In-Office CT Imaging
Chicago Nasal & Sinus Center is able to offer in-office CT imaging using the Xoran MiniCAT™ Compact CT scanner. Specifically designed for sinus imaging, the MiniCAT™ is able to provide high-definition 3-D images with slices as thin as 0.4 mm to visualize small anatomic structures, sinus drainage pathways and sinus disease. Unlike conventional full-body CT scanners, patients sit upright in a chair, without any enclosure that might induce claustrophobia. The MiniCAT™ provides quality images in 20-40 seconds, with much lower radiation exposure than conventional scanners. In-office CT imaging allows patients to see their scan almost immediately, and this helps them understand their condition as well as the discussion of their treatment options.
Endoscopic Sinus Surgery
Endoscopic sinus surgery is a functional procedure designed to enlarge the natural openings of the sinuses as they drain into the nose. The use of a thin fiberoptic telescope enables Dr. Pritikin to visualize the sinuses through the nostrils, without having to make an incision on the face. The inflamed or infected tissue lining the sinus cavities sometimes needs to be removed to open the sinuses.
In conjunction with septal surgery, endoscopic sinus surgery has the potential to eliminate or significantly improve sinus headaches, relieve sinus pain and pressure, reduce the frequency and severity of recurrent sinus infections, and decrease post-nasal drainage with about a 90% success rate. Those patients with underlying medical problems (immune disorders, asthma and allergies) may require continued medical therapy for their sinus problems, but the frequency and severity of these problems should be significantly reduced following surgery.
Patients with recurrent acute sinus infections and those with sinus pressure and weather-related sinus headaches due to small sinus openings often benefit from enlargement of these openings. Balloon Sinuplasty™ technology utilizes a soft flexible illuminated wire guide to navigate the nasal and sinus passages. A small balloon catheter is passed over the wire and used to dilate blocked sinus openings without tissue or bone removal. There is minimal discomfort, almost no bleeding, and very little recovery time. Chicago Nasal and Sinus Center has been at the forefront of this technology since its introduction in 2006.
Chicago Nasal and Sinus Center is pleased to be able to offer in-office balloon catheter dilation (Sinuplasty™) of the sinuses under local anesthesia. For properly selected patients with chronic sinus pain, weather-related sinus pressure and recurring sinus infections, this in-office procedure has the potential to provide dramatic improvement with minimal risk, minimal discomfort and rapid recovery.
Polyps in the sinuses represent focal areas of inflammation and tissue swelling, leading to obstruction of the sinus openings, decreased sense of smell, impaired nasal airflow and sinus pressure. Treatment of polyps can include use of steroid anti-inflammatory agents, sinus surgery or both. Because of their potential to recur, long-term maintenance therapy with some type of anti-inflammatory medication is often necessary following surgery to prevent re-growth of nasal polyps. In the past, this maintenance therapy was usually a one-daily steroid nasal spray.
Local delivery of medications to the sinuses has revolutionized the treatment of chronic sinusitis with polyp formation. Small implants placed within the sinuses during sinus surgery can deliver anti-inflammatory medication continuously over a period of time, bathing the tissues with this medication and suppressing the inflammation that leads to polyp formation.
When placed in the sinuses, the PROPEL™ steroid-releasing implant decreases tissue inflammation, reducing the need for additional surgical procedures and reducing the need for oral steroids and steroid sprays. The spring-like PROPEL™ implant is placed within the ethmoid space to maintain the surgical opening, delivers an anti-inflammatory medication directly to the sinus lining, and then dissolves without the need for removal. Use of the PROPEL™ implant may prevent recurrent polyp formation and may decrease the need for maintenance therapy; in fact, placement of the PROPEL™ implant in the office under local anesthesia 2 or 3 times a year may become an alternative to preventive therapy with a steroid nasal spray.
Spirox Latera™ Implant
The “nasal valve” is the narrowest part of the nasal passage and determines the rate of airflow through the nose. Typically, nasal obstruction is due to decreased space between a deviated nasal septum (the wall that divides the two sides of the nose is crooked) and swollen inferior turbinates (enlargement of the radiators within the nose that warm and humidify the air); however, some people still can’t breathe clearly through their nose even after surgery to straighten the septum or reduce the turbinates. There is increasing awareness of the importance of a third component to the “nasal valve” and that is the nasal sidewall.
A new implant to support the nasal sidewall is now available. The Spirox Latera™ implant is a thin polymer strut that is inserted through a small needle placed inside the nasal passage. The strut sits on top of the nasal bone and beneath the cartilage of the nasal sidewall, lifting the sidewall and preventing collapse during breathing. This low-profile implant sits flush against the bone and beneath the skin of the nasal sidewall; improvement in nasal breathing is almost immediate and the implant is essentially invisible.
