A sinus
sufferer chooses surgery
By: Judy Foreman
March 17, 2008
After years of suffering from
chronically inflamed and infected sinuses, I finally
decided I'd had enough. I chose to do what 500,000
other Americans do every year - have sinus surgery.
It wasn't an easy decision. I had
to balance my need for a fix against my fear of
surgery and research that raised questions about the
procedure.
I was miserable. My sinuses, those
supposedly hollow spaces around the nose, had become
clogged by scar tissue and the build-up of thickened
mucus from decades of infections and inflammation.
My nose drained so poorly that nearly every time I
got a cold, I got a bacterial infection superimposed
on the viral one, leaving me sick and tired for
weeks.
I had already tried everything
short of surgery. I was religious about nasal lavage
- rinsing out the sinuses with salt water every day.
I had acupuncture. I took endless decongestants,
antihistamines, and nasal steroids, contributing to
the $5.8 billion a year that Americans spend on
sinus treatments, according to the American Academy
of Otolaryngology-Head and Neck Surgery Foundation.
For 80 percent of people with
chronic sinusitis, these treatments keep sinusitis
under control. For me, they didn't, which meant bout
after bout of sinus infections with all the
attendant facial pain, post nasal drip, congestion
and - my most-hated symptom - fatigue.
But I was a wuss about the
surgery, which removes swollen tissue so the sinuses
can drain. The mere idea of someone poking sharp
instruments up my nose near my optic nerve and
brain, even if I was under general anesthesia at the
time, was appalling. Sure, the risk of going blind
in one eye was teeny - less than one 10th of 1
percent - and the risk of the surgeon puncturing the
brain, allowing brain fluid to leak out, was also
about 1 percent. But these risks weren't zero. Nor
did I relish the idea of the less dramatic, more
common risks: infection, bleeding, and post-op
congestion.
And I wasn't sure whether the
surgery would work - it doesn't help everyone with
sinus issues.
A review of three randomized
controlled trials published this year by the
Cochrane Collaboration, an international group that
evaluates healthcare data, was not encouraging. It
found that a common type of sinus surgery was no
better than medications.
But I chose not to put too much
faith in those studies - perhaps because there were
only three of them, but also because my doctor was
planning a somewhat different procedure than the
ones examined in the studies. Besides, the studies
did say the surgery was safe, which allayed my
fears. I also just wanted to believe there was
something that could help me.
Still, I waffled until early this
year, when I saw a new analysis of 28 observational
studies of 3,427 patients published online in the
journal, The Laryngoscope.
The study showed that the
operation reduced fatigue significantly in 80
percent of the people who had experienced
significant fatigue before sinus surgery, said Dr.
Neil Bhattacharyya, one of the authors and an ear,
nose, and throat specialist at Brigham and Women's
Hospital. That makes sense, he added in an e-mail,
because if nasal mucus containing viruses and
bacteria can drain correctly, the body does not have
to spend so much energy fighting lingering
infections.
That did it. I went back to the
ear, nose, and throat specialist I had seen
intermittently for years, Dr. Ralph Metson, a sinus
surgeon at the Massachusetts Eye and Ear Infirmary.
He ordered a CT scan of my head, and together we
looked at it on his computer.
Even my untrained eye could see
how blocked my sinuses were. "Nine out of 10 people
with your symptoms and your CT scan would have the
surgery," Metson told me, though he didn't push it.
"There's no rush. You can always do it later."
I went online, read as much as I
could stand about sinus care, talked to people who
had had the surgery and, knowing I was going to
write this column, called ear, nose, and throat
specialists across the country.
Sinus surgeons, not surprisingly,
believe the procedure often reduces the duration and
frequency of sinus infections, but whether the
surgery is worth it is an individual matter.
"It's a big surgery," said Dr.
Marilene Wang, a professor in the division of head
and neck surgery at UCLA. "A lot of patients are
surprised by the amount of fatigue after sinus
surgery. I tell patients to take a week or two off
work."
In the end, I was swayed by
technology, in particular a new image guidance
system that is not used for all patients but,
because of the complexity of my case, would be
available to me. The key is an infrared camera
system through which a sensor on an instrument
placed inside the nose creates an image on a video
screen in the operating room.
"This technology has
revolutionized surgery," Metson told me. "The
infrared camera tracks the movement of the surgical
instruments. During surgery, the image shows up on a
3-dimensional video monitor. So you, as the surgeon,
know exactly where you are, especially how near you
are to the eye and brain."
So, three weeks ago, I went for
it. As in most cases, my operation took about an
hour and half. It went well, and I had surprisingly
little pain afterward - Tylenol with codeine was all
I needed. There was also almost no bleeding. As
promised, the post-op fatigue was considerable,
forcing multiple naps a day for two weeks and
counting.
Sinus surgery isn't for everyone.
And it's still too soon to tell whether I'll get any
significant benefits long-term.
But I'm optimistic. It's
lovely to think I could catch a cold and not be sick
for weeks. At the very least, now I know I've done
everything possible to make myself feel better.
Judy Foreman’s column runs every other week. Past
columns are available on
www.myhealthsense.com.
Listen to her live
call-in webcast radio show every Wednesday night
from 8:30 to 9:30 EST on
http://www.healthtalk.com.
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