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Central ENT Consultants PC offers minimally invasive sinus procedure

August 09, 2013|By CRYSTAL SCHELLE | crystal.schelle@herald-mail.com
  • Dr. Kirby Scott performs a minimally invasive in-office sinus surgery on David Caldwell of Falling Waters, W.Va., at Central ENT Consultants PC, off the Dual Highway in Hagerstown.
Photos by Joe Crocetta/Staff Photographer

 Matthew Dick of Williamsport spent the better part of his life suffering from sinus problems.

“Except, what’s funny, was when I was in the Navy and out to sea. I didn’t have much of a problem,” Dick, 44, said last month while seated in a room at Central ENT Consultants PC in Hagerstown. 

Dick said he wheezed through his nose a lot and it progressively got worse. 

“I guess my wife had had enough and said ‘You’d really need to go and it get taken care of, and have someone take a look at it,’” he said.

Dick decided on Central ENT Consultants. There he was given a CT scan, he said, which showed “it was probably a lot worse than I’d ever thought it was.” He said he had three polyps and a deviated septum.

“It was pretty bad,” Dick said. 

Under the care of Dr. Kirby Scott, a physician with Central ENT Consultants PC, Dick opted for the minimally invasive sinus surgery in-office procedure.

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Scott said that it’s a procedure “developed for those folks with chronic sinusitis that may not be amenable to antibiotic and steroid treatment, what we would call maximum medical therapy.”

Scott said patients have the option of having the procedure performed in a hospital setting, outpatient surgery setting, on in Dick’s case, an in-office setting.

“The in-office setting is ideal for those patient candidates (who) have a positive outlook on an in-office sinus procedure, may not have too much anxiety and are willing to have a minimally invasive procedure done under local anesthetic or general anesthetic that is required,” Scott explained. 

Scott said there are eight parasinuses — two above the eyes in the forehead called the frontal sinuses; two under the eyes behind the cheek bones called maxillary sinuses; a set of sinuses between the eyes called ethmoid sinuses; and sinuses in the back of the head (place one finger at the center of head and another above the left ear and draw an imaginary line) called the sphenoid sinuses.

It is these areas where the doctors look for any issues.

“These sinuses can be addressed with minimally invasive sinus maneuvers and procedures that allow for the sinuses to be open and allow for the sinuses to focus in a more natural way,” he said. 

Scott said patients usually have symptoms such as “sinus congestion, facial pain and headaches, and are treated with multiple courses of antibiotics before entertaining the idea of any sinus procedure,” which includes the in-office procedure.

For about two years, Scott has been performing the minimally invasive sinus surgery in-office procedure, doing a few procedures a month.

Scott said after the patient is told about the risk, benefits and alternatives for the surgery, he or she takes a narcotic pain medication about 90 minutes before the surgery, then again in 30 minutes before the procedure. Before the procedure, the patient is topically anesthetized with lidocaine, which Scott explained was the same medication that would be used to fill a tooth at the dentist. The patient is given what is called a neurosurgical cottonoid pledget. The patient then is injected with a local anesthesia about 15 minutes before surgery. 

The doctor then looks to correct the issues the patient has had with his or her sinuses. 

“Oftentimes patients can suffer from anatomical issues like a deviated nasal septum or the midline structure of the nose may be deviated from one side to the other, turbinate hypertrophy,” Scott said. “Turbinates are structures that act to filter  air, warm the air and humidify the air; and they swell in times in folks with allergic rhinitis or other nasal issues.”

Other issues the doctors could encounter could be polyps or inflammatory tissue that might obstruct the airway and cause problems, he said. 

“The sinus surgery, in essence, opens the sinuses so that the sinuses can heal themselves,” Scott said.

One tool used during the procedure is the use of a balloon. Scott said the balloon “has revolutionized and allowed for more procedures to be used in the office.”

“Similar to angioplasty balloons, balloons are inflated to a pressure that opens ducts or openings in the sinuses and allows them to remain ... open,” he said. “After the balloon is inflated, it is then removed so there’s nothing (that) remains in the patient.”

Scott said the procedure takes about an hour. Recovery takes about 48 to 72 hours, depending on the level of surgery, Scott said. 

“In most cases, patients are very satisfied of the level of post-operative pain and usually take one to two courses or post operative pain medication,” he said. 

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