Standard Sinus Surgery

Endoscopic sinus surgery uses small nasal endoscopes to open the natural pathways that drain the sinuses. It is used to treat patients who have chronic sinus issues. The nose and sinuses are part of the upper respiratory tract system. The function of the nose is to warm, humidify, and filter the air that passes through it. The true function of the sinuses continues to be debated, but it is imperative that the sinuses remain patent and drain normally. If the sinuses become blocked, normal sinus drainage is hindered and sinusitis can develop. Patients with chronic sinusitis have significant impairment in their quality of life.

What Are Sinuses?

There are four paired sets of sinuses in the facial skeleton: 1) the Maxillary sinuses are located beneath the cheeks right under the eyes, 2) the Frontal sinuses are situated behind the forehead above the eyes, 3) the honeycomb shaped Ethmoid sinuses are set between the eyes, and 4) the Sphenoid sinuses are located deep in the nose and below the brain. Each of these is enclosed in a space that drains through an opening (ostium) into the nose. These ostia can become blocked due to inflammation/swelling of the mucosa lining or by tumors or bony structures (turbinates).

Effects of Blocked Sinuses

The term sinusitis refers to inflammation of the sinuses. Common causes of inflammation in the nose are allergies (“hay fever”), acute viral infections, or tobacco smoke. Other important causes include bacterial infections, fungal/mold allergies, and obstructive inflammation due to polyps or abnormally enlarged turbinates. There are two major types of sinusitis:

Minimally Invasive Sinus Surgery

Balloon Sinuplasty employs small nasal endoscopes and dilating balloons to safely and effectively widen specific sinus openings. The nose and sinuses are part of the upper respiratory tract system. The function of the nose is to warm, humidify, and filter the air that passes through it. The true function of the sinuses continues to be debated, but it is imperative that the sinuses remain patent and drain normally. If the sinuses become blocked, normal sinus drainage is hindered and sinusitis can develop. Patients with chronic sinusitis have significant impairment in their quality of life.

What is Balloon Sinuplasty?

Balloon Sinuplasty is an FDA approved procedure that safely and effectively widens the sinus openings, without trauma to surrounding tissues, while preserving the natural sinus openings. Balloon Sinuplasty is a technique similar to Angioplasty that uses balloons to dilate the sinus openings instead of using microdebriders and forceps. While it is less traumatic than traditional sinus surgery (FESS), it is NOT indicated for every patient with sinus symptoms and must be tailored to each individual patient.

What Are Sinuses?

There are four paired sets of sinuses in the facial skeleton: 1) the Maxillary sinuses are located beneath the cheeks right under the eyes, 2) the Frontal sinuses are situated behind the forehead above the eyes, 3) the honeycomb shaped Ethmoid sinuses are set between the eyes, and 4) the Sphenoid sinuses are located deep in the nose and below the brain. Each of these is enclosed in a space that drains through an opening (ostium) into the nose. These ostia can become blocked due to inflammation/swelling of the mucosa lining or by tumors or bony structures (turbinates).

Effects of Blocked Sinuses

The term sinusitis refers to inflammation of the sinuses. Common causes of inflammation in the nose are allergies (“hay fever”), acute viral infections, or tobacco smoke. Other important causes include bacterial infections, fungal/mold allergies, and obstructive inflammation due to polyps or abnormally enlarged turbinates. There are two major types of sinusitis:

Deviated Nasal Septum Repair

Septoplasty is a surgical procedure used to correct defects or deformities of the Nasal Septum…often by alteration or partial removal of obstructing structures.

Statistics estimate that over 80% of all nasal septums are off-center, but this often goes unnoticed. If the septum is severely deviated away from the midline where it should be, this condition can cause problems such as breathing difficulties, nasal congestion, and perceived sinus infections. Septoplasty is a very common surgery that corrects a deviated septum and improves nasal airflow.

What is the Nasal Septum?

There is a wall inside the nose that divides the nasal cavity into halves. This wall is called the “nasal septum” and is ideally positioned precisely in the midline, thus separating the left and right sides of the nose into passageways of approximately equal size. The septum is composed of a central supporting cartilage covered on each side with mucous membrane. In many individuals, there are minor deviations of the septum due to injury sustained during childbirth and natural skeletal growth. In some individuals, due to trauma or excessive skeletal growth, the septum becomes excessively deviated and nasal obstruction occurs.

