Balloon your blocked nose

TGEETHA, 42, a manufacturing plant supervisor, has been having sinusitis for 20 years. And it has impaired her quality of life. Every day, she suffers from a running or blocked nose, which leads to watery eyes and sometimes severe headache.

"Medication helps to a certain extent. When there's buildup of mucus, it causes pain and pressure. I find difficulty breathing, sometimes I even lose my sense of smell, and it makes me tired," she says. Her condition has interfered with her regular activities and she would be on medical leave when it gets worse.

She got her relief when her ENT surgeon recommended balloon sinuplasty. It's been a year since the surgery, and she's still free of sinusitis.

Balloon sinuplasty ENT surgeon Dr Kuljit Singh, who got his Master's in otorhinolaryngology from University of Malaya in 2002, says many Malaysians are still unaware of this minimally invasive surgery.

Introduced here three years ago, balloon sinuplasty is a Food and Drug Administration-approved treatment to relieve the symptoms of chronic sinusitis. This procedure uses a thin, flexible balloon catheter that is placed in the nose and gradually inflated to relieve blockages in the nasal passage by gently restructuring the bones in the nose.

Dr Kuljit, who has performed the surgery on a handful of patients at Prince Court Medical Centre, says it restores normal sinus function while maintaining the lining of the sinus, and keeps post-operative pain and bleeding at minimum.

It is performed under general anaesthesia on outpatient basis. Most patients return to work and their regular activities within 24 hours. While the majority of patients find relief from their sinus symptoms, it varies from patient to patient. In fact, the procedure doesn't treat ethmoid sinusitis or nasal polyps and can't be used on patients with extensive scarring within their sinus openings.

Sinus basics

Sinuses are hollow air spaces behind the bones of the upper face which can get blocked and inflamed, causing a buildup of mucus. This buildup can cause difficulty in breathing, yellow or green mucus discharge, teeth pain, loss of sense of smell or taste, headache, fatigue and sore throat.

Dr Kuljit says since allergies can cause sinusitis, one should take preventive measures, although that can sometimes be difficult since one is exposed to various allergens in one's daily chores.

When sinusitis is caused by a bacterial or viral infection, you get a sinus infection. This sometimes occurs after one's had a cold. The cold virus attacks the lining of your sinuses, causing them to swell and become narrow. Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses. And this buildup of mucus is fertile ground for bacteria, leading to a sinus infection.

Sinusitis affects 37 million people each year. It's more prevalent than heart disease and asthma and said to have a greater impact on quality of life than chronic back pain or congestive heart failure.

Sinusitis care

• Get plenty of rest. Lying down can make your sinuses feel more blocked, so try lying on the side. You can prop yourself up with a pillow.
• Sip hot liquids and drink plenty of fluids.
• Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel. This will relieve sinus pressure and help open your sinus passages.
• Always check with the doctor before using an over-the-counter cold medicine. Some cold medicines can worsen your condition or cause other problems.
• Don't use a nasal spray with a decongestant in it for more than three days. If you do, the swelling in your sinuses may get worse when you stop using it.
• Avoid alcohol, which can worsen swelling in the sinuses.

Treatment options

The most frequently used are medication and/or functional endoscopic sinus surgery (FESS).

Treatment with antibiotics or topical nasal steroid spray is often successful in reducing mucosal swelling and relieving obstructions within the sinus ostium and ostio-meatal region. But at least 20 per cent of patients don't respond adequately to medication. For these patients, surgery is often their next option.

The goals of sinus surgery are to clear blocked sinuses and to restore normal sinus drainage and function while preserving normal anatomy and mucosal tissue. Currently with FESS, specialised probes are used to cannulate closed ostia, and small forceps are used to resect periostial bone and tissue to enlarge the sinus ostia.

Removal of bone and tissue may lead to post-operative pain, scarring and bleeding. Nasal packing may be required to control the bleeding.