The Seattle Sinus Surgery Center™
William A. Portuese, M.D.
1101 Madison Street, #1280
Seattle, Washington 98104
Phone: 206.624.6200
   
   
   

Sinus Surgery FAQS


What is acute sinusitis?
Acute sinusitis is a short-term inflammation of the sinuses that is treated medically with antibiotics (Zithromax, Augmentin, or Keflex) in conjunction with decongestants and mucolytics. It is not treated surgically. Acute sinusitis is often triggered by an upper respiratory infection that is viral in nature and turns into an acute bacterial infection. These infections last less than one month and typically are self-limiting and resolve on their own.

What is chronic sinusitis?
Chronic sinusitis is characterized by a three-month history or longer of symptoms such as headaches, facial pain, facial pressure, congestion, ongoing nasal discharge, postnasal drip and drainage. There is a long history of repetitive and extensive sinus infections that have failed to respond to medical therapy and will not resolve with repeated treatments of antibiotics and medications. Chronic sinusitis is treated with endoscopic sinus surgery, to open up the sinuses and remove polyps that are obstructing the sinus drainage pathway.

What is endoscopic sinus surgery?
Functional endoscopic sinus surgery is a procedure whereby a surgeon uses telescopic instruments inside the sinuses to remove polyps and enlarge the natural opening of sinus windows to allow better drainage. This is an outpatient procedure performed under general anesthesia in a certified ambulatory surgery center and takes approximately one hour. Only the diseased sinuses noted on a CAT scan of the paranasal sinuses (frontal, maxillary, sphenoid, and ethmoid sinuses) are opened during the surgical procedure.

What is a deviated septum?
The nasal septum is the cartilaginous and bony structure that divides the left lane and right lane of airflow breathing through the nose. When a septum is crooked, it is termed to be a deviated septum and can be caused when the nose is struck, sustains trauma, or be due to developmental reasons. Either the cartilage or bone alone can be deviated. Typically when the nose suffers trauma the deviation is a combination of both bone and cartilage.

What is a septoplasty?
Septoplasty is the surgical procedure that corrects a deviated septum and improves function of the nose. A straightened septum allows for better breathing and sinus drainage. Patients usually sleep better at night and experience an improved sense of smell. Septoplasty is and outpatient procedure performed under general anesthesia.

What are sinus and/or nasal polyps?
Nasal polyps develop due to an inflammatory allergic response to some type of stimuli in the environment. Lined within the sinus cavities is membranous tissue, which is where the allergic response takes place. When a stimuli triggers an allergic response, the membranous tissue become swollen, inflamed, and so large that they fold over upon themselves creating polyps. In time they become numerous like grape clusters occupying enough space inside the sinus cavities that they prevent adequate aeration and block normal sinus drainage, which creates chronic sinus infections.

Is chronic sinusitis treated with antibiotics?
Typically chronic sinusitis is treated surgically, by removing the polyps to unblock the sinus drainage pathways. Once the blockage is removed, the symptoms of chronic sinusitis resolve. On occasion, a flare up of chronic sinusitis can be treated with antibiotics such as Augmentin, Keflex or Zithromax.

What causes nasal polyps?
Common causes of nasal polyps include environmental allergies to items such as weeds, trees, grasses, molds, feathers, fungus, etc. Patients who have nasal polyposis tend to have severe allergies that are undiagnosed and should be allergy tested to determine the cause. Asthma is also a component of this triad and is frequently seen in these types of patients with chronic sinusitis. Allergy treatments such as immunotherapy, nasal sprays, and inhalers help manage both allergies and asthma, and are a thorough treatment for this ongoing disease.

What types of allergy testing are best for chronic polyps and sinusitis?
There are two types of allergy testing, both skin testing and radioallergosorbent testing (RAST). Both are excellent ways to determine what a patient may be allergic to. RAST testing has advantages of ease ability of just one needle stick in the arm for a blood draw, while the skin test requires 40 or 50 needle sticks up and down the arm. The goal of testing is to determine what the patient is allergic to and how allergic they are to each one of the allergens that are tested. It is important to quantify the amount of allergen and severity of allergies to prepare a person for the possibility of allergy shots (immunotherapy), environmental controls, and/or medications.

How is endoscopic sinus surgery performed?
Endoscopic sinus surgery is an outpatient procedure performed under general anesthesia in a certified ambulatory surgery center. It involves placing telescopic instruments in the nose and use of small, little instruments to open the sinus windows and enlarge the natural opening. Polyps are removed, the sinus valves are opened, and normal physiologic drainage is allowed to occur through the natural healing process. It is important to preserve the natural landmarks so as not to create empty nose syndrome.

What type of anesthesia is used for sinus surgery?
Endoscopic sinus surgery is done under general anesthesia by a board-certified physician anesthesiologist. Dr. Portuese uses the Swedish Hospital physicianís anesthesia group and has performed thousands of successful nasal surgeries with them.

What are the medical treatments for sinusitis?
Medical treatments for chronic sinusitis include cortisone nasal spray, antihistamine nasal spray, and antibiotics.

