Ask the Expert

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

Please be aware that the “Ask the Expert” feature is for general Q&A about Balloon Sinuplasty, chronic sinusitis, and/or Acclarent products. We cannot advise, evaluate, or respond to an individual’s specific health history. "Ask the Expert" is not a substitute for the advice and care your own doctor, who knows your medical problems, can provide. Product complaints or concerns about a past procedure should be directed to Customer Service.

Selected questions and answers may be posted online in the future; please note that not all questions will be answered and questions that are posted may be edited.

Note: This section provides general information only and should not be construed as medical advice or diagnosis. It is meant as an additional resource for people interested in learning more about chronic sinusitis. The information presented in these pages is 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..

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Recent Expert Answers

CAN BALLOON SINUPLASTY HELP ME?

Q. My sinuses look healthy on a CT scan but I still have sinus pain and congestion and feel terrible. I am about one year into allergy shots. I also had my maxillary sinuses opened and turbinate reduction. Could my problem be helped by Balloon Sinuplasty or is it just swollen and inflamed? I have no yellow discharge at all.

A. There are many reasons for sinus and nasal congestion and pain. These can relate directly to the sinuses, or be caused by nasal congestion from swelling of the turbinates. Turbinate swelling has many causes such as from allergies. Also, facial pain and congestion can be due to non-sinus problems. Balloon Sinuplasty is a safe and effective method to open obstructed sinuses. You should seek a physician skilled in the use of Balloon Sinuplasty to determine if you are a candidate.

Q. I am a candidate for Balloon Sinuplasty based on recurrent sinus infections of the maxillary sinuses. After an initial evaluation, the ENT surgeon indicated that she would be unable to access my left maxillary sinus due to a moderately deviated septum and recommended that I consider a septoplasty procedure to correct the deviation. I was wondering if the Acclarent system is able to navigate around a moderately deviated septum. Thanks.

A. The Acclarent Balloon Sinuplasty technologies can effectively reach and access tight and narrow spaces and is an excellent way to manage many cases of persistent maxillary sinusitis. There are times when a severely deviated septum will make that access difficult and the septum must be corrected. Your physician has the best ability to determine if a septoplasty is needed and can base this on a combination of your medical history, your examination, and your computed tomographic (CT) scans.

Q. I am scheduled to have Balloon Sinuplasty on Friday, under local anesthesia. I am concerned about "being awake". Should I be?

A. Balloon Sinuplasty can be safely and comfortably performed under local anesthesia. Each individual has different sinus problems that need treatment and different pain tolerances. You should discuss your particular needs and problems with your surgeon to determine if you are a good candidate for local anesthesia.

Q. Hello My son is 5 years old. He has a deviated septum and therefore often struggles to breathe through one of his nostrils. He has a lot of difficulty breathing when he has a cold. He does not have sinus issues. Would ballooning be effective in his case? I am aware when he reaches 15 that is the best time to have surgery, but ballooning may solve this issue. Looking forward to your response.

A. Balloon Sinuplasty is an effective and safe technology to manage maxillary sinus disease, which is the most common sinus to be involved in a 5 year old child. While balloon dilation has been shown to be effective for maxillary sinus disease in children, a deviated septum is a nasal and not a sinus problem. You should discuss with your physician the ways a deviated septum is managed.

Q. I have suffered from an ongoing sinus infection for the past six months and have been put on nine rounds of antibiotics. The surgeon is reluctant to perform surgery as my CT during the first few weeks of symptoms was normal. I was on antibiotics for quite some time when the CT was performed. My question is could antibiotics change the results of the CT? Symptoms always are tolerable until five days after discontinuing antibiotic, which leads to another round of symptoms, including facial pressure, teeth pain, and postnasal drip.

