If medical therapy is not fully opening up the sinuses and getting a patient to feel well, and there's radiographic evidence that the sinus passageways are blocked, then we can turn to sinus surgeries. What are the options that are available today for interventions in the operating room or indeed in the office? So the tools that are used today for sinus surgery have improved greatly. Many people today are using navigation technology to perform sinus surgery so that we can follow our instruments very clearly on the screen, we can see both the real time picture of what we're operating on, plus we can see a crosshair moving on the CAT scan images so we can get a really good idea of exactly where we are. And the technology today has gotten us to where, within a millimeter, there's an accurate look at where you are in sinus surgery. So sinus surgery really there's a scope of how aggressive you can be with sinus surgery. There is in-office sinus procedures that are done in my office. I perform sinus surgery under local anesthesia, sometimes using technology known as a balloon where we do balloon sinus dilation of the ostium of the sinuses. And in select patients, that's a good option for relieving their symptoms. And in my patient population, I've seen significant improvement using this technology in a select portion of the population with sinus disease. There, we numb the nose up topically with cotton balls soaked in good numbing medicine. And then we'd go in and stretch the natural openings to the sinuses with the balloon. Patients typically go home, sleep off the medicine that we've given them that day, wake up, and by the next day they're feeling fine. So in that regard, it's a good option for certain patients with minimal disease in order to not have too much downtime after the procedure. Traditional sinus surgery involves removing bone and being more aggressive in removing content from within the sinus cavities themselves, whether it be polyp or whether it be a buildup of thick mucus and so on and so forth. There, we remove eggshell thin bone from the openings to the sinuses, that there's paired sinuses in the cheeks, in the forehead, in between the eyes and in the back of the nose, under the skull base called the sphenoid sinuses. And depending on the extent of the disease, sometimes we need to open up a portion of the sinuses, sometimes all of those sinuses.
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