Effects of a Deviated Nasal Septum?

When the septum is significantly protruding off the midline (deviated), patients often have complaints of nasal obstruction, nasal congestion, chronic sinusitis, and headaches. A crooked septum impairs the natural flow of air through the nasal passages and can significantly affect breathing through the nose and potentially interfere with normal sinus drainage. Many patients who complain of constant sinus infections and pressure are simply suffering from impaired nasal airflow and congestion due to a deviated nasal septum. A severely deviated septum can also alter the outward appearance of the nose and can be corrected with a cosmetic surgery called Rhinoplasty.

Most Common Symptoms of Deviated Septum

Surgery for Nasal Obstruction

Turbinate reduction surgery corrects the problem of nasal obstruction by reducing the turbinate size, which decreases airway resistance, while preserving the natural function of the turbinates.

Turbinate enlargement (hypertrophy), along with a deviated nasal septum, is the major cause of nasal airway obstruction and leads to breathing problems in both adults and children.

What are Turbinates?

Turbinates are small, scroll-like bony structures inside the nose that filter and humidify air as it passes through the nostrils and into the lungs. There are three turbinates on each side of the nose: 1) inferior, 2) middle, and 3) superior. They are covered with a mucous membrane, containing vascular channels, which can swell under certain conditions such as allergies or inflammation and lead to nasal obstruction.

Effects of Turbinate Hypertrophy

An abnormally enlarged turbinate caused by inflammation typically blocks the key areas of nasal airflow and sinus ventilation. This causes nasal congestion that can mimic sinus pressure and lead to significant daytime obstruction and nighttime sleep disordered breathing. A deviated septum may also be part of the problem causing the blockage and is usually addressed at the same time as a turbinate reduction.

Common Symptoms of Turbinate Hypertrophy

What is Sleep Apnea?

More than one-third of the world’s population struggles with interrupted sleep caused by lifestyle choices, work schedules, or health conditions. Sleep disorders include insomnia, persistent sleep deprivation, restless leg syndrome and obstructive sleep apnea syndrome (OSAS). These disorders usually worsen with age, but can affect both children and adults.

Obstructive sleep apnea syndrome is becoming an increasingly prevalent problem in the United States. Sleep apnea refers to a reduction or cessation of breathing during sleep and is caused by an anatomic blockage of the nose and/or throat. During sleep, there is a decrease in the activity of muscles that keep the airway patent. This leads to an increase in the collapsibility of the airway and can lead to significant airway obstruction. Patients who are overweight typically have thicker neck tissues and a smaller airway diameter that is more at risk. This obstruction greatly affects gas exchange in the lungs and can lead to lower levels of oxygen in the blood (hypoxemia). This loss of oxygen places stress on the heart and lungs and leads to “arousals” – disruptions of the normal brain activity during sleep necessary to tighten the airway muscles and restart breathing. Due to these frequent arousals, patients with sleep apnea get fragmented sleep and over time complain of nonrefreshing sleep and chronic sleepiness. Chronic snoring is a major symptom of obstructive sleep apnea and is often the reason for referral to a sleep specialist. Loud and interrupted mouth breathing is usually seen in children with sleep apnea and is often due to enlarged adenoids and tonsils.

Obstructive sleep apnea has been clinically linked with obesity, hypertension, heart and lung disease, stroke, and unexplained sudden death. It also leads to chronic daytime sleepiness that greatly impairs memory, mood, and concentration. In short, obstructive sleep apnea greatly impairs a patient’s quality of life and may pose a significant health threat.

