How do I know if my patient needs
Jeffrey Terrell, M.D., director of the Michigan Sinus Center and professor of otolaryngology, Melissa Pynnonen, M.D., associate professor of otolaryngology, and Mark A Zacharek, M.D., associate professor of otolaryngology
Determining when a patient's sinus problems warrant surgical intervention is more complicated than one might expect.
Nearly half of all Americans have allergies, nasal obstruction, colds or frequent headaches that can mimic the symptoms of true chronic sinusitis. And 30 to 40 percent of people without sinus symptoms, if given a CT scan, would have abnormalities consistent with sinus infection.
So, in a random collection of people on the
street, roughly 1 in 6 would have symptoms
and radiologic findings that might indicate
they're a good candidate for sinus surgery
when, in actuality, few of them would actually
"The problem is a lack of specificity of 'sinus' complaints - headache, nasal drainage, stuffiness, post nasal drip - combined with a lack of specific findings on a sinus CT scan," says Jeffrey Terrell, M.D., director of the Michigan Sinus Center and professor of otolaryngology at the University of Michigan Medical School.
Melissa Pynnonen, M.D., associate professor of otolaryngology at U-M, adds, "I always tell my patients that a doctor can't just look at their CT scan and know whether they need sinus surgery. It requires a thorough workup."
That would include taking a detailed patient history, carefully reviewing CT films and conducting a physical examination, which might include nasal endoscopy, she notes.
"The most common diagnoses that masquerade as chronic sinusitis are allergic rhinitis, a deviated septum, gastroesophageal reflux disease, and migraine headaches or other headache syndromes," says Mark A Zacharek, M.D., associate professor of otolaryngology at U-M.
Here are five indications a patient is NOT likely to be a good candidate for sinus surgery:
Here are five indications a patient IS likely to be a good candidate for sinus surgery:
The Michigan Sinus Center, located in Livonia, specializes in the medical and surgical management of patients with chronic sinusitis and in all surgeries of the sinuses. The Center is staffed by the U-M Department of Otolaryngology, which was ranked No. 9 in the country by U.S. News & World Report in 2011.
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