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Treatment Options

Medical Treatments

Nasal/sinus irrigations (rinses): Washes can be done with saltwater alone, as well as steroid and antibiotic additives. High volume and positive pressure methods work the best. They have been demonstrated to be beneficial, safe, and well-tolerated, in the treatment of sinusitis.

Systemic antibiotics and steroids: Often in oral form, antibiotics and steroids are initial treatments for chronic sinusitis, with surgery reserved for refractory cases.

Aspirin desensitization: This is a treatment option for Aspirin Exacerbated Respiratory Disease, which requires having three specific conditions, nasal polyps, asthma, and sensitivity to aspirin/aspirin-containing medications or non-steroid anti-inflammatory drugs (NSAIDs). This is pursued for appropriate patients in collaboration with the allergists at UI Health.

Biologic therapy (biologics): These are newer medications, such as dupilumab (DUPIXENT®), that target specific components of the inflammatory pathway responsible for sinusitis. Biologics may be offered to appropriate patients in collaboration with the allergists at UI Health Biologics may be offered to appropriate patients in collaboration with the allergists at UI Health. 

Allergy treatment: Options include daily medical therapy, such as sprays, eye drops, and pills, and behavioral modifications and environmental controls. Allergy shots (immunotherapy) and sublingual immunotherapy are offered in collaboration with the allergists at UI Health. 

Endoscopic Sinus Surgery

Functional endoscopic sinus surgery is the use of telescopes and cameras through the nose to reach, open, and clear out the sinuses. As an analogy, a sinus cavity can be thought of as balloon with an aerated portion and a small opening. Sometimes, it is beneficial to widen this opening to aid in the long-term function of the sinus as well as to remove disease and secretions from the sinus.  

There are no external facial cuts in this type of surgery. As a result, there is less morbidity associated with this type of surgery as compared to surgical approaches to the sinuses with external facial cuts – no change in the external appearance of the face, faster recovery, and less pain.

In our practice, the importance of post-operative care and long-term follow-up with ongoing endoscopic surveillance of the sinus and nasal cavities is emphasized. In general, medical therapy with antibiotics and nasal saline irrigations, and sometimes oral steroids are used in the postoperative period along with weekly or bi-weekly (every 2 weeks) endoscopic surveillance and adjustment of medications as sinus inflammation resolves.  

Afterwards, we follow patients with periodic nasal endoscopic exams. So, in addition to discussing the pros and cons of the treatment for your condition, we emphasize long-term follow-up for continued management of your chronic sinusitis. 

Revision Sinus Surgery

For some patients, sinus surgery may not have achieved the desired results. There are many reasons that sinus surgery may not have been successful.  

Some of these reasons include the following:

  • Severe chronic sinusitis. Some forms of sinusitis are more difficult to treat than others. 
  • Development of scar tissue.
  • Inadequate tissue removal.
  • Inadequate sinus drainage (often caused by inadequate tissue removal or development of scar tissue).  

This type of surgery involves removing inflamed tissue that was left behind from the previous surgery, with the goal of opening all of the sinuses as wide as possible 

Image-Guided Surgery

During image-guided surgery, a computer helps the surgeon known the precise location of his or her instruments within the sinuses in real-time. The patient’s imaging, a CT scan or MR, is used by the computer to create a map of the patient’s sinuses. This technology has the potential to make procedures safer and more complete. Our practice has image guidance capabilities for all nasal and sinus procedures.  

Septoplasty and Functional Septorhinoplasty Problems with nasal breathing may be due to anatomic obstruction of the nasal passages. A deviated septum is an example of this. A septoplasty is a procedure that removes the deviated portion of the septum to improve nasal airway breathing.  

In addition to the septum, the nasal skeleton is made up of nasal bones, upper lateral cartilages, and lower lateral cartilages. If any of these portions of the nasal skeleton are crooked or broken, they may obstruct the nasal passages and lead to complaints of nasal obstruction or difficulty breathing through the nose. A functional septorhinoplasty addresses the structure of the nasal skeleton to improve nasal breathing.  

Turbinate Reduction

Turbinates are on each side of the nose and humidify the air as it moves through the nose. Sometimes they can be enlarged, known as turbinate hypertrophy. Turbinate reduction surgery can reduce their size, increasing the size of the nasal passageway and improving nasal breathing.  

Cerebrospinal Fluid (CSF) Leak Repair 

Once it is confirmed that clear drainage from the nose is CSF, it is important to determine the cause. In some cases, the underlying cause can be treated, and this is critical to optimize success. If surgical repair is indicated, the defect site can be repaired from either the brain side or nasal/sinus side. More recently, the repair has been performed from the nasal/sinus side, as this is done via a minimally invasive “endoscopic approach” that avoids any external incisions and significantly speeds up recovery time. There may also be the placement of a lumbar drain, and typically a stay in the hospital for a few days is necessary.  

Endoscopic Resection of Sinonasal and Skull Base Tumors

Endoscopic resection involves the use of telescopes and cameras through the nose to reach the tumor and remove it.  This type of surgery is used to avoid external skin incisions to remove the tumor.  The Skull Base Program at UI Health is dedicated to the use of minimally invasive procedures to treat sinonasal and skull base tumors.

When you are seen, we may schedule you to undergo radiographic studies such as an MRI or CT scan. You may also be seen by other specialties, such as neurosurgery, ophthalmology, endocrinology, radiation oncology, or medical oncology, for further workup of the tumor. Once we have the information we need, we will devise a treatment plan best suited to you. 

Tear Duct Surgery

The purpose of the surgery, endoscopic dacryocystorhinostomy (DCR), is to correct tearing caused by obstruction of the tear duct. The endoscopic approach leaves no scars on the face in contrast to conventional open DCR. In comparison to the conventional open approach, the endoscopic approach also allows concurrent addressing of intranasal issues that may lead to complications or failure, such as a deviated septum or enlarged middle turbinate.  

When you are seen, we may schedule you to undergo radiographic studies such as an MRI or CT scan. You may also be seen by other specialties, such as neurosurgery, ophthalmology, endocrinology, radiation oncology, or medical oncology, for further workup of the tumor. Once we have the information we need, we will devise a treatment plan best suited to you. 

Orbital Decompression

This surgery is performed to relieve swelling of the tissue in the orbit, creating bulging of the eyes, such as in thyroid eye disease. It creates more space by removing one or more of the bony walls surrounding the eye. It is typically recommended when symptoms of eye pain, eye irritation, or vision changes/loss become severe. The endoscopic approach does not involve cutting through the skin, as it is performed entirely through the nostrils, in contrast to the conventional open approach. Therefore, the endoscopic approach also avoids bruising and swelling associated with the conventional open approach.