What is Endoscopic Sinus Surgery?

Interviewer: What is Endoscopic sinus surgery? We'll talk about that next on The Scope.

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Interviewer: Endoscopic sinus surgery is more commonly just referred to as sinus surgery. This podcast's purpose is to tell you what this procedure is, how it compares to some other alternatives, and if there are any risks or side effects, and how it changes people's lives.
We're with Dr. Richard Orlandi who's one of the experts here at University of Utah Healthcare and Sinus Surgery. I think when somebody goes in to get surgery, the first thing they want to know is what difference is this going to make. How is it going to change my life? Let's ask that question first.

Dr. Orlandi: Absolutely. I think that's a great question and obviously the most important one. What can people expect? You know, sinus surgery is not a cure, and that's one of the first things I try to tell people. It is going to help with the management of your sinus problems overall, but it's not going to cure them. So it's going to require additional medical therapy afterwards. But what we're talking about is going in and opening up the sinuses primarily to let them drain, let air in, get medications in there to the surface of the sinuses to try to reduce the inflammation. That's the overall purpose.

Interviewer: So when you say, "open them up", is that the problem, because usually things are little too constricted in there?

Dr. Orlandi: Yeah. What we're finding is that with the sinuses, they drain through small openings into the nose. We think of the nose as a hallway and sinuses are like rooms off of that hallway. That opening between the room and the hallway is small. It's supposed to be. But when we have long-standing inflammation, the lining, or call it the wallpaper, will swell up and block off that doorway so things can't get in. Air can't get in and the secretions in the sinuses can't get out and that sets us up for chronic sinus problems.

Interviewer: Does that kind of turn into scar tissue? Is that what's going on?

Dr. Orlandi: No, it just stays really inflamed and it just won't, that inflammation just won't back down.

Interviewer: No matter what you do.

Dr. Orlandi: Absolutely. We try different things with medical therapy but when that doesn't work then we start looking at making the openings wider.

Interviewer: So somebody that's suffering this type of thing that this surgery might help, it makes a significant impact to their quality of life after they have it, from what I understand.

Dr. Orlandi: It's a huge impact. Sinus problems we know are correlated with sleep issues, with depression, with fatigue, not just the sinus symptoms themselves, and so when we get that sinus inflammation under control through a combination of surgery and medications, we're able to reduce those factors in people's lives as well.

Interviewer: I've heard they refer it to as endoscopic sinus surgery. You have told me that it's just sinus surgery, that all of it is endoscopic, which indicates that at one point it was different. So what exactly is endoscopic and how's that compare to the way things used to be done?

Dr. Orlandi: The endoscopic refers to using a scope. It's like a fiber optic-type scope that we use that goes through the nostrils. Previously sinus surgery was done by making incisions underneath the upper lip, alongside the eye, between the eye and the nose, and up in the forehead and the hairline. Rarely those things are still done for unusual circumstances, but now everything is pretty much done through the nostrils.

Interviewer: So a lot less invasive.

Dr. Orlandi: Obviously, yes, and much easier to tolerate, much less painful afterwards.

Interviewer: Gotcha. What are some of the risks or side effects that somebody should be aware of if they're considering this type of surgery?

Dr. Orlandi: Knowing those risks is important as you weigh the risks and benefits, obviously, and make a decision about sinus surgery. The sinuses are right next to the eyes and they're right next to the brain, and those two areas we worry about during sinus surgery. We think about it as sinus surgeons and make sure that things are safe. Injury to the eyes, including damage to the vision, and injury in the brain that could lead to a spinal fluid leak are the two things we worry about, and those are fortunately extremely rare. But any surgeon is going to have that in the back of his or her mind.

Interviewer: Yeah. It sounds kind of terrifying, but out of all the procedure you do, just not likely.

Dr. Orlandi: No, far less than 1%, and that's important to know.

Interviewer: Gotcha. What about some side effects afterwards?

Dr. Orlandi: Clearly, like many surgeries, we're going to make the problem worse for a few weeks or months before we make it better. So more swelling, inflammation, obviously people are going to be bleeding from the nose. Some surgeons will use packing, others do not. Most of the packing that's used now is dissolvable to try to cut down on bleeding. But those are some of the things that we look at immediately after surgery.

Interviewer: Singers or people that use their voice for a living, are they concerned that that's going to change?

Dr. Orlandi: Luckily, not a huge impact, but the voice does resonate through the nose and sinuses, and for a professional singer or someone who spends a lot of time with their voice, like yourself, we are going to see that the voice will change slightly in how it resonates.

Interviewer: Yeah, maybe for the better, in my case.

Dr. Orlandi: It can be for the better.

Interviewer: All right. What are some alternatives to surgery? If somebody just goes, "Gosh, I don't know. This seems like a huge commitment," what else can be done?

Dr. Orlandi: Yeah, the surgery, very rarely are we're dealing with a life or death problem here, right? So the surgery is always as an option but not necessarily does one have to have it. Continuing with the medical therapy is always an option and a lot of patients elect that. The surgery, obviously, isn't appealing for some folks and we certainly understand that.

Interviewer: And the benefits, though, in some patients, tell me a personal story of maybe somebody that had just some great results.

Dr. Orlandi: Yeah, I think that we see people when often they've gotten to that point where they just are done with, they've done everything, has gone as far as they can with the medical therapy, with medications, rinses, sprays, antibiotic pills, even steroid pills, and they're just not getting there. We're able to take a patient like, that open things up, and then get that medication accessing the sinus surface and keep that inflammation down. And you're taking someone who's . . . again, that fatigue and depression can really be an issue, and it really helps people out in addition to resolving a lot of the inflammation and pain and pressure in the sinuses.

Interviewer: This is your opportunity to address any myths or misconception that people might have about this procedure. What are those?

Dr. Orlandi: You know, a couple of them. One is that - and we talked about this already - that I'm going to have my surgery and it's going to cure my sinus problem. I'd love to believe in that myth, but unfortunately it's just not true. We talked a lot about, I hear people talk about I'm going to have my sinuses scraped. Yeah, that doesn't sound very good, does it?

Interviewer: No.

Dr. Orlandi: And what instead we find is, what we're doing is actually opening up the holes that we talked about and actually really preserving that natural lining. We want that lining there because if we scrape it out, not only does it sound horrible, but it's going to lead to more scar tissue. So we're actually very careful to preserve the function of the sinuses.

Interviewer: We've covered a lot of ground in what is sinus surgery or endoscopic sinus surgery. Is there anything that I left out that a patient might want to know about this procedure?

Dr. Orlandi: No, I think that maybe the last thing that's important is, you know, when you have your gallbladder taken out, you have it taken out, you're cured, you may have one visit with your surgeon afterwards to make sure everything is healed up, and you're done. Sinus surgery is not like that. It requires tailoring the medical therapy afterwards. It's very individualized. We do see patients for a few visits after the surgery, sometimes three or four or more, to really tailor their medication to make sure that they're getting the most out of the surgery.

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