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Medical Forum / Diseases and Disorders / Sinusitis / July 2005

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Why are ENTs  surgeons for the most part and don't treat chronic sinus?

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Jeffery  Davis - 05 Jul 2005 13:17 GMT
I know 2 ENT's that are among the best in the USA and possibly in the world
as surgeons but are lacking in knowledge or effective treatment for chronic
sinus. I live in Ohio which is well known for very common sinus problems yet
it seems I have been unable to find a physician with much knowledge or skill
at treating chronic sinus.  I have seen several of the best allergist and
ENTs but none have been very helpful and seem to be less informed than those
who read this group let alone effective at treating sinus.  It seems chronic
sinus is a disease with no specialist or even good general knowledge at
least in my area, when pressed the doctors I have seen and know admit they
have no effective treatment and little understanding of chronic sinus
problems the best I have found do recommend irrigation which is great but I
should think they could go beyond that.
Steven L. - 05 Jul 2005 16:34 GMT
Jeffery Davis wrote:

> I know 2 ENT's that are among the best in the USA and possibly in the world
> as surgeons but are lacking in knowledge or effective treatment for chronic
> sinus. I live in Ohio which is well known for very common sinus problems yet
> it seems I have been unable to find a physician with much knowledge or skill
> at treating chronic sinus.  

Did you try the Cleveland Clinic?  Their otolaryngology department has a
very good reputation.

> I have seen several of the best allergist and
> ENTs but none have been very helpful and seem to be less informed than those
[quoted text clipped - 4 lines]
> problems the best I have found do recommend irrigation which is great but I
> should think they could go beyond that.

I'm not sure what you mean.  You've already had allergy treatment,
antibiotics, and steroids.  Those are the first line of sinusitis
treatment.  When those fail and your CT scan shows chronically blocked
sinuses, surgery is usually the main remaining option.  I don't know of
any non-surgical magic way to unblock a chronically blocked sinus, once
medications and allergy treatment have failed.

When ENTs saw your CT scans, didn't they discuss surgery with you?

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Steven D. Litvintchouk
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Jeffery  Davis - 05 Jul 2005 17:02 GMT
Thank you for your reply

I think all of them assume the other is taking care of the problem, and for
my part perhaps I have not laid out the case well enough .
One reason I made this post is I have not heard of ENT's doing any surgery
unless it is to fix a septum or turbinate and my septum has been repaired
and the turbinate are not bad enough to warrant surgery. Are there other
surgeries to open chronically blocked sinisuses ? other than the nasal
stuff?

Thank you again
Allen L. - 05 Jul 2005 17:27 GMT
> Thank you for your reply
>
[quoted text clipped - 7 lines]
>
> Thank you again

The other surgeries are older and much more invasive than the 'scope'. The
others involve going through the top of the mouth, or side of face. The
nasal route sounds much better after you hear that, I'm sure. :)
Ankur - 05 Jul 2005 19:27 GMT
I know lot of peoples with chronic sinus ( if you mean chronic sinus =
sinus problem that never goes away ) . they only thing they do is use
hankerchief and keep cleaning there nose .. and believe me peoples with
chronic sinus infection lived 80 years and more without even surgery or
medicines  and some i know are of 90 years are still alive ...
according to peoples thinking here medicines/surgery  are harmful  and
life threatning but polyps/sinus infecations are not ... so they prefer
to live with it ............
On the other doctors i consult told me they do sinus surgery( if you
mean removing polyps from sinuses ) they can do it from nussle route.
and surgery will be done by partial anesthia . that is  you will be
alive and know whats happening during your surgery .

