July 14th, 2017 by Sepehr Oliaei, MD

Anyone who has ever had a bout of chronic sinusitis or a child with numerous middle ear infections requiring round after round of antibiotics knows the toll that amoxicillin and other oral antibiotics can take on the body.

There has been a growing trend in the recent years away from aggressive use of pharmaceutical drugs and towards treatments with lower side effect profile. This has been a natural reaction to known (and unknown) short-term and long-term side effects of many medications. The problem with alternative treatments, however, is that they are not always as effective as the first choice. Physicians have grappled with this issue for years.

But what if you could use your first choice antibiotic or other medication,  — perhaps even at a higher concentration — and deliver it directly to the tissue that is affected (for example the middle ear or the sinuses) without that drug reaching the rest of the body at all?

That is what is being addressed today with new innovations in topical drug delivery.

The idea of topical antibiotic delivery is certainly not new. Placing ear tubes in children with recurrent ear infections is recommended by the American Academy of Pediatrics, and it has been in practice for decades. Ear tubes are a very easy way to deliver a high concentration of antibiotic ear drops to the space behind the ear drum where the infection resides, resulting in a highly effective treatment without any of the associated reactions of oral antibiotics.

Variations on this idea are now in use, or being developed, for treating chronic infectious and allergic disorders of the nose and sinuses. Saline (salt water) rinses are a traditional natural remedy for hygiene and maintenance of the sinuses and has been highly effective using various forms of delivery that are readily available at retail stores and pharmacies, such as Neti pots, squeeze bottles, and so on. Modern advances in anti-inflammatory and antimicrobial treatments have allowed us to take compounded topical drugs, add these to saline rinse bottles and deliver them directly into the sinuses with minimal to no absorption in the rest of the body. This provides an effective treatment with fewer side effects!

Are the days of brightly colored elixirs and tablets for treatment of various ailments over? Not quite, but at least we now have some alternatives. For more information, ask your physicians about the availability of topical alternatives to anti-inflammatory, antibiotic and even non-steroidal pain medications.

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May 25th, 2017 by Sepehr Oliaei, MD

Balloons are a popular new medical device that have been used in recent years to treat sinus symptoms. They offer a minimally invasive, low downtime method for opening sinuses to allow better drainage and more importantly access for topical drug therapy to the sinuses. Now that we are nearly a decade removed from wide spread adaptation of this technology I wanted to answer some common questions regarding balloon sinuplasty.

1. Does balloon sinuplasty replace regular sinus surgery? 

Short answer is no. Although there are some cases where balloons are used exclusively to treat sinus conditions, it is best to think of a balloon as one of many high tech tools used in endoscopic sinus surgery.

2. Is balloon sinuplasty risk free?

Again no. Although minimally invasive and designed to minimize soft tissue trauma. High pressure dilation can fracture thin bones surround the sinus opening and cause injury to important structures such as the orbit (eye socket) or the skull base. Surgeon familiarity with latest surgical techniques, use of image guidance and balloon technology are the most important factors in preventing injury.

3. Is balloon sinuplasty better in children?

In children, the desire to be minimally disruptive to bony growth plates, puts balloon technology at the forefront of the treatment strategy. I feel that there is potentially an even bigger role in pediatric chronic sinusitis for balloons than there is for adults.

4. Can balloon sinuplasty be done in an office setting under local anesthesia?

It can be. In very select cases. There are limitation in terms of the anatomy and patient tolerance. In my practice that is reserved mostly for patients who have had prior sinus surgery requiring a “touch up”.

5. I have headaches and facial pain but normal sinus CT scan, can balloon sinus surgery help me?

Although this may be advertised by some to be helpful, I suspect it is not much more than a placebo treatment. If you do not have proven sinus disease, balloon is not a magic wand and is likely not going to help much.

6. I have recurrent sinus infections many times yearly, is balloon sinus surgery the answer?

There may be a role for this as an adjunct to medical treatment and traditional functional endoscopic sinus surgery.

7. I have had sinus surgery before, am I still a candidate for balloon sinuplasty?

Potentially yes. Balloons are a good way to dilate previously opened (but subsequently scarred and narrowed) sinus openings. Speak to your ear nose and throat surgeon about the possibilities.

