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All About Sinus Conditions [Podcast]

Posted May 18, 2021 by Dr. Philip Khalil and Dr. Ryan Gerritsen

Listen to this episode of the Healthy Vitals Podcast.

Dr. Philip Khalil and Dr. Ryan Gerritsen lead a discussion on sinus conditions, as well as treatment options.


Scott Webb: 
Your sinuses are hollow airspaces within the bones between your eyes and behind your cheeks and forehead that are connected to the nose by narrow channels. These four pairs of sinuses produce thin mucus that drains out of the channels from your nose. And when your sinuses can't drain, you often feel pain or pressure and are at much higher risk of sinus infections.

Not only are sinus problems uncomfortable, they can have a significant impact on your overall health and quality of life. And joining me today for a discussion on the most common sinus conditions, including diagnosis and treatment options are Dr. Phillip Khalil, he's a board-certified otolaryngologist, and Dr. Ryan Gerritsen, he's an otolaryngology surgeon and they both work at Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So doctors, thanks so much for your time today. We're talking about common sinus conditions. So I'll start with you, Dr. Khalil. What are the most common sinus conditions that you see?

Dr. Phillip Khalil: Living in Northeast Ohio, we see quite a bit of patients who suffer from sinus conditions and they can range from a variety of symptoms of facial pressure, headaches, chronic nasal congestion and runny nose, that can also affect your sense of smell and taste. And these conditions, as providers, we kind of quantify them into patients who have either acute sinus issues or chronic sinus issues.

And chronic sinusitis is really, as an ear nose and throat specialist, the types of patients that we typically see more often. And these are generally patients that have, you know, suffered from those types of symptoms for greater than three months or have had kind of recurrent infections throughout the years.

Scott Webb: And so you're seeing both, right? You're seeing both acute patients, chronic patients. And Dr. Gerritsen, maybe I can have you elaborate a little bit. Tell us what is chronic sinusitis and how is it treated.

Dr. Ryan Gerritsen: Chronic sinusitis is defined as paranasal sinus disease lasting greater than 12 weeks. So typically, we see patients who are referred to us who have completed a number of different rounds of antibiotics and are on different nasal sprays. And they may get temporary relief with the antibiotics. However, their symptoms still persist, either mildly or still present. And they're coming to us for a second opinion or for a referral from a primary care physician.

And we'll evaluate those patients with different imaging studies, try to tailor their treatment as far as do they need other antibiotics versus are they on the appropriate nasal sprays or intra-nasal steroid sprays and kind of go from there to figure out a treatment plan, and see if we can get that patient's chronic sinusitis under control.

Scott Webb: Yeah, Dr. Khalil, is that to your experience as well? That you, you know, work with the patients to try to figure out, okay, what's troubling them? How can you best help them? And then develop a plan of action for each of them.

Dr. Phillip Khalil: Yeah. And again, I would agree. I think what we try to do here is really tailor the individual's situation to the best management for the patients. So some patients, their issue is really their anatomy and they simply cannot get, you know, the medication where it can be effective. Other patients, it's more uncontrolled allergies or not addressing the underlying allergic component.

We are always looking for, I tell patients this all the time, the simplest way to provide them with the solution they're looking for. And sometimes that is medication management or adjustment. And other times, it's moving to surgical treatment options that would be appropriate for their specific circumstance.

Scott Webb: Yeah. And it seems in the Spring, everybody chalks up a runny nose to their allergies. And I often wonder, Dr. Gerritsen, you know, how many people really have allergies? Or is it really undiagnosed other sinus conditions? It just seems a lot gets chalked up to seasonal allergies, but I'm not sure that's true for most people. What's been your experience?

Dr. Ryan Gerritsen: Yeah, so there's definitely a significant proportion of patients who suffer from allergies and they come in with those classic complaints of itchy, watery eyes. And typically, their nasal congestion and runny nose remains clear and they can notice a fluctuation dependent on what season we're in.

So in patients with those sort of descriptions, it does tend to fit that allergy picture. In patients with more severe facial pain and pressure and drainage that isn't clear in consistency, that we tend to describe as mucopurulent or it's colored, it may have a foul odor, those are the patients we're sort of transitioning the thought process to is it an infection versus or is there something anatomical that's leading to these recurrent sinus symptoms?

Scott Webb: Yeah, I see what you mean. And there are those sort of classic allergy symptoms. And then when someone doesn't fit that profile, then you might look at some other things like perhaps chronic sinusitis and some of the other stuff that we've talked about here today.

So Dr. Khalil, let's talk about nasal obstructions. Deviated septums is something that confuses me a little bit. There seems to be a lot of maybe misinformation or misunderstanding about deviated septums. So just in general, take us through nasal obstructions, especially deviated septums.

Dr. Phillip Khalil: Yeah, I know. And I think that's a great point to make a deviated septum. So something I think most people have heard of. And first of all, what is the septum? I'll take a step back. The septum essentially is the partition in our nasal cavity, so literally between our nostrils, our left and right nostrils. It's made of cartilage, kind of in the front where everybody can feel and then, further back, it's bony.

And that partition essentially separates our nasal and sinus cavities completely to a left and a right side. So a deviated septum by definition is a deviation or a crookedness of the septum to one side or the other that typically, depending on the severity of it and/or other factors, will cause symptoms of nasal obstruction.

Keeping in mind, you know, frankly, the majority of us have a deviated septum to some degree. It's actually fairly unusual to have a completely straight septum. So that the degree of deviation, other anatomical factors and then other, you know, contributing factors such as recurrent infections or significant allergies are typically what lead patients to seek treatment as to options for this because of the degree of nasal obstruction as a result of it.

Scott Webb: Yeah. And Dr. Gerritsen, are there other nasal obstructions that you also deal with?

