advanced sinus surgery

Why should you be with the advanced and latest sinus surgeons?

Sinus surgery has truly evolved over the years into super specialty surgery. Sinus surgery was once performed through tedious procedures with more complications and more failures with external incisions (surgical cuts on the face and in the mouth), was required extensive nasal packing (i.e. gauze or other material were placed in the nose to control bleeding after surgery) caused significant pain and discomfort to patients and was often followed by a long recovery period.

With recent advances in technology, including the nasal sinus endoscope, sinus surgery is now commonly performed entirely through the nose, without the above said face or mouth incisions. The nasal endoscope is a small telescope placed into the nostril with bright illumination and magnified image when connected to camera. The endoscope allows the surgeon to see inside of nose and sinuses with a special video camera attached to the endoscope.

Advanced Sinus Surgeries:

Today, endoscopic sinus surgery is typically done with minimal nasal packing that too with airway to breathe through nose after surgery and the next day patient can go home and office.

What will sinus surgeon do in the sinus surgery?

Endoscopic sinus surgery is performed when the medical treatment has not been successful in improving your sinus symptoms. The main goal of Video Endoscopic Sinus Surgery is to improve the function of the drainage pathway of the sinuses by widening the natural drainage pathway of the unhealthy sinuses and removing extra growth of tissues.
This is surgical correction of the sinus anatomy but not the surgical excision contrary to many people belief. One of the most important benefits of sinus surgery is the ability to deliver medications (sprays, rinses, nebulized drugs) to the lining of the sinuses after sinuses have been opened by widening.

Will endoscopic sinus surgery cure my sinus problems?

Many of the sinus problems are cured with the sinus surgery, as it is done after finding out the root cause of the sinus problem and is done for removing the root cause. Sinus problems caused by structural abnormalities are permanently cured, but those caused by allergic reaction are controlled.
Overall, the majority of patients who have allergy and sinus problems will have significant improvement with the combination of surgery and continued medical management.

Are there any alternative methods to sinus surgery?

Many people are being afraid of surgery and think of other routes to get rid of sinus problems. But, when you are having structural problems, you cannot avoid surgery. Initially, you can get relief with Antibiotics which may help to clear the infection, Antiallergics or by avoiding the ‘triggers’ of your allergy if your sinusitis is caused by an allergy, Nasal Steroid Spray can reduce the size of polyps if you use for a long time.

What complications can happen in sinus surgery?

With the advanced sinus surgery done at MicroCare ENT Hospital and Research Institute, you will almost never see complications as we take utmost care with each patient clinically.
The general complications of any operation are Pain, Bleeding and Blood clots
Specific complications of this sinus operation are Infection, Damage to the bone around your eye, Blindness, Leak of fluid from the brain

How soon will I recover?

The packing in your nose will usually be removed the day after your operation depending upon the type and extent of your sinus surgery. You should be able to go home later on the same day and office the next day i.e. on the second post-operative day.

But your nose will continue to feel blocked for quite a few days because of crusting from nasal secretions. Your sinus surgeon will prescribe a nasal spray or drops to use and you may be given a course of antibiotics to reduce the risk of infection for one or two weeks. Regular exercise like walking should help you to return to normal activities as soon as possible.

How much pain is there with this sinus surgery?

The pain you will have after the sinus surgery is minimal, not significant. Usually you will be given intravenous pain killers during the surgery itself or post operatively. However every patient tolerates pain differently. Most patients manage sinus surgery pain with oral pain killers after the discharge from the hospital.

Are there types of sinusitis?

Different groups of sinuses are there in the skull and facial skeleton communicating each other via narrow passages called ostia within the nasal cavity, indicating different types based on the area affected.

• Frontal sinusitis (in the forehead)
• Ethmoid sinusitis (between the eyes)
• Maxillary sinusitis (in the cheekbone area)
• Sphenoid sinusitis (in the middle of the head, behind the eyes)

What will happen after the Endoscopic sinus surgery / FESS?

First day:

You may awake from anaesthesia with some packing in your nose to stop any bleeding. It should be left alone and will be removed by your nursing staff when appropriate, usually the following morning. You can breathe through your nose even with the pack sometimes you may have to breathe through your mouth and thus get a very dry mouth.
You may get a blood stained, mixed secretions along the nose, Don’t worry, this is normal.

Second Day:

The pack will be removed and you will be discharged from the hospital.
You will be asked to come back for review after one week for endoscopic cleaning of your nose of any secretions or crusts.

What should I follow after Endoscopic sinus surgery / FESS?

Essentially you will be normal after second day and go to your routine work either be college or office or home work. Some of precautions mentioned here are helpful for those who do heavy work.

