SURGICAL OPTIONS FOR SINUS PROBLEMS

Balloon Sinuplasty Sinus Dilation

Have you ever heard someone say that medications don’t work for their sinus, breathing or allergy problems. If so it may not be the medication, it may be an underlying structural problem. Meaning that they were born with or acquired a structural problem and the medications just aren’t able to get in the nose where they can work.

If you’ve tried every type of medication for your sinus condition and you still aren’t feeling better, it might be time to consider a procedure. Balloon sinuplasty (BSP) is just one of the many procedures offered by Dr. Atkins, along with other new minimally invasive technology such as TRACTTM, TruDiTM BSP or ClariFixTM. Dr. Atkins can combine balloon sinus dilation with other procedures that promise less pain, less downtime and improved outcomes for the patient. Even better, many of these can be performed in our office under local or IV anesthesia — no hospitalization required and are covered by most major insurance plans.

Our success rate with TruiDiTM BSP has been very high over the years — with many satisfied patients — and just another example of our ongoing commitment to providing the very latest in technological advances and treatment for our patients. At Atkins Expert Sinus Care, surgery is limited to those for whom treatments and medications have been ineffective. In fact, most of our patients (70 percent) do not need surgery. BSP is a straightforward and brief endoscopic sinus surgery that restructures the sinus passages without removing tissue and bone. The minimally invasive, in-office procedure can be a great solution for those suffering from chronic sinusitis and are looking for relief. This modern, convenient, safe, and proven effect approach requires no post-surgery nasal packing and little bleeding. Most patients can return to work the next day. To learn more about TriDiTM Sinuplasty, click here.

Septoplasty

About 70-to-80 percent of the population has a septum that is deviated enough to be noticed upon examination. However, most people with a deviated septum can go their entire life without any symptoms. Individuals with significant symptoms should consider having a septoplasty.

Symptoms of a deviated septum include:

Difficulty breathing — usually worse on one side of the nose
Recurrent sinus infections
Nose bleeds
Snoring
Headaches
Post nasal drainage
Runny nose
Congestion

A septoplasty refers to a surgical repair of the septum. Dr. Atkins offers a new less invasive way to correct a deviated septum. TRACT is a newly approved balloon used to correct a deviated septum. When inflated in the nose, it repositions the septum without any cutting or tissue removal. Dr. Atkins was the second surgeon in the country to perform a septoplasty using TRACT and has had great success using this technique. Dr. Atkins is a recognized expert on TRACT; he lectures and teaches other ENTs how to use TRACT for their patients. TRACT can be done in our office under local or IV sedation, so patients don’t have to go to the hospital.

There are instances in which the septal deviation cannot be corrected with TRACT. In those cases, a classic septoplasty is done by making an incision just inside the nose and elevating the tissue off each side of the septum to expose the deviation. The deviation is then removed and the tissue overlining the septum is placed back in its normal position.

Patients who have undergone a septoplasty are among the most satisfied patients in our practice. They report that their breathing is improved, they sleep better and often have more energy during the day.

Inferior Turbinate Reduction

Turbinates sit on the side walls of your nose. They warm, humidify and filter the air that enters your nose. When turbinates become enlarged, they can cause symptoms similar to a deviated symptoms such as difficulty breathing through one or both sides of your nose, snoring and congestion.

Diagnosis of turbinate hypertrophy can usually be made on your first visit. After taking your history and performing an exam, we can see that if your turbinates are enlarged. We may also perform a nasal endoscopy or in-office low dose CT scan to confirm the diagnosis.

Many people with turbinate hypertrophy use prescription and or over-the-counter (OTC) medications to control the swelling in their nose. Nasal steroids, nasal antihistamines and decongestants can be used to treat inferior turbinate hypertrophy; these medications help to reduce the swelling and improve nasal breathing. If you do not respond to medications, it may be necessary to perform a simple surgery to reduce the size of your inferior turbinates.

There are many different techniques used to reduce the size of turbinates. Dr. Atkins uses only minimally invasive techniques — meaning he will never partially or fully resect your turbinate. There is no cutting or removing bone.