A. I am sorry you are experiencing so many infections in spite of all of the antibiotics. It sounds as if you are having recurrent acute episodes of sinusitis where an infection occurs, is treated properly, resolves and then recurs. These kinds of infections are typically initially managed with medications such as antibiotics. Physicians believe that a CT scan can become normal after medical management only to recur with another infection. When an infection recurs, your physician may choose more studies like additional sinus scans and nasal endoscopy and even surgery. The recurrent sinus infections may be related to anatomic obstruction of the sinus. Sometimes this is managed with Balloon Sinuplasty to open the sinus outflow while preserving the surrounding structures.

Q. Once you've had balloon sinuplasty surgery, will you be able to stop using nasal sprays?

A. There are several different nasal sprays that physicians might use. Some are used for inflammation and allergies and others for infection. The ability to stop nasal sprays will depend on the cause of the sinusitis. You should check with your physician and understand the reasons why you are taking your spray and the chances for continued use after Balloon Sinuplasty surgery.

Q. Based on my CT scan, my ENT said he has to go with using a scope and carve bone and tissue as opposed to sinuplasty. Should Sinuplasty always be tried first before using a scope and carving bone and tissue?

A. Balloon Sinuplasty is an excellent and safe method of managing many types of sinus disease. There are many different causes of sinus disease and your specific type may not lend itself to Balloon Sinuplasty. If you wish to explore if you are a candidate for Balloon Sinuplasty, you should seek an opinion from a surgeon who is skilled in Balloon Sinuplasty and performs Balloon Sinuplasty frequently. Note that traditional sinus surgery and Balloon Sinuplasty both employ the use of an endoscope, which is a small camera inserted into the nasal cavity to assist the surgeon in seeing inside your nose.

Q. How much does balloon sinuplasty cost without insurance?

A. The cost of Balloon Sinuplasty will vary depending upon your region and physician. Check with your surgeon to determine the cost.

Q. Can the same balloon used for sinuplasty also be used to straighten the septum from a nasal deviation after several procedures?

A. Balloon Sinuplasty is a surgical tool to open the drainage pathway of the sinuses. The balloon does not move or straighten the nasal septum.

Q. I have had a chronic sinus infection for more than eight years. I first learned of the balloon treatment in 2006. My infection is fungal according to my doctor, and he said the balloon does not work for that. My question is has anything changed since then where the balloon will work for fungal infections?

A. Balloon Sinuplasty is a surgical tool to open the sinuses and permit them to drain. At the time of opening the sinuses with Balloon Sinuplasty tools, the sinuses can be washed and irrigated to remove mucous and bacterial or fungal infections. In some instances the fungus can form a firm ball or be very thick and the irrigation will not remove the fungus. Since 2006 there are newer irrigation tools as part of the Acclarent Balloon Sinuplasty tools that may help. If you still have sinus problems you should seek a surgeon with skill and expertise in Balloon Sinuplasty.

Q. I had sinus surgery over one year ago. I have never regretted it because I can now breathe through my nose, however, I am still having sinus infections, which I expected. My problem: I have recently had two sinus infections and feel like I never truly get rid of it on the left side of my face. It's tender to the touch and I feel bad. Would balloon sinuplasty be an option for me after I have already had surgery?

A. The left sided facial pain you are experiencing can have several causes, among which is a sinus problem. Balloon Sinuplasty is a minimally invasive effective tool used to manage sinus problems and can be used after previous nasal or sinus procedures. It is important to determine the exact nature of your sinus history and present problem to decide if you are a candidate for Balloon Sinuplasty. Seek a surgeon familiar with Balloon Sinuplasty. Your surgeon can advise you after a complete examination that might include your ENT history, a nasal endoscopic examination and computed tomographic (CT) scan.

Q. I had the balloon surgery to open the left frontal sinus passage. I have had five endoscopic laser surgeries prior to the balloon procedure. I have not had a sinus infection since the balloon surgery; however, I continue to have pressure over my left eye and sinus headaches caused by the pressure on most days. Would another balloon surgery that opens the sinus discharge area be helpful? If not, what can I do? These headaches are terrible! I have had a cat scan. No problems other than the sinus problem. Thanks.

