Ryan Vaughn, MD, Founder, CEO, and Director of Exhale Sinus and Facial Pain Center, specialty in ears, nose, and throat otolaryngology, talks about a new surgery for chronic sinusitis.
What exactly is chronic sinusitis?
VAUGHN: Chronic sinusitis is a chronic condition, meaning that this has lasted for longer than 12 weeks at a time. When somebody has chronic sinusitis, it’s referring to the inflammation they have inside of the sinus cavities. Those are these little pockets that we have above our eyes, between our eyes, below our eyes and then behind our eyes. When somebody has chronic sinusitis, it can be affecting one or all the sinuses. They can be suffering from symptoms that range from facial pressure, headaches, loss of taste or smell, nasal congestion, or nasal drainage that can come out the front of the nose or the back of the nose. With that, they can be getting some symptoms of hoarseness, coughing, or needing to clear their throat.
What typically causes chronic sinusitis?
VAUGHN: That’s a great question. There are many different things that will cause chronic sinusitis and lots of ongoing research trying to figure that out. We know that there are causes that can be genetic, where my mom or my dad had this type of problem and I’m also susceptible to it. We also know that things like allergies or environmental irritants or pollution can contribute. Anatomic, or the way that our body is put together, can play a role. If somebody has a deviated septum or problems breathing through their nose, that could be contributing to the development of chronic sinusitis.
When somebody has this condition, how could it impact their daily life?
VAUGHN: When somebody has chronic sinusitis, their day-to-day life can be impacted in multiple ways. It can impact their ability to get a restful night’s sleep, and without restful sleep they can be suffering from fatigue or feeling groggy throughout the day. Patients can often be suffering from the inability to breathe through their nose. With chronic mouth breathing, we see the tendency to develop facial pain and headaches. Patients are often feeling dissatisfied because they can’t really taste and smell things, which provides a lot of satisfaction to our day-to-day being. They are dealing with lots of frustrating symptoms, whether that’s the need to blow their nose frequently, swallowing lots of postnatal drip, or frequent coughing.
What are the standard treatments people use for this?
VAUGHN: The standard treatments for chronic sinusitis include nasal saline irrigation, similar to the Neti Pot type of irrigation, to try and rinse through the nose. There’s also medicated nasal sprays that we can have patients start, and those can be anything that would be a steroid, an antihistamine, or other products that are used to help decrease the inflammation or congestion in the nose. We’ll also have patients use things such as allergy control, trying to clean up their environment, and avoiding things they could be allergic to or taking allergy medications or receiving allergy treatments for.
Talk to me about PROPEL. How does that differ from other treatments?
VAUGHN: When somebody has chronic sinusitis and they require procedural intervention to facilitate better drainage of the sinuses, that process involves opening one or more of the sinus cavities. One of the things that we worry about as surgeons after we’ve opened a sinus cavity is that it may close back down, giving the patients the same symptoms that they came to us with in the first place. The PROPEL stent can be placed after the sinus has been opened and what it does is sits inside that opening, putting pressure outward in a gentle fashion, and also releasing an anti-inflammatory medication. What that does is prevents that sinus from scarring back and prevents us from having to do surgery in the future.
If somebody decides to go with surgery, before PROPEL, what was the likelihood of it closing back up again?
VAUGHN: The likelihood of needing to do surgery again can be as high as 50 to 60%, depending on the patient’s conditions. Once we started understanding the inflammatory conditions that were contributing to the high scarring and revision rates, the introduction of an anti-inflammatory medication was able to bring the revision rates down. Typically, today when we’re using something like a PROPEL implant, the revision rate for sinus surgery is about 10%.
What type of patients typically go for surgery?
VAUGHN: Patients will go for sinus procedures, whether that’s a surgery or a balloon dilation, when they’ve failed to improve with other medical options. That may include antibiotics, nasal rinses, or steroid nasal sprays. With PROPEL, it seems like the major benefit is helping to reduce the need of surgery and the cavity closing again.
What are the benefits with PROPEL?
VAUGHN: The benefits of PROPEL help to decrease the need for further surgery. But to have a PROPEL placed, you would need to have a procedure done first to open the sinus cavity so it can be placed. Once a PROPEL is placed, it is going to stay inside the sinus for about 45 days.
After patients do the surgery and they have the PROPEL stent in there, how soon can people see a relief in their symptoms?
VAUGHN: Sure. Once we do a sinus procedure in place PROPEL implants, typically people will start to see relief within a matter of days.
Any restrictions after the fact?
VAUGHN: There are no additional restrictions for the placement of PROPEL beyond what the restrictions would be for your sinus surgery that was performed.
And talk to me about Carol’s case. What led her to come to you?
VAUGHN: Sure. Carol was suffering from an inability to breathe through her nose, chronic sinus infections that would flare up with acute infections leading to postnasal drainage, coughing and chest infections. And she was also suffering from an inability to clear her ears, which for her was a big deal because she was not able to fly to go see her grandchildren.
And is that common? Not being able to fly, is that a common issue that people run into if they have CS?
VAUGHN: Approximately 60 to 70% of people who have chronic sinusitis will also suffer from what we call eustachian tube dysfunction, or the inability to pop their ears during events such as flying or scuba diving.
Carol is going to see her grandkids next week. Will she be okay to fly?
VAUGHN: Correct, yeah. So, at this point she’s all clear for her flight. As of now, she’s all cleared for her flight. When I last examined her, she looked to be cleared of infections and at a very low risk for any complications or issues from the upcoming travels.
I believe she said another doctor’s advice told her that if she flew with the condition, she could lose her hearing. Is that a possibility?
VAUGHN: At this point that is not a possibility that she would lose her hearing.
How do you believe that PROPEL can impact someone’s quality of life?
VAUGHN: After somebody has had a PROPEL placed, we can see a number of areas where they may have an improvement in their quality of life. The first is with the decreased risk for needing revision sinus surgery. The second is, in my experience patients who have had a PROPEL placed will typically recover faster from their sinus procedure, allowing them to have a shorter recovery and fewer days of discomfort after the procedure is done.
Anything I didn’t ask you that you feel that’s important for people to know?
VAUGHN: In my personal practice, using PROPEL has allowed me to perform minimally-invasive balloon sinus dilation on patients who historically would have required more aggressive sinus surgery. When I perform a balloon dilation, one of the things that we worry the most about is that the opening was simply not large enough. What we have found is that even in patients with moderate severe sinus disease, if we perform that dilation, then place a PROPEL, there is an extremely low risk that that patient would need further sinus surgery. There are many benefits to performing a balloon dilation over the traditional sinus surgery, but the most important of that is that the balloon dilation preserves the natural anatomy of the sinuses, preserving their ability for the sinuses to function and drain as they should without disrupting it through tissue removal.
How long has the PROPEL been around?
VAUGHN: I’ve personally been using for PROPEL for about six years.
Do you think it’s common practice to use for most doctors during surgery?
VAUGHN: Yeah. It is becoming more and more common for doctors to use PROPEL. The physicians who are on the leading edge of using the new technology are more likely to be using PROPEL.
Is PROPEL typically covered by insurance?
VAUGHN: Yes.
Do patients typically know that this is going into their nose?
VAUGHN: Yes. Every patient is informed that the PROPEL placement is a possibility. Most of our patients have insurance coverage for PROPEL, and our office does perform a check and a verification with insurance to verify benefits.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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ERICH SANDOVAL
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