Sinusitis is one of the most common health problems in New Zealand presently. It affects both adults and children and has been reported worldwide to affect well over 30 million people every year. Symptoms can significantly affect your health both physically, functionally and emotionally. Though sinusitis is a common problem, it is caused by a complex array of different factors such as bacterial, viral, fungal, and immune changes within the nose such as allergy and nasal polyps to name but a few. These conditions lead to inflammation plus or minus infection of the lining of the sinuses. The sinuses themselves are small air-filled pockets in the areas around the nose (see diagram).
Common symptoms of sinusitis include facial pain, congestion, pressure or fullness of the face. People often complain that their face feels heavy or that they feel like they have a cold they just can’t get rid of. Nasal obstruction or blockage is common. Discharge of discoloured mucus can come forward, requiring the use of tissues or hankies throughout the day, or even discoloured post nasal drainage may be the only symptom. Loss of sense of smell is possible, as well as headache and general tiredness. Clinical examination at my rooms, combined with CT scanning of the paranasal sinuses, can often aid in the diagnosis.
The drainage pathways from these sinuses into the nose are relatively small and inflammation from any of the above factors or even environmental factors can lead to a sinus obstruction. A cold, caused by a virus, is a classic example of simple sinusitis. However, if symptoms persist for several days, bacterial infection or acute sinusitis may be diagnosed. If the problem lasts 3 months by definition “Chronic Sinusitis” is said to exist. Treatment for chronic sinusitis often involves either multiple medical therapy (including sprays, antibiotics, and oral steroids) or sinus surgery.
Sinus surgery has rapidly evolved in recent years with the advent of fibre optic telescopes connected to high definition cameras, real-time suction irrigation microdebriders and computer assisted surgical navigation. I have been at the forefront of using surgical navigation and image guided surgery for sinusitis in Christchurch. This is an aid to assist safety and confirm landmarks as well as facilitating complete removal of diseased obstructive tissue in complex surgical cases.
Endoscopic sinus surgery is performed through the nose, usually with the patient asleep under general anaesthesia. A minimally invasive technique is utilised removing diseased or swollen tissue and removing small bony partitions to create improved ventilation of the sinuses.
I was trained in 2007 to use the exciting Balloon Sinuplasty technology to aid in minimally invasive sinus surgery. I have the largest experience in Australasia with this type of surgery and have run several hands-on teaching courses in labs for surgeons in NZ and Australia. This exciting catheter-based device uses a balloon that is placed inside the narrow sinus passage over a flexible guide wire. A balloon is blown up using fibreoptics to track the position, as well as endoscopic instruments. Early studies have shown that this therapy is safe and effective. Because the technology uses very small, soft, flexible devices it is minimally invasive with significantly reduced bleeding and often no tissue or bone is removed; rather the bony passages are permanently remodelled. Nasal packing is rarely required, and there is a return to normal activity within up to 24 hours with little or no pain.
At the time of writing we were the first and at present the only group in New Zealand to be able to offer this surgery as an Affiliated Provider to Southern Cross.
For complex cases such as those with nasal polyps or other immune issues, or in the setting of someone who has had failed previous surgery, other techniques may be required using advanced endoscopic techniques such as endoscopic lothrop surgery.