Introducing the PolypVac...
Nasal polyps are benign growths that form within the nose and sinuses. They can block the nasal passages, preventing normal airflow and sinus drainage, leading to difficulties breathing, smelling, and sleeping. Up to 12 million people in the United States suffer from nasal polyps. Their exact cause is unknown, but they result from inflammation and are often associated with infection, asthma, allergies, aspirin sensitivity, or a hyperactive immune system.
While surgery is not a cure for polyps, and further medical therapy is routine, surgery is often necessary to remove the bulk of polyps within the nose and sinuses. In the past, this required treatment in the operating room under anesthesia; however, there are some patients whose polyps are limited to the nasal passages or whose polyps are small and can be removed in a less aggressive fashion.
The PolypVac is an FDA-cleared, safe, clinically proven technology that allows doctors to remove nasal polyps in the office setting without general anesthesia. The procedure is relatively pain-free, causes minimal bleeding and usually takes less than 45 minutes. Patients are generally able to breathe freely after this procedure and there is little or no delay in returning to normal activities.
Topical Sinus Therapy
While a number of sinus problems can be resolved with surgery, there are some conditions that require ongoing medical therapy after surgery. Topical sinus therapy involves the use of medicated nasals sprays and irrigations and affords us the ability to treat a wide variety of conditions (persistent infections, nasal polyps, etc) by delivering medications directly to the sinuses. These sprays and irrigations can be customized for the individual patient and condition. Through the use of either a NasaTouch Personal Atomizer or the ActiveSinus Saline Rinse Kit, patients are able to deliver these custom compounded medications to the site of the problem without relying on medications taken by mouth.
Turbinate reduction or trimming of abnormally enlarged inferior turbinates is intended to improve nasal breathing, decrease nasal stuffiness, decrease the impact of allergies on nasal breathing, and reduce snoring. The turbinates may be surgically reduced, cauterized, or frozen to make them smaller and less prone to swelling and obstruction. Similar to liposuction on the belly, submucosal reduction decreases the size of the turbinates while preserving the warming and humidification function of these structures, thus improving airflow with minimal disruption of normal function and the preservation of nerve endings and mucus producing glands. Chicago Nasal and Sinus Center is now able to offer in-office inferior turbinate reduction under local anesthesia.
Allergy Testing & Desensitization Therapy
Allergies affect more than 60 million people in the United States, and have a serious impact on overall health. We are now able to offer allergy skin testing to identify indoor and outdoor allergens as well as food allergens. Testing and identification then allows us to tailor a treatment regimen, using either subcutaneous immunotherapy ("allergy shots") or sublingual immunotherapy ("allergy drops").
Subcutaneous immunotherapy involves injections of dilute concentrations of allergens beneath the skin. Over time, the immune system becomes less and less responsive to these allergens, and symptoms such as sneezing and nasal congestion subside. We are pleased to be able to offer a novel alternative to shots. Sublingual immunotherapy, or SLIT, is a form of immunotherapy that involves putting drops of allergen extracts under the tongue and it is a safer and more convenient alternative to allergy shots. This form of immunotherapy has been used for years in Europe, and has recently become popular in the United States. Generally, SLIT is administered either once a day or several times per week over a period of several years. In contrast to allergy shots, most patients are able to administer SLIT at home with almost no risk of systemic reaction.
Home Sleep Study
Obstructive Sleep Apnea (OSA) occurs when the upper airway (nose or throat) temporarily collapses during sleep, stopping breathing. OSA patients typically suffer from low oxygen levels in the blood, high blood pressure and an overall decrease in the quality of life due to daytime drowsiness and fatigue. Breathing pauses can occur anywhere from 10 to over 100 times per hour of sleep, severely disrupting normal sleep rhythms. Untreated OSA can severely affect one's health and clinical research shows that it is linked strongly to a range of serious, even life-threatening, illnesses and conditions such as stroke, heart failure, hypertension, and coronary artery disease.
The diagnosis of sleep apnea used to require an overnight stay in a sleep laboratory, but sleeping in unfamiliar surroundings can also affect sleep quality. We are now able to offer the ARES Home Sleep Test Device, a multi-channel device that can record breathing, snoring episodes, depth of sleep, heart rate and rhythm, abnormal movement during sleep and blood oxygen level. The patient takes the device home, wears it that evening while they sleep, and returns it to our office the next day. Results are typically available within 24 hours. Based on the results, we can a) rule out OSA b) diagnose OSA and prescribe therapy or c) prescribe further testing or CPAP titration to be performed in a sleep laboratory.