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Health Sense

A sinus sufferer chooses surgery

Email|Print|Single Page| Text size + 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.

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