deviated septum who is experiencing trouble with sinus issues and antibiotics don’t help? Scheduled for surgery but not for 3.5 months. Looking for some help/relief in the short term.

A: Balloon Sinuplasty (BSP) has been shown to be safe and effective when used by ENTs to treat patients with chronic sinusitis. It is a minimally invasive technology to manage sinusitis that has not responded to medical management. Balloon Sinuplasty does not correct a deviated septum but rather opens the obstructed sinus outflow tract. A deviated nasal septum can block the nose and/or sinuses. A deviated nasal septum may contribute to sinusitis by obstructing the normal sinus flow as it tries to get from the sinus into the nose. The deviated nasal septum may be corrected to improve breathing, relieve sinus obstruction in the areas that it is impacting the drainage pathway, or to gain access into the sinus. Short term relief for sinus symptoms usually comes from antibiotics, decongestants, and prescription nasal sprays. If these are not effective, then surgery is the best choice.

Q: I am 60 years old, and had sinus infections since I was 14 years old. I have had 15 surgeries on my nose. The doctor said he wouldn’t do any more surgeries. The operations were done by different doctors. I have 2 infections. The infections are mrsa, and serrita marcenus. Now, he wants to do Balloon Sinuplasty. I am in pain and can’t sleep. I have a pain, coughing, asthma.
Do you have any suggestions? Thank You

A: It is unfortunate that you are one of so many who are lifetime sinus disease sufferers who have had multiple sinus operations yet still have a problem. Some of the difficulties that can occur actually occur from the scar tissue created from chronic infection and the scar tissue from surgery. This causes the mucus to stagnate in the sinus (instead of flowing outward over the normal mucus membrane) and it becomes infected. In attempts to minimize scar formation, Balloon Sinuplasty Technology was developed. This is often combined with medical management. Medical management using irrigation with saline, topical antibiotics determined by culture from your doctor and mucolytic medications (those that contain guaifenisin) may help. In addition, surgery can help to open a scared and obstructed sinus permitting medication access into the sinus. Balloon Sinuplasty provides a delicate tissue preserving method to accomplish this. While Balloon Sinuplasty cannot restore normal membranes when sever scar is present, it may minimize additional scar formation.

Q: What is the recovery time for Balloon Sinuplasty? I am considering the procedure and do contractual assignments. Could I return to work the evening following the procedure?

A: Balloon Sinuplasty offers a minimally invasive way to have sinus disease managed. There are some patients whose disease permits surgery in the office under local anesthesia. For others it requires a general anesthetic in an outpatient surgery center. Most patients are able to return to activities very quickly. For some it can even be the same day and for others it is within a few days. All of this is dependent upon what is causing the sinus problem, how much surgery is needed and if any other nasal procedures must be performed at the same time like removal of nasal polyps or correcting a deviated nasal septum. You should discuss all of this with your doctor.

Q: I have had a recurring issue with phlegm, in my throat and back of my nasal cavity.  It is usually worse when I wake up, but lingers all day long.  I often clear my throat or cough, have a scratchy throat, and blow my nose to get the mucous/phlegm out. Sometimes I can feel that there is something larger (like a clump) between my throat and my nose. After clearing and coughing it usually is dislodged.  It causes me to gag because it is large, like a scab or chunk of dried phlegm. It’s pretty gross and bothersome. The doctor put me on Aciphex, thinking it might be from gastric reflux but the Aciphex is not working. My ears are also clogged quite often and produce a lot of wax and/or oozing and then dry crust.  Perhaps eczema?
I do have Sjogren’s Syndrome and Lupus. I am curious to see if there are any ideas that might help in a diagnosis and treatment.  Thank you.

A: It is quite common for individuals to have symptoms like you are experiencing.  To reassure you, there is rarely a serious problem, but rather these symptoms are typically quite annoying.  Some of the common causes can be from allergies, sinusitis, and/or gastric acid reflux.  A complete ear, nose and throat evaluation is needed.  Your doctor may be able to completely assess the problem but may need other specialists like an allergist or gastroenterologist to be certain of the correct treatment and diagnosis.

Your doctor is correct in trying gastric acid relieving medications.  Acid from the stomach can work its way into the throat while lying down (like sleeping at night) and cause scratchy sore throat, hoarseness, throat clearing and a lump in the throat, worse in the morning. Your Sjogren’s Syndrome and Lupus have been known to commonly make nasal and sinus problems and normal throat mucus much worse because of the drying of the normal secretions and from some of the medications you may have to care for those problems.

As for the ears, it is unusual for the ear problems to be related to the throat mucus.  However, your ear, nose, throat doctor should examine the ears.  Simple things like wax in the ears and eczema as you suggest are possible.

