What is Chronic Sinusitis?

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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.

 

Advances in endoscopic sinus surgery

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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

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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.

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