A. Balloon Sinuplasty is a safe and effective method of managing sinus disease and it is pleasing to hear that your sinus infections have ceased. Headaches have many causes such as migraine, tension and sinus. In view of your history you should return to your ENT physician and determine of the frontal sinus is still a problem. If the sinus is open and there is no disease remaining, you should consider seeing a headache specialist to see if there is a non- sinus cause of the headache.

Q: I have had sinus problems for over fifteen years. After three operations (deviated septum with sinus wash and two surgeries to make the ostia wider), I am still having really bad sinus issues. One ENT tested for allergies, found nothing, then repeated testing a month later and 3 substances were offenders! Do I need to get a third opinion or would a Balloon Sinuplasty help?

A. It certainly sounds as if you have had years of sinus issues. It is difficult to know the next best steps without additional information. If the sinuses are the source of your problems then medical management is usually tried. You may have done this already. A computed tomographic (CT) scan of the sinuses and a complete nasal endoscopic examination will determine which of the sinuses are the culprit(s) and the best surgical treatment. Balloon Sinuplasty is a safe and effective tool and procedure to manage sinus disease involving the frontal (forehead), maxillary (under the cheek), or sphenoid (towards the middle of the head) sinuses.

Q. I’ve read that there is a risk of optic injury during the Balloon Sinuplasty procedure and was wondering how that may affect someone that has a scleral buckle due to a detached retina.

A. Balloon Sinuplasty has been shown to have minimal risks and to be safe. However, sinus surgery by any means, including Balloon Sinuplasty, has risks because the sinuses are located adjacent to the eye, the nerves that provide vision and eye movement, and the brain. To our knowledge, there has been no reported case of Balloon Sinuplasty causing or worsening a retinal tear or scleral buckle. However, to be safe, you should ask your ophthalmologist about any increased risks associated with your eye problems that might occur during sinus surgery.

Q. I have been diagnosed with chronic sinusitis and after trying lots of medications, surgery was recommended. I went to a doctor that performs Balloon Sinuplasty and he told me I was not a good fit for the surgery because I have a slightly deviated septum on one side of my nasal passage. Can you please tell me if that is the case?

A. It is not clear from your question as to why you are not a candidate for Balloon Sinuplasty. If it is because of the deviated septum limiting access to the sinuses, the nasal septum can be repaired as part of the sinus surgery. Balloon Sinuplasty is a safe, durable and effective procedure to manage many types of sinus disease involving the maxillary, frontal and sphenoid sinuses. If the ethmoid sinus is involved, then Balloon Sinuplasty can be combined with ethmoid sinus surgery (hybrid procedure) to manage the disease. You should ask your physician why your disease cannot be managed with Balloon Sinuplasty.

Q. I have had sinus infections & pressure for years. Within the past four years it has gotten really bad. I feel like I can’t breathe, which makes my chest feel heavy. I take decongestants very often, which isn't good because I have high blood pressure. I am now dealing with snoring. Some nights it is very bad! I have gone to my ENT and he has advised me that I am a candidate for Balloon Sinuplasty. Will this help with my snoring?

A. Balloon Sinuplasty is a proven and safe technology to manage chronic sinusitis. There are numerous causes for snoring, among which can be nasal obstruction. You need to discuss with your physician the causes of your snoring and whether nasal surgery is anticipated to help this. Balloon Sinuplasty can address sinus disease, but would not be expected to affect snoring.

Q. In researching the Balloon Sinuplasty procedure, I found several references indicating that the procedure is not recommended, or has been found to be ineffective, in patients with connective tissue disorders (such as scleroderma). I have been unable to find a reference that explains exactly why it is not recommended. Can you refer me to a link to a medical journal article, or explain the reason(s) why Balloon Sinuplasty is not effective in patients with connective tissue disorders?