Dr. Atkins usually uses a very fine radiofrequency wand, a small suction device or a laser to remove tissue inside the inferior turbinate. This improves the nasal airway, allowing patients to breathe easier. This surgery is occasionally performed by itself, but is often combined with a septoplasty to completely address nasal obstruction. Turbinate surgery used to involve resecting part of the turbinate, but Dr. Atkins does not perform this aggressive form of surgery. Turbinate surgery without any other procedures, can be performed in our office.

ClariFix a Solution for Runny Nose and Congestion

Clarifix, is an amazing technology for runny nose and congestion. Dr. Atkins was lucky enough to participate in the FDA studies to approve ClariFix. He has years of experience with this technology and has used it to treat congestion and postnasal drainage with great success.

ClariFix works on a nerve in the back of the nose. This nerve can become overly active in some individuals and cause severe congestion and drainage. ClariFix uses cryotechnology to freeze the nerve in the back of your nose for about 30 seconds on each side. It's quick and easy and can be performed in the office under IV or local sedation. Patients go home right away and may feel a little plugged up or like they have a cold for a week or so. It takes about six weeks to develop the full effect and has about an 80 percent success rate. It is unclear how long Clarifix lasts, but Dr. Atkins treated his first patients in July 2015, and they are still doing well four years later. Dr. Atkins has performed more ClairFix procedures than anyone else in San Antonio or South Texas.

Here are a few key symptoms that can help us determine if ClariFix may be right for you. If you are experiencing these symptoms on a regular basis and feel they interfere with your quality of life, come see Dr. Atkins and together you can determine if ClariFix is right for you.

Runny Nose
Nasal Congestion
Nasal Itching
Sneezing
Difficulty sleeping due to congestion

Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) means removing diseased and obstructing sinus tissue while viewing the procedure with an endoscope. It is used primarily to treat chronic sinusitis, recurrent sinusitis and nasal polyps and can help relieve nasal congestion, sinus pressure and sinus pain.

Most of the diseased nasal tissue removal is done with a shaver which removes tissue by cutting and suctioning at the same time. FESS is more invasive than a balloon sinuplasty because patients who need a FESS usually have a more extensive condition which a balloon sinuplasty can’t help.

Some patients can undergo a "hybrid" procedure where the most diseased tissue is removed with a shaver and the less diseased tissue is dilated with a balloon. While endoscopic sinus surgeries performed in the 1990s were very aggressive and sometimes removed diseased as well as healthy tissue (“roto-rooter” surgery), most endoscopic sinus surgery these days removes diseased tissue only and tries to limit the removal of healthy tissue. This leads to a much quicker recovery.

Vivaer Treatment for Nasal Valve Stenosis

Vivaer is a new treatment for nasal obstruction that is caused by narrowing in the front of your nose, called nasal valve stenosis. The narrowing is a mechanical problem and is usually unrelated to allergies or swelling in your nose. Vivaer treats nasal valve collapse — also known as nasal valve stenosis. People who chronically use external “breathe right” strips often have a problem with the nasal valve. Patients with this narrowing tend to breathe through their mouth and have more trouble breathing from their nose when they are lying down or during exercise. Traditionally, nasal valve stenosis has been corrected by a very special type of surgery that often required a plastic surgeon and involved cutting and a long recovery. With Vivaer, there is no cutting and no bruising or change in the appearance of your nose. It takes about 30 minutes in our office and can be done with IV or local anesthesia.

Post-Surgery Care with PROPEL® Drug Eluting Stents

Post-surgery care usually involves inserting stents into the nose to keep nasal passages open to facilitate recovery. The type of stent that Dr. Atkins uses is PROPEL. There are several forms of Propel, but essentially these are small stents put in after sinus surgery that are made out of absorbable suture and are coated with medication that help keep the sinus open during recovery. Dr. Atkins’ preferred choice is the Propel Contour stent. The device springs open to keep the sinuses open during the healing process and stays in place for about one month. The medication helps cut down on scarring and recurrence of polyps. Propel is covered by some insurance companies and is needed in some, but not all types of sinus surgery.

Whether or Not to Have Surgery

Although Dr. Atkins may advise surgery in your case, ultimately, it’s your decision. The key issue for you to think about is quality of life. Think about how sinus symptoms affect your day-to-day life. How many sick days do you take? How often are you tired? How do you feel about the amount of medication you are taking? It’s a very personal decision. If surgery becomes an option for you, we will do everything we can to explain things so you feel comfortable making a decision.