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Breathing Easy: Finding Relief from Sinusitis
A perfect human nose is much more complex on the inside than it is on the outside. The nose and sinuses are designed to humidify the air we breathe as it moves through the bone and cartilage that hold the airways open. When it works well, the nose and its attendant sinuses improve our lives by filtering the air, enhancing the flavors of the foods we eat, fending off germs and making our voices resonant. For two years Julie Legeros, a staff nurse in Day Surgery at Northwest Hospital, wasn't able to enjoy any of these benefits. She suffered from a series of painful sinus blockages, known as sinusitis, which made it difficult to breathe even on a good day.
Sinusitis is the inflammation or swelling of the tissue lining the sinuses. It is caused when the sinuses become blocked and filled with fluid. Bacteria, viruses and fungi may subsequently develop, leading to infection. Sinus blockages can be triggered by many things, including the common cold, nasal polyps or a deviated septum.
"Most mornings I woke up with a lot of pain right behind my face, and my face was tender and swollen," Julie recalls. Julie was getting an average of four sinus infections each year. Even with antibiotics, it would take about 30 days to get over the infections and they always recurred. Additionally, Julie had a deviated septum, a condition in which the thin wall of bone and cartilage between the nostrils is crooked, making it difficult to breathe. In Julie's case, her deviated septum all but blocked one airway. Because of the sinus infections and the deviated septum, Julie snored in her sleep and suffered constantly from a dry mouth, since she was forced to breathe through her mouth.
In Julie's case, her immune system had been impaired by a medication, leading to the development of her chronic sinus infections. Sinusitis can also be associated with diabetes; allergies also can trigger sinusitis.
Julie's primary care physician referred her to Dr. Karen Lin, a specialist at Seattle Ear, Nose & Throat. Dr. Lin says Julie's symptoms are fairly typical for a patient with chronic sinusitis.
Although Dr. Lin would eventually operate on Julie's sinuses and correct the deviated septum, the first priority was to try a course of broad-spectrum antibiotics, plus the use of a steroid. "Surgery is typically not the first step in treating chronic sinusitis," Dr. Lin explains. Julie received instructions on nasal irrigation, to help flush the chronic infection from her sinuses. She was also scheduled for a CT, or computed tomography, scan. The detailed imaging gave Dr. Lin information on the level of inflammation in Julie's sinuses, and provided landmarks for possible later surgery.
After several weeks of medication and irrigation, Julie had a second CT scan, which showed no changes. "That's when we started talking seriously about the surgery," Dr. Lin says. "Julie was still feeling a lot of facial pressure and tenderness, especially when she leaned forward. Her symptoms were not significantly improved so the procedure was medically necessary. In addition to removing some diseased tissue, we straightened her septum and surgically reduced her inferior turbinates, to make it easier for Julie to breathe through her nose"
Turbinates are three small, sausage-shaped structures inside each nostril that help filter and humidify the air we breathe. Each turbinate swells and shrinks in the course of the day, but they can, as in Julie's case, be too large for the narrow airway.
During Julie's outpatient surgery, Dr. Lin used an endoscope, a viewing tube equipped with a small camera. The tube also allows the surgeon to insert small surgical tools. Endoscopic surgery is less invasive than traditional open surgery on the nose and sinuses and requires a shorter recovery time. Julie was able to go home the same afternoon as the surgery. "I had some pain during the recovery, but no dizziness or anything. I had the surgery on a Tuesday and was back at work the following Monday," Julie says.
Since the surgery, Julie feels a lot better. She still irrigates her nose daily and uses nasal sprays to maintain the health of her sinuses, but the symptoms she had before are gone. "I breathe a lot better at night, but it's important for me to continue to have my check-ups and take care of myself," she says.
Julie adds that she really appreciates the care she got from Dr. Lin. "She's very attentive and tries to make sure you understand everything that's going on," Julie says. "She makes time for her patients, too. If you call up with a problem, she wants to see you as soon as possible."
||For more information about Seattle Ear, Nose & Throat and the treatment of sinusitis and other nose disorders, phone (206) 389-7100.