WASHINGTON - "It's full of yellow pus. It's fluorescent yellow," says Kristin Thomas, who has been my primary care physician for nearly 10 years.
She's peering up my nose and sees an infection teeming with bacteria. "For you, it's time," she says.
Time for sinus surgery. I, along with about 14% of the U.S. population, or 37 million Americans, had chronic sinusitis, inflammation of the linings of the sinuses bad enough to block the drainage of mucus into the nose.
My path to surgery involved more than a decade of on-again, off-again congestion, pressure, trouble breathing and fatigue. Over the years, any time I flew in an airplane I was likely to develop a sinus infection. Colds and flu could also cause them. Despite preventive measures -- nasal steroid sprays, allergy shots and twice-daily sinus rinses -- I regularly got infections that required antibiotics to subdue.
At their worst, my symptoms affected my work and my outside activities. Sometimes I couldn't sleep and often didn't have the energy to exercise. I sought out numerous doctors and had several CT scans. One doctor attributed my face pain to migraines, and another surgeon suggested that I wait until my case became unbearable, as corrective surgery had no guarantees.
New way to open nasal passages
Last summer, I got a sinus infection that lasted for four months despite aggressive treatment of steroids and antibiotics. During the treatment, my allergy doctor referred me to a different sinus surgeon who had been doing a new procedure called balloon sinuplasty, which uses a small, flexible balloon catheter to open nasal passages.
"It is the evolution of the minimally invasive sinus surgery. So instead of actually cutting or remov- ing tissue or bone, you are expanding a small balloon in the opening (of the sinuses)," says ear, nose and throat surgeon Jack Williams, "much like they do to open up a partially clogged artery."
In my initial examination, Williams said that my sinuses were swollen shut with trapped fluid in the frontal sinuses. Having performed more than 100 balloon procedures, he considered me a good candidate, but he also planned to correct a crooked septum as part of the surgery.
Each year, about 500,000 patients undergo the more traditional functional endoscopic sinus surgery (FESS), in which a surgeon removes bone and tissue. I had been scared off those by horror stories of painful recoveries and repeat surgeries.
Williams described how balloon sinuplasty induces very little or no scar tissue and heals much better. "It's much less uncomfortable and takes a day or two recovery time."
Balloon sinuplasty was cleared for use in December 2004, says Josh Makower, a Stanford University Medical School associate professor and mechanical engineer who developed the technology. So far, more than 4,500 surgeons trained on the procedure have treated more than 60,000 patients worldwide.
Sapped of my strength
By the time I got to Georgetown University Hospital for the outpatient operation in late January, my lingering sinus infection had sapped my strength.
During the 90-minute operation, Williams blasted AC/DC, the Dave Matthews Band and Austin Lounge Lizards from his iPhone on the operating room sound system. He used a 3-D map of my sinuses and an infrared probe to work the catheter's fiber-optic-lighted guidewire into my sinuses.
Technically, I had a hybrid procedure, part-newfangled and part-traditional. That probably kept me from being one of those patients who goes back to work immediately.
The next day, I felt good enough to check e-mail and watch TV, but it was a week before I was ready for eight-hour workdays. By then I felt rejuvenated and blessed to be done with those days when my head was foggy.
At my two-month follow-up, Williams said, "I can't imagine you looking any better."
I still do a daily nasal rinse -- it is constantly allergy season here -- but have not resumed my allergy shots.
Actually, this past spring affected me less than any in memory.
And I have taken six long flights with no ill effects.
I'm not saying balloon-enhanced sinus surgery is a panacea. Within the medical community there is some concern that the procedure is over-marketed.
As in my case, many patients also need more than just the balloon's opening of the sinuses as part of their surgeries. For now, the American Academy of Otolaryngology-Head and Neck Surgery continues to monitor the research results.
"We don't know what the long-term durability is," says Bradley Marple, past chairman of the academy's rhinology committee, and professor at the University of Texas Southwestern Medical Center at Dallas, "although I do have to say with the limitations of the studies that are available, the two-year data seems to show that it goes in and delivers what it promises."
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