Sinus disease treatment advances

By Tom Phelan - Staff Writer
Enfield - posted Thu., Mar. 10, 2011
Dr. Louis Petcu explained the use of balloon sinuplasty to clear sinus passages and give patients relief from sinusitis. Photo by Tom Phelan.
Dr. Louis Petcu explained the use of balloon sinuplasty to clear sinus passages and give patients relief from sinusitis. Photo by Tom Phelan.

Winter is a particularly difficult time for people who suffer from problems with their sinuses. So it was fitting for the Enfield Public Library to arrange for an update on sinusitis treatments from an otolaryngologist.
Louis G. Petcu, M.D. specializes in ear, nose and throat (ENT) ailments and allergies, and serves as a senior clinical instructor in Otolaryngology at Tufts School of Medicine. Dr. Petcu spent about an hour giving the audience gathered in the EPL community room a quick tutorial on the sinuses, their function and their problems, and explained how new treatments can give relief to many patients who suffer from chronic problems with the condition of their own sinuses.
“We have been fortunate in the last few years to have developed some new ways of approaching a very old problem,” he said, as he introduced his topic. Then he moved on to talk about the sinuses – the air-filled cavities inside our faces. He said, “The job of the sinuses is to produce mucous, which is used to clean the Connecticut valley pollution and grime off the insides of our noses.”
The group was universally surprised to hear that our bodies produce about a pint to a quart of mucous each day. “All that is used for us to flush stuff out of our nose,” Petcu said.
There are four groups of sinuses. Maxillary sinuses are found below the eyes. The sphenoid sinuses are small and closest to the nose. Apparently not everyone has frontal sinuses, which can be found above the eyebrows behind the forehead. And the ethmoid sinuses, Petcu described as “numerous and tiny.”
People suffer from sinusitis – an inflammation of the lining of the sinuses – as a result of bacteria, viruses and inflammatory reactions and fungal infections. Acute sinusitis lasts less than four weeks. Those who experience a chronic level of sinusitis would suffer with the condition for more than three months.
To give the audience some frame of reference, Petcu cited a few statistics. Sinusitis affects 37 million Americans. That makes it more common than arthritis and high blood pressure. And although Petcu admitted the financial information came from a study done two years ago, he said that more than $300 million is spent on prescription and over-the-counter cold medications annually. The impact of direct and indirect cost is estimated to be $7 billion.
Dr. Petcu brought with him copies of “a quiz” – the Sino-Nasal Outcome Test. It is a standard medical test to help define a patient’s symptoms for a doctor. The 20-question test asks the patient to rate each of the conditions on a scale of 0 (“no problem”) to 5 (“problem as bad as it can be”). It asks about sneezing, coughs, runny nose, ear pain, dizziness, sleep problems, fatigue and other behaviors. Petcu suggested to the audience that taking the quiz would help them figure out whether their condition was actually sinusitis.
“Medications,” he said, “have become much better in treating sinusitis.” They are directed at killing bacteria and at keeping the sinuses open. He mentioned steroid nasal sprays as one example. “Using all these medical therapies,” he said, “we can really help about 80 percent of people who have recurrent sinusitis.”
The remaining 20 percent of the 37 million Americans with sinusitis are dealing with problems “that are not very amenable to medical treatment,” according to Petcu. He said that some people could get relief from non-traditional, homeopathic remedies. He cautioned, however, that even those solutions might have interactions with other, unrelated drugs a patient might be taking.
CT scans are sometimes used to determine the condition of the sinuses of a patient who suffer from chronic sinusitis.
Traditional treatments include surgical options that are reserved for those 25 percent of chronic sinusitis patients who have severe symptoms and are unable to respond to medications. Not all that are offered the surgical solutions take that option. In Petcu’s practical experience, he said about half of those patients present themselves for surgery and half do not.
Surgical treatments prior to 1985 involved cutting into the sinus area through the upper gum, so the linings could be scraped clear. It also required opening a small hole between the sinuses, so mucous could flow out.
Since that time doctors have discovered they really only needed to re-open the impacted sinus passages, and the problem would eventually be reversed. Petcu passed around a sample of a balloon sinuplasty device for the audience to examine. Unlike the use of balloon angioplasty, there is no need to put a stent into the sinus. The process of sinuplasty creates micro-fractures in the bone structure, which support the tissue around the sinus passages.

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