A. Balloon Sinuplasty is an effective, safe and durable surgical tool and procedure for chronic sinusitis. I am not aware of specific reports either describing use or difficulties in scleroderma or other connective tissue diseases. Connective tissue disorders have an underlying cause that may cause the sinus to obstruct after any surgical procedure no matter what the technology used. Balloon Sinuplasty can provide the opportunity to open the scarred and diseased sinus and may be repeated if needed. Certainly, the connective tissue disorder must be treated because of its ongoing potential relationship with sinus issues.

Q. My left ear, eye area, and left sinus get congested every time I cry, have allergies, or a cold. It feels like it doesn't get enough air. I get dizzy spells, ear pain, and ear congestion with this left sinus congestion. Right side is always clear and symptom free I think the CT sinus I had done a couple of years ago showed some narrowing and maybe the beginning of a polyp, but it was never confirmed. I’d like to be evaluated again. Would this procedure help with my symptoms?

A. You have asked about many different symptoms that may or may not be related. Trying to sort through this in an on-line question and response is not possible, but rather requires a complete ear, nose and throat examination that might include nasal endoscopic examination, computed tomographic (CT) scan and hearing testing. However, it is possible to make a few comments. It is not unusual for the nose to become congested when crying since tears travel from the eye into the nose through the tear ducts at the corner of the eye. Not getting enough air might be related to a blocked nose. Dizzy spells are almost never a sign or part of sinus disease. Not knowing the diagnosis since so much information is needed, it is impossible to know if Balloon Sinuplasty will help. Find a surgeon near you with expertise in ENT and skill in Balloon Sinuplasty.

Q. My husband has had sinus symptoms, headaches, and painfully acute hearing, for which he was treated with allergy injections, steroid sprays and Claritin®, for many years. A CT scan done for something else showed a completely blocked sphenoid sinus. Front sinuses are clear. What can be done? Decongestants and antibiotics seem to have little or no effect.

A. Like any sinus disease, first treatment is typically medical management that most often includes anantibiotic and nasal steroid spray. If medical management fails, then surgery should be considered. Surgery of the sphenoid sinus can be safely performed using Balloon Sinuplasty. Depending on the computed tomographic (CT) findings, the nasal endoscopic examination and your husband’s health, a surgeon may choose to perform the sphenoid sinus Balloon Sinuplasty either under local anesthesia in an office, or under general anesthesia in an operating room. Your husband should seek an ENT physician with skill and expertise in using Balloon Sinuplasty.

Q. I am a candidate for Balloon Sinuplasty based on recurrent sinus infections of the maxillary sinuses. After an initial evaluation, the ENT surgeon indicated that she would be unable to access my left maxillary sinus due to a moderately deviated septum and recommended that I consider a septoplasty procedure to correct the deviation. I was wondering if the Acclarent system is able to navigate around a moderately deviated septum.

A. The Acclarent Balloon Sinuplasty technologies can effectively reach and access tight and narrow spaces and is an excellent way to manage many cases of persistent maxillary sinusitis. There are times when a severely deviated septum will make that access difficult and the septum must be corrected. Your physician has the best ability to determine if a septoplasty is needed and can base this on a combination of your medical history, your examination, and your computed tomographic (CT) scans.

Q. I had sinus surgery over one year ago. I have never regretted it because I can breathe through my nose now, however, I am still having sinus infections which I expected. My problem: I have recently had two sinus infections and feel like I never truly get rid of it on the left side of my face. It's tender to the touch and I feel bad. Would Balloon Sinuplasty be an option for me after I have already had surgery?

A. The left sided facial pain you are experiencing can have several causes, among which is a sinus problem. Balloon Sinuplasty is a minimally invasive effective tool used to manage sinus problems and can be used after previous nasal or sinus procedures. It is important to determine the exact nature of your sinus history and present problem to decide if you are a candidate for Balloon Sinuplasty. Seek a surgeon familiar with Balloon Sinuplasty. Your surgeon can advise you after a compete examination that might include your ENT history, a nasal endoscopic examination and computed tomographic (CT) scan.