Amazing thing is when i consulted 3 ENT surgens all of them recommended
me surgery for my left nasal polyps .  they dont even want to give
medicines ( may be they will make $$$$ thats y ) ..

on the other hand i know some peoples with chronic sinus get cured
with homeopathic medicines (  keep two things in mind these peoples i
am talking about never gone through CTSCAN .. and  there is always a
white colored material comes out from there nose . so after using 3-4
months of homeopathic medicines they r fine now . and never need
medicines from 5-7 years .......
so you can try homeopathy too . i know thousands of peoples in my city
use and millions in india .. and its not life threatning like
allopathic medicines or antibiotics even though its not recommended by
FDA  . Indian govt have approved " aayurveda > art of treating  dieases
by changing diet habits or  medicienes made from natural substances . >
homeopathy :  acids or natural substances at very low dosage " so you
can try that too . """" last time some peoples told me that in  this
group or anywhere in america peoples will listen licenced practiciner .
so i am wondering why i get millions of result when i type "
homeopathy" . why donot govt ban it and why there are millions of
peoples still practicing homeopathy worlwide.... " i am not favouring
anything but still wanna tell that there are lot of greedy doctors in
world who will recommend you surgery even if possibility of cure with
medicines exists .. GOOD LUCK
Steven L. - 05 Jul 2005 22:07 GMT
Jeffery Davis wrote:

> Thank you for your reply
>
[quoted text clipped - 4 lines]
> and the turbinate are not bad enough to warrant surgery. Are there other
> surgeries to open chronically blocked sinisuses ?

Functional Endoscopic Sinus Surgery can involve more than septum and
turbinate.  In my case, back in 1997, I had:

Septoplasty (to fix septum, which you've had done too)
Double ethmoidectomy (to open up my ethmoid sinuses)
Bilateral maxillary antrostomy (to open up my maxillary sinuses)

In 2004, I had a second endoscopic surgery to do an ethmoidectomy on the
one remaining pair of ethmoids that hadn't been operated on the first
time around.

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DD DDD - 07 Jul 2005 06:55 GMT
Ok and how do you feel about the surgeries? Did they help? Would you do
all 3 again? Do you breath well? Do you get sinus infections? Let us
know
Don Brady - 05 Jul 2005 22:09 GMT
>Thank you for your reply
>
[quoted text clipped - 4 lines]
>and the turbinate are not bad enough to warrant surgery. Are there other
>surgeries to open chronically blocked sinisuses ?

Absolutely there is ethmoidectomy and antrostomy and many variations.  These
are very widely done.

See http://www.nyee.edu/ent_rss_sts_ethmoid01.html .

>other than the nasal
>stuff?
>
>Thank you again
Allen L. - 05 Jul 2005 23:51 GMT
>> Thank you for your reply
>>
[quoted text clipped - 8 lines]
>In news:vgtlc1hra7imvsvdc0lclf03k8qg9f6sf8@4ax.com,
>Don Brady <dbrady@pobox.com> typed:

> Absolutely there is ethmoidectomy and antrostomy and many variations.
> These are very widely done.
>
> See http://www.nyee.edu/ent_rss_sts_ethmoid01.html .

Thanks for the link Don, that is a very interesting 'tour' of the sinusis
and the methods of surgery.

...Allen
Murray Grossan - 05 Jul 2005 19:58 GMT
On 7/5/05 5:17 AM, in article
pTuye.17754$eM6.1559@newsread3.news.atl.earthlink.net, "Jeffery  Davis"
<jayd328@hotmail.com> wrote:

> I know 2 ENT's that are among the best in the USA and possibly in the world
> as surgeons but are lacking in knowledge or effective treatment for chronic
[quoted text clipped - 8 lines]
> problems the best I have found do recommend irrigation which is great but I
> should think they could go beyond that.

I would recommend that you check out Steven Houser in Cleaveland. He has a
web site . He is on my list of ENT doctors with web sites at
www.eht-consult.com
He has written and studied extensively on how the nose/sinuses work.
Jeffery  Davis - 07 Jul 2005 01:57 GMT
Thank you to everyone for al the information
and to Dr Grossan for the referral information

One last thing I wonder is how much damage is done by the endoscopy ? if any
Don Brady - 07 Jul 2005 02:53 GMT
>Thank you to everyone for al the information
>and to Dr Grossan for the referral information
>
>One last thing I wonder is how much damage is done by the endoscopy ? if any

None at all.

Many of have had them done dozens of times by many different doctors at every
visit.

