What is Chronic Sinusitis?

Chronic rhinosinusitis (CRS) is a common and prevalent disease in the United States. Symptoms include nasal congestion, drainage, facial pain or pressure and smell loss for at least twelve weeks. Previously bacterial infections were thought to be the reason for the symptoms, but now it is thought that chronic inflammation is the cause. The inflammation in sinusitis is similar to the chronic inflammation seen in asthma, and frequently people will have both disease processes. There are two main variants of chronic sinusitis – chronic sinusitis with polyps and chronic sinusitis without polyps.

Chronic sinusitis with polyps is largely an inflammatory disease and manifests with nasal obstruction, drainage and smell loss. Infections and pain are less frequent. Polyps are the end result from over-inflammation of the normal lining of the nose, in which the mucosa becomes swollen and eventually forms the grape-like polyps. They are not tumors, and are different from colon polyps. If treatment with topical nasal steroids fails, then endoscopic sinus surgery can improve quality of life for patients. Polyps do recur, however, revision sinus surgery is only required when the patient’s symptoms recur and cannot be controlled with medicine.

Chronic sinusitis without polyps has similar symptoms to CRS with polyps, but pain and infections are more common. Topical steroids and rinses are the initial treatment of choice. If the patient fails medical therapy then endoscopic sinus surgery can help through improved aeration and improved access for topical therapies to reach the sinuses.

Since both of the diseases are inflammatory, the treatments of choice to decrease inflammation are topical steroids. Flonase or any of the OTC topical steroid sprays are a good initial treatment option, in conjunction with a saline sinus rinse. If a patient continues to have symptoms then the addition of budesonide (a steroid used in treatment of asthma) to the saline rinses can have more efficacy.


Josh Meier, M.D. F.A.R.S.


Image Guidance in Endoscopic Sinus Surgery

Endoscopic sinus surgery is surgery that is performed using cameras through the nostrils to open up and drain the sinuses. There are no external incisions. Since its inception in the 1980s, it has advanced in leaps and bounds, allowing more extensive surgery with less complications and easier recovery. One of the keys to this advancement has been the use of “image guidance” or computer assisted surgery.

At the beginning of endoscopic sinus surgery, the surgeon will trace the outline of the patients’ face and the computer will align and fuse it with the patient’s sinus CAT scan.   There are two ways that the computer can track where the instruments are during the operation, using magnets or an infrared system. We use the Medtronic Fusion® system at both St. Mary’s and Renown. Once it has been registered, the computer screen will show the surgeon where the tip of the suction or probe is during the operation on the computer screen. This enables the surgeon to confirm his or her location within the sinuses and allow the surgeon to access more complicated structures such as the frontal sinus, the sphenoid sinus and orbital or skull base lesions.

The American Academy of Otolaryngology – Head and Neck Surgery and the American Rhinologic Society endorses the use of image guidance in endoscopic sinus surgery in following situations:

  • Revision sinus surgery.
  • Distorted sinus anatomy of development, postoperative, or traumatic origin.
  • Extensive sino-nasal polyposis.
  • Pathology involving the frontal, posterior ethmoid and sphenoid sinuses.
  • Disease abutting the skull base, orbit, optic nerve or carotid artery.
  • CSF rhinorrhea or conditions where there is a skull base defect.
  • Benign and malignant sino-nasal neoplasms.

Dr. Meier uses this technology commonly, and it enables him to address more disease safely. In the past extensive frontal sinus disease would require an external approach that has increased morbidity, however now with improved visualization, techniques and instrumentation in conjunction with image guidance, Dr. Meier is able to endoscopically treat the majority of frontal sinus disorders without incisions.


Josh Meier, M.D. F.A.R.S.


Advances in endoscopic sinus surgery

Rhinology is one of the newest medical specialties with many exciting technological advances occurring in recent years. Endoscopic sinus surgery began in the 1980s, and has progressed in leaps and bounds over the ensuing decades. Dr. Meier attends multiple courses annually to stay up to date on the newest technologies employed in the medical and surgical management of chronic sinusitis and diseases of the anterior skull base.

Dr. Meier uses a combination of old and new products to ensure proper healing after endoscopic sinus surgery. He uses a new product, Posisep X, which is a dissolvable dressing made from Chitosan, a naturally occurring molecule that has hemostatic and anti-inflammatory properties. Most of the Posisep will rinse out in the week after sinus surgery.

Another product Dr. Meier uses is the Propel stent in specific cases. This is a degradable steroid-eluting stent that stays in the ethmoid cavity for one month after surgery. By delivering mometasone, it can decrease inflammation after endoscopic sinus surgery.

Dr. Meier does not use splints or non-absorbable packing after endoscopic sinus surgery and septoplasty. This is because of the mucosal-preserving techniques he uses, which reduce bleeding, and speeds up healing and recovery. When packing is not used, there is minimal pain after nasal surgery.

Under Dr. Meier’s guidance, both Renown and St. Mary’s have upgraded their endoscopy camera and tower to the Karl Storz Image One system. Video examples of this technology can be seen at the Karl Storz website. This advanced, high-definition technology has enabled Dr. Meier to perform more complicated endoscopic sinus surgery involving the skull base, the frontal and sphenoid sinuses.

Josh Meier, M.D. F.A.R.S.

New Cone Beam CT Scanner at Nevada ENT

Nevada ENT and Reno Tahoe Sinus Center are excited to announce that we have just completed installation of a brand new Carestream CS 9300 cone beam CT scanner. Our office has offered in-office CT imaging for the last 7 years, and we recently decided to upgrade to the latest technology. We can image both the paranasal sinuses and temporal bone (ear).

Your doctor will review your images with you immediately after the scan. In addition, the board-certified radiologists at Reno Diagnostic Center will review your scan and send a report to our office.

Advantages of in-office cone beam CT imaging:

  • High resolution, down to 0.09mm, for excellent imaging detail
  • CBCT radiation dose is much lower than low-dose and standard conventional CT exams (approximately 1/10 of the dose)
  • Convenience – imaging can be done in our office without a second trip to an imaging center
  • Images can be used for image-guided sinus surgery

We are pleased to offer this new technology to our patients, please do not hesitate to ask your provider for more information.

Josh Meier, M.D. F.A.R.S.

Update on Chronic Sinusitis

Chronic rhinosinusitis (CRS) is a condition that a large segment of the population suffers from, with a significant decrement in quality of life. Symptoms of CRS include nasal drainage, congestion, facial pain or pressure, and smell loss. Frequently nasal allergies can contribute to symptoms. In Reno, the bulk of allergy symptoms occur in the fall, when the sagebrush and rabbit brush bloom.

The first line of treatment for CRS is a saline rinse (Neilmed sinus rinse) and an over the counter topical steroid spray (Flonase, Nasocort). For most CRS patients, this will lead to a significant increase in quality of life.   For patients that do not improve, then a consultation with an otolaryngologist can be helpful, and other treatment options can be discussed.

An option for patients that continue to have symptoms, despite appropriate medical therapy, is endoscopic sinus surgery (ESS). New technology and techniques have resulted in much less discomfort and recovery after ESS. Because of my focus on mucosal preservation, there is less bleeding; as a result I do not use nasal packing or splints for patients that undergo nasal surgery.

If you have any questions about your nose or sinus health, please do not hesitate to call and schedule an appointment.


Josh Meier, M.D. F.A.R.S.

Nevada ENT



(775) 322 4589

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