Q: I’ve been using an OTC nasal spray for years and am experiencing the rebound effect from this. Does Balloon Sinuplasty help to lessen the rebound symptoms? I’m afraid of having sinus surgery because I've heard it can damage the nerves in your nose and contribute to a stuffed up nose and difficulty breathing.

A: Excessive use of over the counter decongestant sprays can lead to rebound causing more frequent use of the spray and in greater doses. Congestion in the nose is related to nasal structures called turbinates. Normally the turbinates swell and contract throughout the day. With the rebound effect, the decongestant spray initially shrinks the turbinates making breathing easier; however, after the spray wears off there is even more swelling of the turbinates, which can block breathing. The Acclarent Balloon Sinuplasty technology can open the sinus passages that drain into the nose. In a few instances, sinusitis can cause turbinate swelling. You need to see an otolaryngologist to see if you have a turbinate or sinus problem. If it is only a turbinate problem, Balloon Sinuplasty does not help the problem since it is designed for sinus and not nasal or turbinate problems.

Q: For several years I’ve had major sinus drainage into my throat causing a chronic cough. A CT sinus scan revealed a blocked sinus cavity related to the bone structure. How can a sinus cavity be blocked, while I still experience "Niagara Falls" mucous flowing into my throat? I have evidence of sinus infection but several courses of antibiotics have not helped. My doctor is suggesting Balloon Sinuplasty. Will this stop the flood?

A: The paranasal sinuses drain into the nasal cavity through small channels. These channels can become obstructed from many causes. Some of these include inflamed membranes, infected mucous membranes, or bone structure. Repeated sinus infections and/or allergies can contribute and worsen the obstruction. It is the body’s natural defense to create and secrete mucous in response to each of these. Generally, these symptoms are initially treated with combinations of antibiotics, decongestants, nasal saline spray and steroids by mouth or spray. If this medical management is unsuccessful and computed tomography (CT) demonstrates obstruction, surgery is frequently recommended. Balloon Sinuplasty has been shown to be a safe and effective minimally invasive method to expand and dilate the sinus outflow. You should discuss the options you may have with your physician.

Q: Is Balloon Sinuplasty recommended or approved in children? If yes, what age range? My 4 year old has had chronic sinusitis since her birth at 25 weeks gestation, despite aggressive antibiotic treatment, allergy injections, and nasal sprays.

A: Acclarent Balloon Sinuplasty technology has been successfully and safely used by doctors in pediatric patients. Peer reviewed studies detailing the successes have appeared in the medical literature. Balloon Sinuplasty permits opening of the sinus flow with minimal tissue trauma. Acclarent Balloon Sinuplasty is indicated for the dilation of pediatric maxillary sinuses. You should to discuss Balloon Sinuplasty with your child’s physicians (Pediatric Ear, Nose and Throat and Primary Care Physician) to obtain a full understanding of risks and benefits to determine whether this procedure is right for your child. Prematurity may result in other health conditions that need to be carefully weighed in assessing the suitability of Balloon Sinuplasty for your son or daughter.

BALLOON SINUPLASTY RECOVERY

Q I am getting Balloon Sinuplasty in a couple of weeks. What makes the sinus' stay open once they remove the balloon?

A. When inflated, the balloon micro-fractures the bone, which is then expected to heal in the newly displaced position and not "rebound". Clinical results suggest the dilation is durable.

Q. I am having Balloon Sinuplasty and my doctor has prescribed oral steroids. Do you believe that it is necessary to take this before and days after the procedure? And is this the norm or more of a precautionary measure?

A. The use and need of oral steroids will depend on the sinus problem being treated. It is not specific to Balloon Sinuplasty. You should discuss the reasons and need for the steroids with your surgeon.