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May 10th, 2017 by Sepehr Oliaei, MD

Chronic sinusitis is a condition in which patients’ sinuses become swollen and inflamed, leading to difficulty breathing, facial pain or headache and loss of smell and taste. The condition is often misdiagnosed as allergies or a “never ending cold” and greatly impacts quality of life.

For patients suffering from long-term nasal congestion and chronic sinusitis, surgery is often a last resort option. Many have already tried over- the-counter nasal decongestants, antihistamines, humidifiers,  saline and steroidal nasal sprays, as well as multiple courses of antibiotics and steroids, with only temporary relief.

The goal of endoscopic surgery is to give patients the access to better combat this chronic debilitating disease. By opening sinus passageways, patient can receive topical medications in form of nasal rinses more readily into the sinuses in order to keep swelling and inflammation under control.

A new treatment, called PROPEL® Sinus Stent, involves a dissolvable, spring-like device inserted during endoscopic sinus surgery. It helps prop open the sinus passage after the surgery and gradually delivers anti-inflammatory medications directly into the sinus lining where it is needed most. This implant gives patients yet another tool for combating sinus disease in the crucial period immediately following endoscopic sinus surgery.

PROPEL helps keep the sinuses open and gives us another tool to reduce the likelihood of nasal polyps and inflammation from recurring, which are common in patients who suffer from chronic sinusitis. The dissolvable stent — which is modeled after drug-releasing cardiac stents — targets the sinuses with a sustained release of medication to help reduce inflammation and scarring during healing. Once the medication has been fully released, it dissolves away.

I have been using this FDA-approved sinus stent since early 2015 and have seen positive results in my patients — particularly those with severe chronic sinusitis associated with nasal polyps.

Have you had any personal experience with nasal polyp disease and/or Propel implants that you would like to share? (note: comments are publicly visible)

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May 10th, 2017 by Sepehr Oliaei, MD

Spring is here, and winter is gradually coming to an end. With cherry blossoms in bloom and temperatures making their way toward 60, allergy season is in full swing.

In the Pacific Northwest, tree pollen (especially alder) is most prevalent from February to April, grass pollen from May to July, then weed pollen in August and September.

A three-pronged approach of avoidance, medication and allergy testing can help improve symptoms. Avoid going outside when pollen is at its peak, take medication as needed and allergy testing if your allergies become too severe.

Below are some additional ways to minimize exposure to pollen and some treatment options if you experience symptoms.

Avoiding pollen

  • Allergies tend to be worse in middle of the day, so play outside during the morning or evening to provide less exposure to pollen.
  • Wear glasses and a hat to keep pollen off the face and eyes.
  • If a child starts to experience a reaction while playing at a park, find a water fountain and wash their hands and face.
  • It also helps to wash off after play time outdoors.
  • Don’t dry their sheets outdoors in the pollen season, as they’ll accumulate pollen.
  • When you sleep at night, keep your head away from any open windows.

Seasonal allergy treatments

  • Taking a simple antihistamine before outdoor activity can help. Generic, over-the-counter antihistamines are very good and can cost a penny or less per dose. Don’t be afraid to avoid the expensive name brands.
  • A saltwater nasal wash or a neti pot can be effective at reducing nasal secretions and congestion, and saline doesn’t have any side effects.
  • Eye symptoms are primarily related to congestion. Any decongestant for the nose can also reduce eye symptoms, without the need for eye drops, which can sting and be hard to put in your child’s eyes.
  • If those steps don’t work, a whole host of other medications are available by prescription:
    • Intranasal steroid sprays
    • Antihistamine, as a nasal spray or taken by mouth
    • Eye drops
    • Cromolyn, which is available by prescription or as over-the-counter nasal spray or drops

How do I know whether I should try something more than simple medication?

Generally, allergies can be managed with simple medications and avoidance if:

  • Symptoms are mild and don’t limit attendance at school or work
  • They don’t interfere with your ability to sleep at night
  • They don’t interfere with your daytime activities

Do you suffer from seasonal allergies? Do you have unusual management strategies that you would like to share? I am interested to hear your stories, please share them below. (note: comments are publicly visible)

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