We all know well what a blocked nose feels like when we have a cold. A runny or congested nose can cause significant discomfort, disrupting our productivity and affecting our quality of sleep. Usually, to resolve this problem, we use a nasal spray or drops, which help reduce nasal swelling and make breathing easier. If left untreated or treated incorrectly, a cold can develop into chronic sinusitis. How do you know if you might have sinusitis?
“If you have been suffering from a blocked nose for more than three months, you have most likely developed chronic sinusitis,” notes Baltic American Clinic ENT consultant Donata Šukytė-Raubė. According to the doctor, patients often ignore a long-term blocked nose and breathing difficulties, but over time, this condition can cost them their sense of smell or even lead to depression. Patients who do not undergo surgery in time struggle with difficulty breathing through the nose, lose their sense of smell, and may face more serious infectious complications. Not to mention that quality of life and sleep suffer significantly.
“In my practice, I have treated a patient who ignored a blocked nose for three years. She suffered from aching eyes and headaches, struggled with breathing difficulties and low mood, and frequently experienced weakness and fatigue. No medication helped her, so the only solution was sinus surgery, after which the patient made a full recovery,” the doctor shares, urging people not to dismiss what seems like a simple blocked nose.
According to researchers, patients suffering from chronic sinusitis feel even worse than those with asthma. It is known that around 150,000 to 360,000 people in Lithuania suffer from chronic sinusitis, and these numbers are growing every year. There are many causes for this condition – air pollution, various environmental irritants, allergies, and sinus bacteria. Dental infections and anatomical changes in the nose and sinuses can also play a role, such as narrow sinus openings, a deviated septum, or enlarged turbinates. According to doctor D. Šukytė-Raubė, smoking, vitamin D deficiency, gastro-oesophageal reflux, and certain systemic diseases like cystic fibrosis – where the body produces nasal secretions that are too thick to drain easily from the sinuses – can also be contributing factors.
The gold standard – minimally invasive surgery
Nasal sinus or paranasal sinus surgery is one of the most commonly performed nasal procedures, although compared to the number of people suffering from this condition, the number of operations remains too low. It is estimated that in Europe, only up to 2% of patients per 1,000 sufferers undergo surgery. The doctor says that such a small number of operations only confirms that patients tend to tolerate nasal congestion and do not take it seriously. “Scientific research shows that the earlier the necessary surgery is performed, the better the long-term outcomes of the disease,” says the doctor. Speaking about surgical sinus treatment, the doctor highlights that endoscopic nasal surgery is a highly innovative field due to complex anatomy, high patient expectations, and a relatively large number of patients presenting with issues. These problems can be resolved with correct surgical treatment. The procedure performed with an endoscope is minimally invasive, using an endoscope that allows the surgery to be carried out with millimetre precision. Under general anaesthetic, the surgeon operates using an endoscope – typically a 4-millimetre-diameter long metal tube with a built-in optical system connected to a light source and video system.
“Operating with an endoscope allows me to clearly see the inside of the nose and to zoom in on and enlarge all structures, enabling me to see precisely what to open, what to remove, and to do so accurately while causing minimal trauma to healthy tissue. These operations are sometimes like jewellery-making and require exceptional precision, as this is a highly complex and narrow area: close to the brain, eyes, and major blood vessels. The patient is asleep during the operation. An endoscope is inserted through the nostrils into the nasal cavity, connected to a high-definition light source and a monitor, where the operating surgeon sees an illuminated and magnified view of the internal nasal structures,” explains ENT consultant Donata Šukytė-Raubė.
According to the doctor, the duration of the surgery depends heavily on the condition being treated. While 10 minutes might be enough to stop bleeding, a tumour removal operation, for instance, can last 6 to 7 hours. “We always discuss with patients not only the surgery and the post-operative period but also how we will proceed with treatment and what the long-term nasal care plan will be. We establish a connection for a while, as it were: I ask them to come in for regular check-ups so they can gradually learn how to care for their nose and prevent, for example, flare-ups of chronic sinusitis,” the doctor notes. She adds that in practice, there are cases where sinus surgery must be performed as an emergency, and she warns not to delay, as these are life-threatening conditions.
“Emergency sinus surgery is required when complications are imminent or have already occurred: an orbital abscess, meningitis, a severe headache that does not improve with medication, or deteriorating vision. Of course, it is also necessary when malignant tumours are detected,” says Baltic American Clinic doctor D. Šukytė-Raubė.
Medical progress is impossible without the involvement of doctors and patients
Having recently defended her medical thesis in Italy, ENT consultant Donata Šukytė-Raubė is already successfully applying the knowledge she gained during a year-long training course in endoscopic skull base surgery to her practice in Lithuania. So, what innovations are being applied in this field of treatment? We ask the doctor. “There is an increasing focus on performing minimally invasive, less traumatic, yet highly effective nose and paranasal sinus surgeries. The goal is to minimise the post-operative recovery period. Gradually-releasing steroid sinus stents, lasers, image-guided navigation, and additional aids that promote healing and ease the recovery period are being used more and more widely,” the doctor says of the medical advancements.
The doctor notes that no progress in medical science would happen without engaged, inquisitive doctors, and also highlights that the course and results of treatment depend heavily not only on the latest technologies and the doctor’s expertise, but also on the patient’s own involvement and cooperation with their treating specialist.
