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Waging a high-tech war against sinusitis

August 18, 2005

SLU physician touts benefits of painless endoscopy, image-guided surgery

ST. LOUIS - Coughing, headaches, fatigue, post-nasal drip and intense pressure throughout the face. For millions of Americans, these aren't just the side effects of a short bout with the flu, but what they experience every day living with sinusitis.

"Sinusitis is the most commonly reported chronic disease in the United States, and it can be very debilitating," says Raj Sindwani, M.D., a SLUCare otolaryngologist and assistant professor of otolaryngology at Saint Louis University School of Medicine. "The quality of life in patients with chronic sinusitis can be worse than in those with emphysema, congestive heart failure, or back pain, not to mention the direct costs of treating patients who suffer from sinus infections."

Sindwani is on a mission to teach patients about modern treatments for sinusitis so they can literally breathe easier. As the head of the SLUCare Comprehensive Sinus Clinic, which brings together allergists, otolaryngologists and radiologists, he says patients no longer need to go through antiquated or painful procedures.

"It's very Star Trek-esque"

The first step, he says, is performing a painless sinonasal endoscopy to check patients' sinuses for sites of blockage, polyps and infection.

"Before sinonasal endoscopy, our ability to look directly into someone's nose and sinuses was very limited," he says. "When a scope is not available, a light source or ear speculum is used to look into the nasal cavity. Only a very limited view of the front part of the nose is obtained this way."

But not anymore. Now Dr. Sindwani uses a tiny telescope that is guided up into the nose and sinuses to look for signs of blockage. With no anesthesia needed, the procedure allows Sindwani to take a closer look at the actual drainage pathways of the sinuses to rule out any problems that may be contributing to the patient's sinus symptoms; Sindwani cites nasal polyps, cysts, scar tissue from previous surgeries and crooked septums as common culprits.

If an infection is detected, the endoscope can also be used to sample some of the pus present within the nose and sinuses, which can then be cultured in the lab and help doctors choose the most effective antibiotic for any given infection.

Not only is the endoscopy effective, Sindwani says, but it also has educational and entertainment value.

"The telescope has a camera attached to it, so patients and their families can watch the entire procedure on a monitor. They really love this because it actually lets them see what the problem is instead of just going by what the doctor says," he says. "It's very Star Trek-esque."

21st century digital surgery

If surgery is needed, doctors can use the same endoscopes used in diagnosing the problem to perform minimally invasive sinus surgery. This particular kind of surgery is the most advanced of its kind, says Sindwani, and has ushered in an entirely new way of thinking among doctors who treat sinusitis.

"At the SLUCare Comprehensive Sinus Clinic, our surgeons also use a state-of-the-art surgical navigation system, which allows them to more safely make their way through the tiny sinus passageways, ensuring that all of the sinuses are adequately opened," Sindwani says. "With the help of a computer, the patient's CT (computed tomography) scan is used as a roadmap in the operating room, and special instruments are used that are tracked as the surgeon enters each of the patient's sinuses."

This minimally invasive procedure leaves the patient with no cuts on his nose or face and allows the surgeon to get a magnified view of the sinuses during surgery - "and using image-guided technology only adds a few minutes to the procedure," Sindwani says.

He recommends image-guided surgery for patients who have had previous sinus surgery or those with abnormal anatomy or extensive sinus disease.

And for more advanced problems unrelated to the sinuses, Sindwani uses those same surgical navigation systems and endoscopes to access other areas of the head to perform surgeries for serious problems, such as thyroid disease affecting the eyes and even brain tumors.

"In patients with thyroid diseases, we can decrease the bulging of their eyes and improve their vision," Sindwani says. "We can also remove tumors of the brain or pituitary gland through the nose without incisions on the face or head. This means they can go home more quickly to their families, jobs and lives."

Sindwani says he is optimistic about the future for sinusitis sufferers.

"Sinusitis is not just a stuffy or runny nose; it oftentimes is a very serious medical condition," Sindwani says. "But as long as we continue to be open to breakthrough technologies and procedures, we can make life a lot better for patients."

Saint Louis University