It just means that they stick a narrow tube into your nose to look around......
Murray Grossan - 07 Jul 2005 07:51 GMT
On 7/6/05 5:57 PM, in article
B5%ye.5580$aY6.1028@newsread1.news.atl.earthlink.net, "Jeffery  Davis"
<jayd328@hotmail.com> wrote:

> Thank you to everyone for al the information
> and to Dr Grossan for the referral information
>
> One last thing I wonder is how much damage is done by the endoscopy ? if any

Endoscopy means looking in your nose with a light. About the same as shining
a light into your throat, but moving the light source along side your
throat.
Ankur - 07 Jul 2005 16:22 GMT
throat irritation for a  week . thats endoscopy did for me  . because
they apply some chemical in nose and if you donot have big polyps it
usually go into throat which may cause throat irritation ... but
usually disappers with in a week ... you can search it in google lot of
other peoples feel same too
MS - 29 Jul 2005 10:00 GMT
> Endoscopy means looking in your nose with a light. About the same as shining
> a light into your throat, but moving the light source along side your
> throat.

Can't you see more, and further back, with an endoscope, the sinuses, etc.,
than just looking into the nose with a light?

Actually, not many of the several ENTs I've been to used the endoscope in
examinations. A couple did.

And at one major university sinus dept, where the ENT did do an endoscopic
examination, I was surprised to see that he had added more than $300 extra
for the couple of minutes looking into my nose with an endoscope. It was
classified as surgery, although it is actually nothing of the kind. Has
anyone else experienced that?
Steven L. - 29 Jul 2005 15:01 GMT
>>Endoscopy means looking in your nose with a light. About the same as
>
[quoted text clipped - 5 lines]
> Can't you see more, and further back, with an endoscope, the sinuses, etc.,
> than just looking into the nose with a light?

Dr. Grossan was just doing sloppy writing.
Sure, you can view the entire nasopharynx, and even push the endoscope
down your throat to view the larynx.
It's much harder to view the sinus cavities because the ducts leading
into the sinuses are so small (typically 2 mm wide).  Endoscopic viewing
of the sinus cavities is much easier after surgery has widened out those
sinus ducts.

> Actually, not many of the several ENTs I've been to used the endoscope in
> examinations. A couple did.
[quoted text clipped - 4 lines]
> classified as surgery, although it is actually nothing of the kind. Has
> anyone else experienced that?

Every endoscopic examination I have had is listed on my medical bill as
a separate (and costly) item from the consultation with the ENT.

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Steven D. Litvintchouk
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kathywb2001@yahoo.com - 29 Jul 2005 16:19 GMT
Yes, mine have always been charged as surgery.  Seems like a scam to
me.  They don't cut anything and it doesn't take very long.  I think
mine have been more than $300.00.  At least I did find out what kind of
bacteria and molds that I had (maybe still have) growing there from
cultures and I have good insurance or I would be in the "poor" house".

Kathyw
MS - 27 Jul 2005 07:53 GMT
>I live in Ohio which is well known for very common sinus problems yet
> it seems I have been unable to find a physician with much knowledge or skill
> at treating chronic sinus.

Unfortunately, your experience is not at all uncommon, and probably sounds
familiar to anyone reading here, not just in Ohio!

Regrettably, there don't seem to be many docs anywhere in the world, whether
ENTs or allergists or internists or whatever, who are very helpful to us
chronic rhino-sinusitis sufferers. :-(

I don't think it's a condition that many in the medical community, research,
etc., take very seriously. Yet many of us suffer terribly from this malady!
Murray Grossan - 27 Jul 2005 17:01 GMT
On 7/26/05 11:53 PM, in article 1122447252.186237@news-1.nethere.net, "MS"
<ms@nospam.com> wrote:

>> I live in Ohio which is well known for very common sinus problems yet
>> it seems I have been unable to find a physician with much knowledge or
[quoted text clipped - 10 lines]
> I don't think it's a condition that many in the medical community, research,
> etc., take very seriously. Yet many of us suffer terribly from this malady!

Please check out the web site of Steven Houser, MD ENT. His web site is
listed also at www.ent-consult.com list of doctors with web sites. He is in
Cleveland, Ohio.

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