• Avoid all heavy physical activity including sports for ten days after the operation.
• Avoid bending down to pick especially heavy weights.
• You must irrigate your nose frequently (“Douching” ) at least 3 times a day with the solution provided (i.e. saline) to clear away crusts which occurs after the operation.
• Avoid heavy nasal blowing for 10+ days after your operation; you can gently blow your nose after nasal irrigation.
• Avoid dusty environment if possible, as this may irritate the nasal lining.
• Avoid very hot baths and showers as it may lead a nose bleed.
• If you take aspirin, please discuss this with your doctor, as you may need to avoid taking aspirin for a few days prior and after the operation. Aspirin can potentially increase the risk of nasal bleeding.

Note: The information provided is for general information only. You should always discuss individually the risks, limitations and complications of your specific operation with your surgeons.

BALLOON SINUPLASTY:

Key issues:

• Minimum risk or complications
• Less bleeding, pain or scarring
• No nasal packing
• Minimum post-operative care
• Overall safety and success of the operation
• Duration of hospitalization: 1 day
• Post-op recovery: 1 day after discharge from hospital
• Fit to fly (after operation): 1 day after procedure

Cutting edge in:

• Availability of modern technology
• Very experienced surgeons to avoid risk and complication
• Excellent post-operative care
• Fully equipped to deal with any complication.

Surgeon: Dr. Sriprakash Vinnakota MS ENT

What are the benefits of using Balloon Sinuplasty?

Safe and effective – While use of any surgical instrument involves some risk, studies demonstrate that the Balloon Sinuplasty system is safe and effective in relieving symptoms of sinusitis.

Minimally invasive – The technology uses small, soft, flexible devices introduced entirely through the nostrils. These devices gently open blocked sinuses.

Reduced bleeding – In many cases, no tissue or bone is removed during surgery using this technology, because of this there is reduced bleeding. As a result, the need for uncomfortable nasal packing is also be eliminated.

Fast recovery time – While recovery time varies with each patient, patients will return to normal activities within 24 hours.

Does not limit treatment options – The Balloon Sinuplasty technology is an endoscopic tool and may be used with other medical therapies and/or surgical techniques. It does not limit future treatment options if a patient has progressive disease.

Balloon Sinuplasty technology is a FDA-approved, endoscopic, catheter-based system for patients suffering from sinusitis. It’s similar to angioplasty; the procedure heart surgeons use to clear out clogged coronary arteries. The technology uses a small, flexible Sinus Balloon Catheter to open up blocked sinus openings, restoring normal sinus drainage, ventilation and function. When the sinus balloon is inflated, it gently restructures and widens the walls of the sinus canals while maintaining the integrity of the sinus lining.

Steps in using the Balloon Sinuplasty technology
The technology is used by qualified Ear, Nose and Throat Surgeons

Step 1

Using the Balloon Sinuplasty system, your surgeon gently places a Sinus Guide Catheter and a flexible Sinus Guidewire through the nostrils to access the target sinus and then a Sinus Balloon Catheter is advanced over the Sinus Guidewire

Step 2

The Sinus Balloon Catheter is positioned across the blocked ostium and gently inflated.

Step 3

The Balloon Sinuplasty system is removed, leaving an open sinus passageway and restoring normal drainage and function.

What is “Balloon Sinuplasty”?

It is an advanced procedure where a balloon catheter is used to surgically repair the sinus ostia during a FESS procedure. FESS is a minimally invasive surgical procedure to open up air cells and sinus ostia (openings) in patients suffering from chronic sinusitis.

What are the Balloon Sinuplasty devices?

The Balloon Sinuplasty™ devices are FDA-cleared, endoscopic, catheter-based tools specifically designed to be used in sinus surgery. The Sinus Balloon Catheter is gradually inflated to gently restructure the previously blocked nasal passage, maintaining the integrity of the sinus lining and restoring normal sinus drainage, ventilation and function.

Does surgery with the Balloon Sinuplasty™ technology work?

Yes. Balloon Sinuplasty™ technology is safe and effective in dilating sinus openings and give excellent results when done in properly indicated patients.
Patients treated with balloon dilation may still require conventional sinus surgery.
In a small group of very selected patients, the use of balloon dilation technology alone may eliminate the need for other surgical procedures.

Are the Balloon Sinuplasty devices safe?

Yes. While use of any surgical instrument involves some risk, clinical studies have indicated the Balloon Sinuplasty™ technology to be safe. Furthermore, balloon catheter technology has been used successfully in other medical procedures such as balloon angioplasty for the heart.

How long does symptom relief lasts after surgery with Balloon Sinuplasty technology?

Results vary by individual. Published clinical data has shown that it lasts long.

How do sinus openings stay open after surgery with Balloon Sinuplasty™ technology?
Balloon Sinuplasty™ technology dilates sinus openings or ostia by pushing aside bones which comprise the sinus ostia. Moving bone remodels the sinus ostia, creating wider openings.

How long does surgery with Balloon Sinuplasty technology takes?
The duration of the procedure varies by individual situations. It takes half an hour to one hour. None of the patient required an overnight stay at the hospital.

