Jan. 20, 2005 Minimally invasive surgery to alleviate the pain and pressure of sinusitis is a safe, effective therapy for geriatric patients who can't be helped by medication alone, according to new research.
"This tells us that we should not neglect sinus problems in the elderly; that if medicines don't work, we have a surgical technique that is not that invasive and results in good outcomes," says Dr. Stilianos E. Kountakis, otolaryngologist, vice chair of the Medical College of Georgia Department of Otolaryngology – Head and Neck Surgery and a principal author on the study published in the December issue of Otolaryngology – Head and Neck Surgery. "There is a way to improve symptoms either with medicine or surgery if necessary, and it's worth pursuing because patients feel better overall and have better quality of life."
Dr. Kountakis and collaborators, led by Drs. J. Chris Colclasure and Charles W. Gross at the University of Virginia Health System, looked at 56 patients over age 60 who underwent functional endoscopic sinus surgery, which uses small cameras and monitors to approach sinuses through the nose and minimize trauma.
They found patients continued to report improvement in symptoms over the year following surgery, had few minor complications and no major complications, Dr. Kountakis says. The findings are comparable to studies of younger patient populations.
Sinusitis, which affects some 30 million Americans, is the sixth most common chronic condition of the elderly, says Dr. Kountakis. "As we mature, the sinus lining is not as efficient at transporting secretions so secretions stay behind, sinuses become obstructed more easily and more easily infected."
Despite the high incidence, sinusitis can go untreated in some elderly patients because other conditions take priority and/or create the perception that sinusitis is more difficult to treat in older patients, says Dr. Kountakis, who directs the Georgia Sinus and Allergy Center.
"We thought that maybe the endoscopic sinus surgery wouldn't be as effective because of the decreased efficiency of the sinuses that naturally occurs with age, but that wasn't the case. We thought maybe other medical problems, might make surgery less safe and effective, but that wasn't the case either," he says.
Instead they found 64 percent improvement in symptoms at three months, 73 percent improvement at six months and 75 percent improvement at 12 months, based on patient reports of their symptoms as well as physical exams.
Medical therapy, including inflammation-reducing steroids, mucus thinners and salt-water douches to moisturize and clean the sinuses, is always the first approach to treatment, Dr. Kountakis says. But after about a month, if the condition is no better, a surgical approach through the nose can be used to remove obstructions and/or widen sinus passages. Typically patients will continue to need some type of medicine following surgery to help keep their condition in check.
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