In-Office Treatment of Chronic Sinusitis

Clinical History:

Patient referred for evaluation of chronic sinus pressure and nasal congestion.  This individual underwent two prior sinus surgeries in the past, with temporary relief afterwards.  In addition to a sensation of sinus pressure and nasal congestion, worse during allergy season, the patient also complains of a dull headache above the eyes.  The patient’s history is relevant for Migraine as well.  Medical treatment consisting of various courses of antibiotics(Z Pak, Penicillin, Levaquin), steroid sprays(Flonase), antihistamines(Zyrtec, Claritin), saline irrigation has been utilized – again without persistent relief.  Seeking further options, the patient was referred to GNO Snoring and Sinus.

Physical Exam:

Clinical and physical exam revealed a component of pressure and discomfort overlying the maxillary(cheek) and frontal(forehead) sinus region.  Nasal congestion was worse while the patient would lay flat, contributing to open mouth breathing and snoring at night.  A nasal endoscopy was performed revealing evidence of prior sinus surgery.  The patient had scar tissue formation that was obstructing normal sinus drainage, likely contributing to the sinus pressure and congestion.  An in-office CT Sinus was then performed revealing evidence of prior sinus surgery, but also evidence of impaired sinus drainage and a build-up of significant sinus secretions(PreOp CT Scan).  This resulted in an accurate diagnosis of chronic sinusitis secondary to scar tissue build up from prior sinus surgery. 

Treatment: The patient underwent in-office balloon sinuplasty of the affected sinuses for treatment.

Before:

PreOp CT Scan: (2/15/2016)

CS-Before

After:

Treatment: In Office Balloon Sinuplasty: (2/26/2016)
PostOp CT Scan:  (3/21/2016)

CS-After

Summary: Following the in-office sinus dilation, the patient noted a decrease in pressure above the eyes and along the cheeks.  There was an improvement in nasal breathing as well, decreasing open mouth breathing at night.   This is evident from the clearance of sinus secretions noted in the PostOp Image.

It is not uncommon for patients undergoing sinus surgery in the past to have scar tissue development that impairs normal sinus drainage – resulting in symptoms of pressure and congestion and lack of relief with medications.  These patients are ideal candidates for in-office procedures as simply restoring ventilation of the impaired sinus can improve overall symptoms.

With an accurate diagnosis, proper treatment is provided resulting in improved clinical symptoms.

To learn more about in-office sinus dilation and various other office based procedures available at GNO Snoring and Sinus, please contact us to learn more.