Will I require general anaesthesia for surgery with Balloon Sinuplasty technology?
Most patients undergo general anaesthesia for sinus surgery with Balloon Sinuplasty™ technology, but some patients have had the procedure under local anaesthesia

How long does it take to recover from a typical surgery using the Balloon Sinuplasty system?
Because the system is minimally invasive it is typically used in an outpatient setting. While recovery time will vary from patient to patient, many people can return to normal activities within 24 hours after surgery.

Does surgery with Balloon Sinuplasty devices limit my treatment options?
No. Balloon Sinuplasty™ devices are endoscopic tools used within FESS and may be used with other medical therapies. They do not limit future treatment options for patients with progressive disease.

Are Balloon Sinuplasty devices right for me?
If you suffer from sinusitis, and medical therapy has not been effective in relieving your symptoms, you need evaluation by skilled ENT surgeon with Nasal Endoscopy and CT scan which suggests whether you are suitable candidate for this technology or not.

Are Balloon Sinuplasty devices covered by Insurance?
No. it is not covered by insurance in India. To be certain of your coverage, contact your insurance provider to find out your specific coverage policy.

CSF LEAK REPAIR (ANTERIOR SKULL BASE SURGERY)

What is CSF leak?

Cerebrospinal fluid (CSF) CSF leak is generally refers to watery, clear nasal drainage coming through a defect of the cranial base and meninges associated with the frontal, ethmoid or sphenoid sinuses.

How will patients present themselves? And the Diagnosis?

Diagnosis of CSF leak: Differentiating CSF leak from other types of nasal secretions is the cornerstone in diagnosing the CSF leak. The diagnosis could be complicated by the presence of fluids exiting from the nasal cavities. It is not rare for CSF leak to be intermittent and sometimes start even years after a traumatic event, when that event has been forgotten. It is in these patients that the diagnosis of CSF leakage could be challenging and frustrating.
We at MicroCare ENT Hospital and Research Institute, come to proper clinical diagnosis with the Chemical and Imaging Diagnosis

How is the CSF leak treated?

Nonsurgical Management:

a) Nonsurgical therapy like bed rest, head elevation (to prevent a negative gradient between intracranial and nose sinus cavities that would allow an ascending path for the bacteria intracranial).
b) Strict CSF leak precautions like avoid nose blowing, Valsalva manoeuvres, the use of straws, the use of an incentive spirometer and so forth).

Surgical Management:

Surgery for CSF leaks is reserved for those patients whose CSF leaks do not spontaneously close or respond to conservative management with CSF diversion. The surgical management of CSF leaks has improved with the use of endoscopic sinus surgery. With the advancements from improvements in instrumentation, visualisation, access and technique, improved imaging and surgical navigation have improved success rates.

ENDOSCOPIC DCR (DACRYOCYSTORHINOSTOMY)

What is Endoscopic DCR?

This is an endoscopic operation to form a new tear drain between your eye and nose when there has been a blockage. A blockage at the lower end of the duct from eyes to internal part of nose (nasolacrimal duct) is the most common cause of a tear drainage outflow problem leading to a watery eye or repeated eye infection. This blockage is treated with Endoscopic DCR at MicroCare ENT Hospital and Research institute. It is simple procedure which opens the blocked duct through the nose without giving you any external scars.

How do tears normally drain away?

Tears are produced continuously and when you blink they are drawn into two small holes known as punctum in the inner corner of your eyelids which in turn lead into small tubes known as the canaliculi, which in turn drain into the lacrimal sac. This lacrimal sac lies between the corner of your eye and your nose and has a duct at the bottom, which drains into your nose, called nasolacrimal duct. Through this duct tears drain into nose and those tears will be swallowed unknowingly.

Why does the normal passage duct become blocked?

The normal system does not have much space capacity (that is why we tear when we “cry”), and the narrow drainage channel becomes even narrower with age. Any structural abnormality surrounding the duct causes it to get blocked.

What does DCR surgery involve?

During DCR, your tear drainage passages are opened widely so that the tears can drain into the nose freely. There are two approaches to DCR surgery, one is external DCR and the other is endoscopic endonasal DCR, often referred to as EndoDCR. They are similar operations with similar success rates; often EndoDCR offers significant advantages to the patient.

What is External DCR?

The operation is performed routinely by an ophthalmologist through a 10-15mm incision in the side of your nose, where a pair of glasses would rest. You will have sutures, which are usually removed seven to 10 days later. This heals up very quickly and is rarely visible when healing is complete in most people and some time may form scar externally.

What is Endoscopic DCR?

Endoscopic DCR is a minimally invasive procedure done by ENT specialist surgeons to unblock tear ducts. The operation is very similar to external DCR, except that there is no cut through the skin and no scar afterwards. ENT surgeon accesses it through your nose, using a small thin endoscope.

What are the advantages of endoscopic DCR over the external DCR?

1. No facial scar, gives immense satisfaction to the patient aesthetically
2. No watering of eyes after the surgery which is common for life time in the external procedure.