Q. Does Balloon Sinuplasty change the appearance of your nose? What are the risks?

A. Balloon Sinuplasty is used to dilate the sinus openings. There are no reported cases of Balloon Sinuplasty altering the shape or appearance of the nose.

Q. Hello, Your FAQ section states that results last two years. In two years, do you need another balloon sinuplasty? Will headaches return? Thank you!

A. It is not that results of Balloon Sinuplasty last only two years, but rather there is now published scientific data following patients for two years. There is no clear clinical data or parameters for how long to follow and watch over any patient with sinus disease with any type of treatment. While certain types of sinus problems will resolve permanently with medical or surgical treatment, others are chronic and might cause lifelong problems. You should discuss your particular sinus problems with your ear, nose and throat physician to determine how long you could expect relief from symptoms, including headaches.

Q. I had Balloon Sinuplasty done yesterday. No pain in office and just a small headache afterwards that went away after about four hours. Feeling fine today, but am very congested feeling. No major discharge, just congested where I cannot breathe well through my nose. Is this normal? How long does it typically last? Thanks for the help.

A. Nasal congestion is a common occurrence after any nasal or sinus procedure. The length of time of the congestion will depend upon the type of surgery performed and findings at the time of surgery. You need to confer with your surgeon who will understand the details of your surgery about your anticipated post-operative course.

Q: With Balloon Sinuplasty, is there a stent that keeps the sinus open once the balloon is deflated?

A: Balloon Sinuplasty opens the maxillary, frontal and sphenoid sinuses by creating microscopic fractures in the bony outflow of these sinuses. A stent is not used to maintain the opening.

Q: I had Balloon Sinuplasty 4 weeks ago, and I’m still experiencing maxillary sinus pressure. How long does it take before the pressure and pain go away?

A: I am sorry you are continuing to have facial pressure. It is difficult to say when the pressure will resolve. Healing and discomfort from nasal and sinus surgery can resolve immediately in some situations and in others take from 6-8 weeks depending on whether there were other nasal and/or sinus procedures performed, the cause of the sinus problem, and your past history. You should consult your surgeon to find out what the expected healing time will be.

MANAGING SINUSITIS

Q. I have a ten year old son who has suffered from mucus in his throat for many years. He has to clear his throat all the time to get any relief. I have taken him to see many different doctors with no answers, but they put him on more medications. He has seen an allergy doctor and took allergy shots for two years with no improvement. He has seen an acid reflux doctor because his primary doctor thought that could be causing it. They put him on additional medications that he has been taking with no improvements. Please help I'm tired of my son being a test subject without any results. He has become very upset with having this challenge all the time and even his teachers are becoming upset because they say his clearing of the throat disrupts class.

A. It sounds as your son has had years of post-nasal drainage and throat clearing. Your son’s physicians have considered and treated the typical causes of allergies, sinusitis, and acid reflux. In addition, other causes need to be considered such as tonsil and adenoid infection, nasal turbinate dysfunction, and diverticula of the throat, to name a few. A complete evaluation by an otolaryngologist most likely has been performed, however can be revisited. And in spite of the best of evaluations and extensive medical management and even surgery like tonsillectomy, adenoidectomy and nasal surgery, the throat mucus may continue.

Q. I am a healthy 36 year old female. I have been on two rounds of antibiotics in the past three months for sinus problems. Symptoms include: headache, constant almost clearing of my throat, running nose, post nasal drip, sinus pressure and pain (mainly frontal sinuses), the most concerning symptoms to me are that I have smelled cigarette smoke off and on since I was seven months pregnant. I am now two months postpartum. Now, I have this horrible pressure at my nose. I have been to an ENT and my recent CT sinus was negative. Please help with a possible solution to this.