Sleep Apnea Treatment

Non-surgical treatments for sleep apnea include lifestyle changes, oral appliances and CPAP (Continuous Positive Airway Pressure). CPAP works by applying air pressure via a mask to the nasal and oral airways to “splint” the tissues open and prevent obstruction. It is the considered the gold standard for obstructive sleep apnea treatment. When CPAP and other conservative measures fail, surgery to widen the air passages in the nose and throat is often recommended. Surgery may include the following:

• Nasal surgery to straighten the deviated nasal septum and reduce the size of the turbinates. Nasal surgery relieves the nasal obstruction component of sleep apnea and can improve CPAP compliance. Nasal surgery alone, however, rarely cures sleep apnea (less than 10%) and other interventions are usually necessary.
• Uvulopalatopharyngoplasty (UPPP) involves removing any tonsillar tissue (if present) and reducing excess length of the soft palate. It is used to relieve obstruction in the back of the throat (oropharynx). UPPP alone is not a guaranteed procedure to completely eliminate sleep apnea. In fact, a large study demonstrated that UPPP alone only cured sleep apnea in ~40% of patients. The low cure rate, however, is greatly impacted by a patient’s weight and anatomy (jaw size, tonsil size, tongue size, etc.). In properly selected patients, the cure rate with this procedure can approach 70%.
• Tongue base surgery is sometimes performed to reduce the size of an overly large or posterior displaced tongue. This enlarges the space between the tongue and the back of throat and lessens the chance of airway obstruction during sleep. As with the UPPP, patient selection and a thorough airway evaluation by an ENT specialist is critical in the decision to recommend this type of procedure.

Dr. Gunnlaugsson is certified by the American Board of Otolaryngology-Head and Neck Surgery and is also board certified in the subspecialty of Sleep Medicine. This dual Board certification involves meeting and exceeding rigorous board standards by passing exams and completing additional specialized training/education in sleep medicine. Dr. Gunnlaugsson has extensive experience in treating sleep disorders and offers the entire array of treatments for patients with obstructive sleep apnea syndrome. He can assist with lifestyle changes, oral appliance recommendations, CPAP fitting, and surgical evaluations. He performs detailed exams of the nasal and oral airways to determine where an airway obstruction may be occurring so that the proper treatment can be discussed for each individual patient.

Recurrent sinus and ear infections, enlarged adenoids & airway obstruction often require an Adenoidectomy…which is the surgical removal of the adenoids. Adenoids (along with tonsils) function, early in life, as the body’s first line of defense by sampling bacteria and viruses that enter the body through the mouth or nose. Over time in children, the adenoids often become diseased and enlarged to create an airway obstruction accompanied by repeated bacterial infections of the nose and ears. Removing the adenoids eliminates these problems and improves ear infections, pediatric sinus disorders, nasal obstruction, and sleep disordered breathing.

What are Adenoids?

Adenoids are a tissue mass located in the back of the nose and are similar to the lymph nodes found in the neck, groin and armpits. Unlike tonsils, adenoids are not visible through the mouth without use of special instruments. The adenoids typically shrink as we age and are often very small and insignificant in adults.

Effects Of Enlarged Adenoids (Hypertrophy)

Persistent and recurrent ear infections, breathing difficulties including snoring/sleep apnea/ loud breathing, foul breath and chronic sinus infections are common problems caused by enlarged adenoids in children and teens.

Most Common Symptoms of Enlarged Adenoids

Ventilation Ear Tubes

Tympanostomy is the placing of plastic tubes through the eardrum to allow air into the middle ear space. This is done to treat and prevent ear infections.

Otitis media refers to an infection or inflammation of the middle ear space (behind the eardrum), often preceded by a viral infection. It is a condition that occurs often in small children and less commonly in adults. Otitis media is usually caused by eustacian tube dysfunction, whereby the normal tube from the ear to the nose which opens with swallowing becomes blocked due to swelling or obstruction. This blockage prevents natural pressure equalization (“popping”) from the ear to the back of the nasal airway. This allows negative pressure to form behind the eardrum that then “pulls” in fluid from the body’s tissues. Young children (age 6 months – 2 years) are especially susceptible to otitis media as they have a shorter and more immature eustacian tube that is easily blocked. The fluid behind the ear can also become infected by bacteria, especially in children. Worsened by viral infections, a common cold and/or nasal allergies, otitis media can be very painful and can also lead to hearing loss and speech problems.

What Are Ear Tubes?

Ear tubes are tiny cylinders inserted through the eardrum (tympanic membrane) to equalize pressure in the middle ear space. Ear tubes have several names including: myringotomy tubes, ventilation tubes or PE (pressure equalization) tubes.

