Surgeons performing functional endoscopic sinus surgery. Photo: Medical Images
For most people, sinus problems or allergies are associated with symptoms such as postnasal drip, nasal mucous, nasal congestion, loss of smell and taste, and headaches. But Jeffrey Suh, MD, an associate professor in the UCLA Department of Head and Neck Surgery and a rhinologist in the UCLA Nasal and Sinus Disease Center, points out that these nasal-focused symptoms are most often characteristic of acute sinusitis. For patients with chronic sinusitis, the symptoms can be much more systemic, and have much more profound effects on one’s quality of life.
“In these patients, we can see a variety of symptoms such as depression, loss of productivity, problems concentrating and sleeping, and the sense that you’re constantly living in a brain fog,” Dr. Suh says. “It’s these intangible effects, not just the runny nose, that tend to bring patients to us for surgery.”
The UCLA Nasal and Sinus Disease Center offers medical and surgical management of complex nasal and sinus problems, including chronic sinusitis, allergic rhinitis and nasal-breathing problems associated with allergic and structural problems of the nose. For the patients seen by the center’s rhinologists, the health impact of their condition is far greater than is appreciated. Dr. Suh points to research indicating that chronic sinusitis sufferers report lower scores on measures of bodily pain and social functioning than patients with congestive heart failure, chronic obstructive pulmonary disease and back pain, for example.
These patients can improve significantly from endoscopic sinus surgery, a minimally invasive approach to opening up and cleaning out the sinuses. The center’s endoscopic techniques avoid the facial incisions and numbness associated with more conventional forms of sinus surgery, Dr. Suh notes. The majority of patients are treated on an outpatient basis and are completely or nearly symptom free within weeks. “Many patients feel better after sinus surgery than they have for decades, if not their entire lives,” Dr. Suh says.
The patient’s care doesn’t end after the surgery, Dr. Suh explains. “Just as important is that we identify the cause of the sinus problem and make sure it’s treated postoperatively,” he says. He notes that unlike acute sinusitis, which is almost always caused by a viral or bacterial infection, chronic sinusitis is usually multifactorial, with infections, genetic conditions, immunodeficiencies and long-standing, untreated allergies all serving as potential culprits. The UCLA rhinologists work closely with allergists and other specialists to ensure that patients receive proper postoperative medical management.
Aside from chronic sinusitis, other types of cases treated at the UCLA Nasal and Sinus Disease Center include rhinitis, a potentially debilitating condition characterized by a stuffy or runny nose; allergic or structural problems, such as a deviated or crooked septum that can interfere with nasal breathing; and more complicated cases, including revision surgeries, sinus tumors and cerebrospinal fluid leaks. Many of these conditions can be resolved endoscopically, sometimes in conjunction with other specialists at UCLA. Dr. Suh says “Most patients who walk into an ENT doctor don’t need a super-specialist,” he notes. “Our goal is to be a resource for the more complicated or unusual problems.”
Rhinology didn’t exist as a subspecialty until the last 20 years, Dr. Suh notes, but it is now widely appreciated that for a subset of patients who need sinus surgery, especially those with challenging anatomies, complicated comorbidities or complex pathologies, physicians with special training are needed to maximize the likelihood of success. Dr. Suh notes that rhinology surgery has changed substantially over the last decade, particularly with the advent of high-definition audiovisual technology and intraoperative navigation — analogous to a GPS system for the inside of the nose. The nasal packing that in the past caused significant trauma when removed in the week after surgery has been replaced by absorbable materials and mucosal sparing techniques, helping to minimize the discomfort from the surgery.
“There is a misconception that sinus surgery is ineffective, and that patients who go through it are likely to have recurrent disease and require multiple operations,” Dr. Suh notes. “But sometimes that is only the case if patients aren’t getting appropriate long-term follow-up and care. Sinus surgery does work, and our goal, by managing these cases from beginning to end, is to make sure it is the patient’s only operation.”