A. I am sorry you are having the difficulties with the nose and sinuses. It would be unusual but possible to have a sinus problem with a normal CT scan. Your problems could be related to allergies, sinus, or nasal problems. Also, the facial pressure you have could be related to headaches of other causes. You should consider an evaluation by an allergist and returning to an ENT physician.

Q. I had Balloon Sinuplasty done a few years ago for a deviated septum and major blockage. I felt better initially but have since been seeing an allergist and pulmonologist because I have severe difficulty breathing through my nose. They have identified that I am allergic to something all year round. However, they have also tried every kind of nasal spray and allergy medicine they can think of. Should I need surgery again? If so, would you recommend going to a different doctor?

A. I am sorry you are continuing to have nasal difficulties after your Balloon Sinuplasty. The fact that you felt better initially, and presumably for some time, most likely speaks to surgical success. Balloon Sinuplasty is a safe and effective technology to manage sinusitis and sinus obstruction. It does not treat allergies, which is a nasal problem. It is common for a patient to have both sinus disease and allergies. Often both need treatment. Additionally, some patients will have asthma. Many patients need management by an allergist, ENT and pulmonologist.

Q. Ever since I was five years old, I’ve had a constant runny nose, usually accompanied by a series of headaches and restlessness. I am easily irritated by dust and cold at the slightest possibility of contact. I have been given series of antibiotics but they have all proven to be abortive. I dread the thought of having to go for an operation as is being recommended. Some say it is chronic sinusitis. I don’t know what to do.

A. I am sorry you have lifelong nasal and sinus problems and headaches. It is difficult to provide advice without a complete history, nasal endoscopic examination and computed tomographic (CT) scan. My advice would be to find a respected and trusted otolaryngologist who can perform a complete evaluation and provide advice and alternatives to treatment.

Q: I’m four weeks pregnant and have had a sinus infection for the past three months. Before I discovered I was expecting, my ENT doctor and I discussed Balloon Sinuplasty and scheduled the procedure. Now that I am pregnant, is it still safe for me to undergo Balloon Sinuplasty?

A: You will need to discuss with your physicians (otolaryngologist and obstetrician) the safety of elective sinus surgery. There may be reasons why it is wise to proceed with sinus surgery to prevent infections and minimize the need for medications. On the other hand, there may be reasons to treat each episode medically until after your delivery.

Q: I’m over 59 years old and have faced sinusitis problems all my life. I feel miserable from dizziness. I had a deviated septum and polyps removal surgery about 30 years ago, but now the CT shows the following: Scans show fluid in the left maxillary sinus. There are opacified left mid ethmoid air cells as well as scattered mucosal thickening of ethmoid air cells bilaterally. There is an opacifiied right posterior ethmoid air cell. There is a hypoplastic right sphenoid sinus with mucosal thickening. There are zones of mucosal thickening in the left sphenoid sinus. The frontal sinuses are clear. My doctor wants to perform bilateral turbinectomy and endoscopic sinus surgery. Do you think the CT results show the need for surgery?

A: It is difficult to know from the computed tomographic (CT) scan of your sinuses whether surgery is indicated. These CT changes may all be from a new and ongoing infection or changes and healing effects from your previous surgery of 30 years ago. It is important for physicians to consider the evidence from at least three sources in determining whether surgery is needed. In addition to the findings of the CT scan, physicians must consider the patient’s history of the problem and also the nasal endoscopic findings. Also, since dizziness is an unusual complaint with sinus problems, you should ask your physician how this relates to the sinus problems and the chances of it resolving with sinus surgery.

SINUS SYMPTOMS

Q. I have congestion often but am unable to take decongestants. I am currently battling a cold/sinusitis. Can Balloon Sinusplasty be performed if there's a current infection? I am going to see my doctor again but was wondering if there's any way to tell for sure if I have a bacterial infection? Also, is there any way a doctor could drain the sinuses in office to avoid antibiotics?

