Minimally invasive balloon sinuplasty to treat Sinusitis with Mr Paul Chatrath

Sinusitis is a common condition where the lining of the sinuses becomes inflamed. Often the result of a viral infection, it is a condition that is usually treated using painkillers, decongestants, and antibiotics. Symptoms will generally improve within two or three weeks. In rare cases where treatment doesn’t work, a number of surgical techniques may then be considered. Minimally invasive balloon sinuplasty is one such surgical technique.

We sat down with leading ENT Consultant Mr Paul Chatrath, part of the renowned London ENT Unit, to discuss all about Sinusitis, revealing why minimally invasive balloon sinuplasty is an effective treatment option for this condition.

What are the main causes of sinusitis?

Upper Respiratory Tract Infections:

The common cold and ‘flu’ are both viral upper respiratory tract infections that lead to sinusitis. When secondary bacterial infections occur, the mucus changes from clear to yellow to green, indicating blockage of the sinus openings.

Allergies and irritants:

These include tree and grass pollen, house dust mite, airborne fungi, cats, dogs, and feathers. Even a tiny quantity inhaled into the nose can cause considerable inflammation of the nose and sinuses. Other irritants include air pollution, diesel fumes, smoke, pesticides, disinfectants, and household detergents. Those who suffer from problems with their immune system are generally more susceptible to sinusitis as their bodies can struggle to stave off infection.

Structural nasal/sinus problems:

A deviated nasal septum, excessive swelling of the inner nasal lining, or the presence of nasal polyps can cause a reduction in airflow passing towards the sinuses. This can lead to reduced oxygenation and the increased likelihood of infection. Traumatic nasal injury is also another cause of sinusitis.

Are there any common misconceptions?

One common misconception is that sinusitis is most prevalent in people who suffer from allergies. This view is not strictly true as many people who don’t suffer from allergies can get sinusitis, particularly in the winter months. Those with asthma are more likely to get sinusitis as they have sensitive Sinus, as are those who have problems with their immune system as it can affect how their sinuses respond to infections. People who work in very dusty environments are also at risk.
Another misconception is that a sinus headache is the only form of headache that gets worse when you bend down. Whilst this is true, there are in fact many types of headaches, such as migraine and tension, which get worse when you bend over. It is therefore not a symptom specific to sinusitis. What is more suggestive of sinusitis is having nasal symptoms such as a blocked nose or discharge coming out of the nose in conjunction with a headache.

When should a patient seek medical help?

If someone is suffering from symptoms such as a blocked nose, infected discharge from the nose, a bad smell in the nose, facial pressure/pain or headaches, or recurrent episodes of sinus infections, it would be worth seeing your GP. You are likely to be given a prescription for some medical treatments in the first instance, and if these do not work, further investigations will then be arranged. It may also be recommended that you see a specialist if your symptoms do not respond to these initial treatment options.
In rare cases, swelling or redness around the eye or over the forehead can occur in the early stages of sinusitis. If this happens, an urgent ENT opinion and/or admission to the hospital may be arranged for you.

What are the most effective treatment options?

An acute episode of sinusitis is usually treated using painkillers and nasal decongestants initially. This helps to reduce the swelling of the nasal and sinus lining and improves nasal airflow. Many patients find steam inhalations and/or salt water douches to be helpful in clearing out mucus. If the acute infection lasts for more than 5-7 days then antibiotics may be prescribed.

Chronic Sinusitis often requires longer term treatment, which includes nasal decongestants, antibiotics, intranasal steroid sprays/drops, and antihistamines in patients with allergies. Often antibiotics will need to be given for several weeks before symptoms fully resolve.
If medical treatments have been tried but without success, surgery may need to be considered. This can take one of a number of forms, including endoscopic sinus surgery (FESS for short) or minimally invasive techniques such as balloon sinuplasty.

What does the surgery involve?

Endoscopic sinus surgery (FESS) is the traditional method of surgery, which involves cutting into the sinuses with instruments and debriders to remove the diseased tissue and any polyps that might be present. Advances in technology have led to the development of minimally invasive techniques including balloon sinuplasty. Balloon sinuplasty involves passing a fine surgical balloon into the sinuses in a manner similar to keyhole surgery. The balloon is so soft and gentle that it allows clearance of the deep narrow sinuses, situated close to important anatomical structures such as the eye and brain, without any risk of injury to these structures. This means that the sinusitis can be treated effectively and safely.

Roughly, how many minimally invasive balloon sinuplasty operations do you perform in a typical year?

I perform approximately 100 to 150 sinus operations each year, including 75 to 100 balloon sinuplasty procedures. This is across the NHS and private sectors, and this means that I am performing sinus surgery on a weekly basis.

What can a patient expect from a consultation?

During the consultation, you will have an opportunity to discuss what symptoms you are experiencing. This will be followed by a thorough examination of the nose and sinuses. A nasendoscopy, a small flexible camera, is often used to evaluate the sinuses in more detail. This can be undertaken during the first consultation and is quite straightforward with little discomfort. Then, any investigations that might be required will be arranged for you, such as allergy tests or a CT scan.

How long is the recovery period and what is the aftercare?

In most cases, you should be able to go home the same day as the surgery. You should try to avoid blowing your nose for the first 48 hours following sinus surgery. It is normally advised that you take 10 days to two weeks off work and remain in a clean environment, away from dusty atmospheres and from people with coughs and colds, to reduce the risk of getting an infection, although you could work from home if your job allows it. After two weeks you can resume normal daily activities and exercise. It usually takes 4-6 weeks for your symptoms to improve and for your recovery to be complete.

What are the benefits of a patient coming to London ENT Unit?

All of the major subspecialties of ENT are represented at The London ENT Unit, ranging from ear symptoms, nose, and sinus disorders, head and neck issues as well as throat, voice, and snoring problems. You will be assured of an appointment with minimal delay, a caring and sympathetic approach, as well as prompt investigations reviewed by highly qualified specialists. Any further treatment will be arranged to fit in around your own work and social commitments.

We have a team of seven world-leading ENT Consultants including Mr Paul Chatrath that make up London ENT Unit. Get in touch to book an appointment!

Flexible appointment times are available.