  • Cortisone nasal sprays such as Flonase, Nasacort, Rhinocort, and Nasonex help control the allergic response.
  • Antihistamine nasal sprays such as Patanase and Astepro 0.15% have a decongestive effect and aides in controlling allergy symptoms by drying up a runny nose. These are used for both seasonal and allergic rhinitis. They are also used for long-term therapy before and after sinus surgery to control the sinus and allergy polyps from returning.
  • Antibiotics are used to treat an acute flare up when a patient is blowing yellow and green drainage out of their nose.
  • Singulair is also FDA approved for allergies and is adjunct to the medical regimen for allergies if there are breakthrough symptoms present.

Are sinus rinses acceptable after sinus surgery?
Sinus rinses with saline are a good idea during the first month after endoscopic sinus surgery. However, the first week after surgery, it is almost impossible to get any saline in the nose because the nasal passageways are so swollen. Begin irrigating the nose three to four times a day starting at one week, progressing onto the fourth week after the endoscopic sinus surgery.

What is the chance of repeat endoscopic sinus surgery occurring in one patientís lifetime?
It all depends on the extent of allergies and the amount of polyps present at time of diagnosis. There is a higher chance of a recurrence if the polyps are massive and severe. On average, 20% of sinus surgery patients will require another procedure sometime in their life.

Do allergies cause sinusitis?
Allergies tend to cause significant inflammation, swelling, and edema inside the nasal passageways, which can shut off the physiologic drainage of sinuses. Once this occurs, anaerobic metabolism occurs inside the sinus cavity and a bacterial infection ensues. When chronic in nature, endoscopic sinus surgery relieves this by placing enlarged windows into the sinuses so that polyps can no longer plug the sinus drainage. Acute sinusitis is treated medically with antibiotics, decongestants, nasal sprays, and mucolytics.

Will patients get another sinus infection after endoscopic sinus surgery?
Indeed patients can get a sinus infection after sinus surgery; however, the incidence is extremely low compared to patients who have not had surgery. When patients have chronic sinusitis and extensive polyps, they are prone to repetitive sinus infections. The endoscopic sinus surgery is designed to allow further drainage and minimize the amount of sinus infections that occur after surgery.

Does endoscopic sinus surgery hurt?
Recovery after surgery is moderately uncomfortable and patients do require moderate pain relievers, especially during the first week. There are typically two or three endoscopic dťbridements that are performed at the first, second, and third week following sinus surgery to remove exudates debris and crusts that accumulate in the sinus passageways. These are done under a topical anesthesia in the office setting.

Is endoscopic sinus surgery covered by medical insurance?
Yes, typically endoscopic sinus surgery is covered by medical insurance. Our office works with many medical insurance carriers to preauthorize the surgery. This is a medically necessary procedure, not elective cosmetic surgery.

Can a rhinoplasty be performed with simultaneous sinus surgery and/or a deviated septum?
Yes, a rhinoplasty can be performed with endoscopic sinus surgery and/or septoplasty; however, patients are financially responsible for the cosmetic component of the surgery. The medical necessity component for sinus surgery will be billed to the patientís medical insurance. Under no circumstances is cosmetic surgery billed to a patientís medical insurance company.

What instruments are used to do sinus surgery?
Endoscopic sinus surgery is performed with small, little instruments to reach up inside the sinuses and the nasal passageway under direct and indirect visualization. Most of the visualization is done with 0, 30, and 70 angle telescopes placed inside the nose. Small upbiting pediatric Weil-Blakesley forceps are used to remove the polyps. These are also used to open the natural windows into the maxillary, frontal, and sphenoid sinuses and un-root the floor of the ethmoid sinuses when needed.

How many sinuses does a patient have?
Most patients have four pairs of sinuses: two frontal, maxillary, sphenoid, and ethmoid sinuses. Approximately 5% of patients do not have frontal sinuses or develop only one frontal sinus.

Can a deviated septum and sinus surgery be performed at the same time?
Yes, any septal deviation can be addressed at the same time as sinus surgery. It is important that the septum is straight to allow excellent drainage through the sinuses and airflow in the nasal passageways. If the inferior turbinates are enlarged and causing decreased airflow, submucous resection can be performed at the same time.

Is the nose packed after sinus surgery?
No. There is no packing placed inside the nose after endoscopic sinus surgery. When the ethmoid sinuses are opened, two small pieces of dissolvable Surgicel are placed in the ethmoid area to allow adequate hemostasis so as to prevent a nosebleed. No other packing is placed.

Do the patientís eyes get black and blue after the surgery?
No. Bruising around the eyes occurs when nasal bones are reset to correct a broken nose or during a rhinoplasty. Endoscopic sinus surgery generally does not cause any swelling or bruising on the outside of the nose. The worse part about sinus surgery is patients are usually unable to breathe out of the nose for one week due to swelling from the procedure.

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The Seattle Sinus Surgery Center™
William A. Portuese, M.D.
1101 Madison Street, #1280
Seattle, Washington 98104
Phone: 206.624.6200