A. Balloon Sinuplasty can be performed while there is an infection although many physicians will prefer to get an infection under control prior to any sinus procedure. A physician can obtain a culture from the nose to determine if the infection is viral, bacterial or fungal. Balloon Sinuplasty can open the sinuses permitting them to be irrigated. Depending on the cause of the infections, this may or may not prevent the need for more antibiotics. You should discuss all your concerns with a physician skilled in Balloon Sinuplasty.

Q. I have suffered from an ongoing sinus infection for the past six months and have been put on nine rounds of antibiotics. The surgeon is reluctant to perform surgery as my CT during the first few weeks of symptoms was normal. I was on antibiotics for quite some time when the CT was performed. My question is could antibiotics change the results of the CT? Symptoms always are tolerable until five days after discontinuing antibiotics. The symptoms are horrible and difficult to manage. The doctor wants to repeat another CT and prescribe another antibiotic. Should I not take the antibiotic until after the CT? I am currently being put on Pulmicort nasal spray.

A. I am sorry you are experiencing so many infections in spite of all of the antibiotics. It sounds as if you are having recurrent acute episodes of sinusitis where an infection occurs, is treated properly, resolves and then recurs. These kinds of infections are typically initially managed with medication. When they recur, your physician may choose more studies like additional sinus scans and nasal endoscopy and even surgery. The recurrent sinus infections may be related to anatomic obstruction of the sinus. Sometimes this is managed with Balloon Sinuplasty to open the sinus outflow while preserving the surrounding structures. Since your physician knows your history and examination best, the timing of scans and the best treatment should be determined by your sinus physician.

Q: I had previous correction of a deviated septum several years ago. Within the last year, I can barely breathe again out of my left nostril and both of my eyes burn horribly, especially the left eye. I have been treating myself for dry eye with no luck. Could chronic sinusitis cause my breathing issues and my eyes to burn?

A: Sinus problems can manifest themselves with nasal obstruction and facial pain over the sinus areas like the forehead. There are other possible causes for your symptoms, some of which include a recurrence of the deviated septum, allergies, and headaches of non nasal and sinus causes. I would recommend you see an otolaryngologist who can obtain a complete history, perform a nasal examination that may include a nasal endoscopic examination, and obtain a computed tomographic (CT) scan of the sinuses. This type of evaluation will permit an accurate diagnosis and lead to the correct treatment.

Q. My eyes swelled up 2.5 years ago, and an eye specialist diagnosed it as Grave's Disease. However, my naturopath believes that I have upper respiratory issues instead. My vision has not declined, but I have big bags under my eyes, which an eye surgeon says is fluid accumulation, so cosmetic surgery is not an option -- only orbital decompression. I also have tremendous sinus pressure all throughout the sinus region. Could the bags be from sinus congestion/inflammation/blockage, rather than anything to do with my eyes?

A. Graves Disease of the thyroid can have associated swelling of the tissues around the eye causing eye protrusion alone or with swelling of the eyelids. This is typically managed by keeping the thyroid under control as best as possible. In addition if there is either cosmetic deformity or functional deformity resulting in visual change then surgery is considered such as orbital decompression and/or eyelid surgery. On occasion the sinuses can be congested and worsen the problem. However, managing a true sinus problem rarely corrects the eye swelling.

QUESTIONS REGARDING INSURANCE

Q. My doctor suggested Balloon Sinuplasty and she told me that it is costly. Can you please let me know the cost of the balloon?

A. You will need to check with your local physician or insurance carrier to determine the costs of Balloon Sinuplasty. These costs will vary with your insurance carrier, around the world.

Q. My husband is having Balloon Sinuplasty next week. The right side of his nose is completely blocked, but the left side is not nearly as bad. The insurance has approved the procedure for the right side only. Is it normal to only do one side?

A. Sinus disease can occur on either the left or right side, or both sides of the sinuses. The operating surgeon will determine which sinuses need surgery and if it needs to be on the left, right or both sides.

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.

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