Q: I have frequent nasal irritations and a kind of cold with mucus. This gives me a headache sometimes. My hearing is also impaired with a kind of loss of sound through the left ear while speaking. My throat also has some effects of it. I have been suspecting it to be a sinusitis. However, it doesn’t block my nostril and sinus cavity and never had difficulty in breathing. Mucus is usually thick but not yellowish. It’s been almost 3 years now since I had these kind of symptoms. Is this sinusitis? Should I see the ENT Doctor soon? Thank you.

A: This may be an upper respiratory tract infection.  Sometimes these are caused by a virus and sometimes by bacteria.  Viral infections are treated with mucus thinning drugs, nasal saline, fluids and rest.  Bacterial infections require antibiotics.   Both viral and bacterial infections can involve the sinuses and become a sinus infection.  You should see your physician for an examination and proper treatment.

Q: Is someone who had previous, and unsuccessful, FESS considered a good candidate for Balloon Sinuplasty?

A: Whether there has been previous sinus surgery by any method, a person may still be a candidate for Balloon Sinuplasty.  If a peripheral sinus (maxillary, sphenoid and/or frontal) is obstructed, the balloon may be able to open the sinus with minimal trauma.  In some instances, if scar tissue from previous surgery is too great, Balloon Sinuplasty may be needed combined with traditional tools to remove the scar and dilate with a balloon.  In some cases the scar may be so severe that Balloon Sinuplasty cannot be used.

Q. My nose seems to get worse while I am sleeping. I have had trouble sleeping for the last two months. I try to blow my nose and it seems to get worse. What kind of OTC medicine would be the better choice?

A. Your problem of nasal difficulties is common and often annoying causing difficulty sleeping. It is not unusual for the nose to be more congested when lying down. This is usually caused by swelling of the nasal turbinates. Each side of the nose has three or four nasal turbinates. These normal nasal structures swell and contract all day and are more congested with allergies or a cold. Just like the legs and ankles can become swollen when sitting all day, the turbinates can become swollen during the night from lying down. The nasal turbinate congestion can shift from one side to the other with the side down being more obstructed. An ear, nose and throat physician should examine your nose and determine the cause. There are usually simple remedies for this.

Q. I am 73 and I have had at least 5-6 near death experiences. I have drainage that that drops to the back of my throat. It feels like about 1/3 of a ping pong ball. It has proved dangerous while I’m eating. Recently, I was treated with loratadine 10 mgs, fluticasone propionate, ventolin….they help but I still have the spells. I was wondering about the nasal balloon. It is awful to be removed from a restaurant or public area because of a violent coughing spell.

A. It is unfortunate that you are experiencing these uncomfortable, embarrassing and distressing symptoms. Post nasal drainage has many sources and the cause should be looked for. A nasal and sinus doctor can frequently find the cause through a complete ear, nose and throat examination including a nasal endoscopic examination and a CT scan of the sinuses. If sinusitis, or sinus inflammation, is present, then management with medicine will most likely be tried. If medical treatment fails, sinus disease may be relieved by opening the sinus and irrigating out any infection using procedures such as Balloon Sinuplasty. However, there are also times when the nose and sinuses are not the cause and all of the mucus can be coming from chest problems like bronchitis or asthma or even from the stomach caused by acid reflux and hiatal hernia. I would encourage you to talk to your primary doctor and get a referral to an ENT specialist in your area.

Q. What is sinusitis?

A. Sinusitis is an infection of the sinuses usually as part of a respiratory infection. The sinus drainage pathways can become obstructed blocking the ability of the sinuses to drain. Mucus trapped in the sinuses becomes infected causing the infection. Sinusitis can be acute (lasting less than 4 weeks) or chronic (lasting more than 12 weeks).

Q. What can I expect in my first exam with an ENT regarding my sinusitis?

A. At a specialist’ s office, you will receive a thorough ear, nose, and throat evaluation. This will include a complete history specifically asking questions about your nasal and sinus symptoms, allergies, headaches and other respiratory problems. It will be important to discuss previous treatments which were both effective and ineffective. You will be asked about current and past use of tobacco. In addition a complete ear, nose and throat examination is typically performed. This may include use of a nasal endoscope to view the inside of the nose and sinus drainage passages. Allergy testing and/or computed tomographic (CT) scan of the sinus may be needed.

Q. When is sinus surgery needed?

A. Typically sinus surgery is recommended when medical management using antibiotics, nasal steroid sprays and sometimes steroid pills have failed.

Q. What does sinus surgery accomplish?

A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia (the microscopic hair-like structures that move mucous through the sinuses located on the lining cells of the sinuses) in place as possible. Otolaryngologists – head and neck surgeons – have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Note: The opinions expressed are for general information only and should not be construed as medical advice or diagnosis. The opinions are meant as an additional resource for people interested in learning more about chronic sinusitis. The information, opinions and recommendations presented in these pages are not intended to replace the care of your own physician. Before you make any decisions about treatment options, you should consult your physician or other qualified medical professionals.