Long-term answers to nasal congestion

[Guest guest]

Daily Features

http://www.journalstandard.com/articles/2005/01/03/daily_features/pul

se/pulse03.txt

HEALTH MATTERS

Long-term answers to nasal congestion

Q. I always seem to be dealing with sinus congestion, and lately it

has become so severe that my nasal passage is completely blocked.

What new treatments might provide long-term solutions to my problem?

A. Nasal congestion continues to be a widespread health issue that

impacts many of us. Luckily, technology and medical science is

discovering new and better ways to treat this common problem.

The field of Rhinology (study of nasal and sinus disorders)

continues to grow rapidly. The Monroe Clinic Department of

Otorhinolaryngology (Ear, Nose and Throat) is committed to providing

the most up-to-date care and recommendations for our patients.

I attended several talks this fall at our Academy Meeting in New

York City. Fungus and sinus has gotten a significant amount of

attention in the press over the last few years. Allergic Fungal

Sinusitis is a disease characterized by chronic nasal congestion,

nasal polyp formation, allergy to fungus, and abnormal cat scan

findings.

We have seen a large number of these patients in our practice here.

These patients react to common environmental fungi and develop

severe nasal obstruction. The lining the sinuses become so inflamed,

they can no longer drain, and become susceptible to bacterial

infections.

In any sinusitis case, we prefer to identify the irritant and remove

it from the patient's environment. For instance, smoking is a major

problem for sinus sufferers, and quitting smoking would be the

solution to their sinus problems. However, in many cases

environmental irritants like dust mites and household molds are so

common that they become realistically impossible to isolate. If we

can't completely eliminate the irritant, then we will try to control

the underlying allergies that cause the patient to have sinus

infections.

Over-the-counter nasal sprays may provide short-term relief, but

over time can become an irritant to the nose and should be used

sparingly. Most cases of acute sinusitis will respond to

antibiotics, decongestants and irrigations. Less than 10 percent of

patients will require surgical therapy.

ADVERTISEMENT

---------------------------------------------------------------------

-----------

---------------------------------------------------------------------

-----------

However, as in cases of allergic fungal sinusitis, over time sinus

inflammation and bacterial infection can cause the lining to make

polyps that eventually obstruct the nose completely. The treatment

of these patients has traditionally been a challenge. Our ability to

remove polyps and safely open the diseased sinuses continues to

improve. Now, minimally invasive techniques have largely eliminated

the need for any incision. Very little nasal packing is necessary

because the bleeding is less.

At The Monroe Clinic, the safety of the procedures has been

significantly increased with navigational technology. Computer

generated models of the patients anatomy are used intraoperatively

to help remove disease while monitoring the position of vital

structures. After the sinuses have been adequately opened, polyp

recurrences can usually be managed in the office, reducing the need

for additional operations.

These advances have also improved the patients' perceptions of sinus

surgery. Ongoing outcomes research in The Monroe Clinic Department

of Otorhinolaryngology show that more than 93 percent of sinus

surgery patients realize long term improvement with a decrease in

the frequency and severity of their disease. Fewer infections and

less obstruction result in better performance.

The next major challenge will be determining the best way to change

the patients' response to these ever-present and unavoidable fungi,

thus reducing the inflammation that causes the major symptoms.

R. on, M.D., F.A.C.S., is an Otorhinolaryngologist at

the Freeport and Monroe sites of The Monroe Clinic. Appointments

with Dr. on can be made by calling

235-1406 or (608) 324-2357.