Dr. Ryan Gerritsen: Sure. So outside of a deviated nasal septum, there are inflammatory-type conditions such as nasal polyps that can cause obstruction. And the turbinates, which are smaller bones that come off the lateral nasal wall, those can particularly get hypertrophied or enlarged and cause significant nasal obstruction.

Those kind of comprise the vast majority of types of obstruction when you include deviated nasal septum. But there are some benign lesions that can grow within the nasal cavity as well as the outside chance of potentially a malignancy that can occur within the paranasal sinuses. So we'll take a patient and take a look at the entire picture and potentially perform nasal endoscopy if a sign of obstruction isn't obvious on the routine exam.

Scott Webb: So let's stay with you there. Let's talk about nasal endoscopy and other, you know, surgical options because we've talked through some of the non-surgical therapies and options for people. Let's stick with surgery or the endoscopy procedure. Tell us more about that.

Dr. Ryan Gerritsen: The nasal endoscopy procedure itself we can perform here in the office. We basically use a small camera and basically go in through the nose and we can get a finer detailed view and look at the nasal cavity in the sinuses for signs of obstruction, any potential polyps or possible obstructions that are occurring within the sinuses. That procedure takes a few minutes. It's accomplished right here in the office and patients tolerate the procedure pretty well.

When patients have failed, what we've termed maximum medical therapy or we've basically tried all the nasal sprays and conservative measures that we can to get patients to feel better, we do perform endoscopic sinus surgery and that takes place in the operating room. It's the same-day procedure. And we basically go in with a camera and instrumentations and open up the sinuses, straighten out the septum if that's needed, and open up the nasal cavity and the sinuses so that we do reduce the chance of recurrent infections and the mucopurulent drainage and things like that to help improve some of those cardinal symptoms of sinusitis, including facial pain and pressure and get the patient sort of feeling back to their normal selves without these symptoms of sinusitis.

Scott Webb: Yeah, that sounds good. And Dr. Khalil, when we talk about these procedures, is nasal endoscopy really the gold standard? Is there anything on the horizon that you're sort of excited about?

Dr. Phillip Khalil: 
Yeah, so the nasal endoscopy is a tool that we use really more diagnostic-wise to get a thorough evaluation of what, again back to what we discussed earlier, needs tailored in that individual patient. There's really a whole slew of newer procedures that we have that allow us to essentially minimally invasively address the issue. So endoscopic sinus surgery over the years has really evolved.

Several decades ago, it involves scraping the lining of the sinuses and these patients required packing and quite a bit of discomfort and external bruising. The procedure today has really graduated to very minimally invasive. And the acronym we use is FESS and that really is very descriptive. It's functional endoscopic sinus surgery. And that really describes what we're trying to do, restore the normal function to the sinuses. It's all done endoscopically, meaning through the nasal cavity, without any external incisions. And the instruments that we use are geared towards tissue preservation, meaning we try not to scrape the lining, but restore the normal anatomy and opening.

And some of the different and newer instruments that we use is an instrument called balloon sinuplasty, where we can actually dilate the openings with a somewhat rigid balloon that provides openings. There are newer techniques also to address nasal obstruction that can also occur from a collapse of the outside of the nose to help kind of provide some rigidity. And the best way I can explain that with patients is it's kind of similar to those Breathe Right Nasal Strips that you'll see. It kind of helps open up the nasal cavity so that you can get more air flow through there. And that's an implant that we use called Latera. We have several new tools and techniques that I think really can benefit patients with a variety of symptoms with nasal obstruction and chronic sinusitis.

Scott Webb: Yeah, it sure does sound like it. It sounds like you guys have a lot of tools in your tool belt, if you will. And a lot of good stuff and a lot of good therapies and surgical options, minimally invasive, which of course everybody wants nowadays. So as we get close to wrapping up here, doctors, Dr. Gerritsen, anything else you want to tell folks about common sinus conditions, whether it's symptoms, treatment, management, anything else you want to tell folks?

Dr. Ryan Gerritsen: I would say that in dealing with chronic sinusitis, that patients, there's a number of different therapies that range from conservative measures, all the way to surgical measures that we can take that can help patients feel significantly better from their symptoms. I always tell patients that the sinus conditions that we typically deal with are not urgent, but they can have a significant impact on the quality of life of patients. And we can improve on that.

And there's a number of different therapies that we can offer and make a profound impact on patients. We're happy to treat and evaluate patients of every different mindset and come up with a game plan to try to treat that patient accordingly and get them feeling better.

Scott Webb: Yeah, it does seem like these sinus conditions are common, but there are a lot of treatment options, therapies, surgery, whatever it might be. Dr. Khalil, what are your takeaways today? What do you want folks to know after clicking play today?

Dr. Phillip Khalil: Well, I think that what we truly enjoy doing is helping these patients achieve the quality of life that they're looking for. And as Dr Garretson said, I would agree a hundred percent. Every patient has different ideas of what they are suffering from and how invasive or minimally invasive they are looking for. And we are respectful and try to tailor that to them. But I think the bottom line is we find that we can achieve results with these patients and that they generally are going to feel relief and be a participant in the decision-making with that, which I think is truly the key to a successful outcome.

Scott Webb: Yeah, I couldn't agree more. It's been really great having you both on. A lot of great information today, just understanding common sinus conditions and what you guys can do to help patients and how you involve them in the process. And really that patient-centered approach is great. And that's one of the things I love about Summa. So thank you both for your time today and you stay well.

Dr. Phillip Khalil: Thank you very much.

Dr. Ryan Gerritsen: Thank you. Appreciate it.

Scott Webb: If you have sinus issues, call (330) 375-6917 to schedule an appointment. And if you've found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well and we'll talk again next time.

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