There are two basic types of tubes: 1) short-term and 2) long-term. Short-term tubes are smaller and typically used in children. They usually remain in place for about 6-24 months and then fall out on their own. Long-term tubes are larger and have flanges (T-tubes) to secure them within the eardrum for a longer period of time. They may fall out on their own or have to be removed by our physicians. They are often used in adults or children who have chronic ear issues or who have had several sets of short-term tubes.

Symptoms of Otitis Media

Eardrum Repair

Tympanoplasty is surgery to repair/reconstruct the eardrum (tympanic membrane) usually due to a hole or perforation in the eardrum.

There are several problems that can permanently damage an eardrum (tympanic membrane) or harm the small bones (ossicles) that are located right behind the eardrum. Chronic ear infections, trauma, and prior ear tube placement can cause perforations of the eardrum while leading to hearing loss and persistent drainage of the ear that does not resolve.

What is a Tympanoplasty?

A tympanic membrane perforation is simply a hole in the eardrum. A tympanoplasty is a surgical procedure where the eardrum is reconstructed using a natural tissue graft from the patient’s body. This graft is usually tissue covering the muscle near the ear or cartilage from the ear itself. The procedure can often be done through the natural canal of the ear with a small incision behind the ear.

Symptoms of Eardrum (Tympanic Membrane) Perforation

Treats Fine Lines and Wrinkles

Botox can inhibit lines and wrinkles from forming and becoming etched into the permanent facial appearance. This aging is typically seen around the outer corners of the eyes and on the forehead.

It’s never too late to prevent wrinkles from forming. Men and women of all ages and ethnicities are having tremendous results with BOTOX® treatments. Lines and wrinkles that appear around the eyes (“crows feet”) and forehead are an inevitable part of normal aging. These furrows are caused by skin that has lost its elasticity due to repeated contractions of the muscles responsible for facial expression. Prior to BOTOX®, surgery was the only option available for restoring a more youthful look to these facial regions. Botox has revolutionized the treatment of aging to the upper one third of the face and is one of today’s most popular non-surgical procedures for men and women.

One ten minute treatment and a few tiny injections gets results in just days.

What is Botox® Cosmetic?

BOTOX® is a non-surgical, physician administered product used to temporarily improve (smooth out) facial lines and wrinkles that typically occur in the forehead and around the eyes. It is safe, simple, and FDA approved for use in men and women older than age 18. BOTOX® is a synthetic and purified form of a protein originally made from the Clostridium Botulinum bacteria. This protein works by inhibiting the release of molecules from nerve fibers which enable muscle contraction. When injected into the muscles that cause facial animation, these muscles relax (usually within 3-4 days) and allow the related lines and wrinkles to “smooth out.” BOTOX® can also be used to prevent the initial formation of fine lines and wrinkles in the forehead and around the eyes. Botox typically lasts for 3 months before the muscles regain function and the fine lines recur. As repeated treatments occur, however, the effect of the treatment typically gets longer and may approach 6 months.

Common Signs of Facial Aging

Treats Fine Lines and Deeper Wrinkles

Welcome back your own natural appearance & smooth out the signs of aging. Radiesse results are natural…immediate…long lasting.

Each one of us ages at a different rate caused by various factors. The main elements that cause facial aging involve changes in the bones along with the loss of fat, collagen, and elastin from the facial tissues. This loss of facial volume, along with skin texture changes, leads to alterations in our appearance as we grow older. Early prevention, by starting non-invasive injectable volume restoration, can delay the need for more aggressive anti-aging measures and are key in lessening the visual signs of aging.

What is Radiesse®?

Radiesse® is a cosmetic “filler” (injection treatment) that provides immediate volume to smooth out the early signs of aging. Composed of smooth microspheres of calcium hydroxyapatite (found naturally in the body), it acts as soft tissue filler while it works with your body to stimulate collagen growth. This can allow the regeneration of new connective tissue and provide extended correction to areas of the facial skeleton where volume loss has occurred. Because of its density, Radiesse is ideal for the nasolabial folds and smile lines in the cheeks along with other areas of soft tissue loss. It is also used by Dr. Gunnlaugsson to restore a youthful quality to the lower eyelid and avoid surgical procedures such as Blepharoplasty. Results are natural looking, immediate, and long lasting (often 1.5-3 years).

Common Signs of Facial Aging