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Interviewer: How do you know if endoscopic sinus surgery or just sinus surgery is right for you? We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: The purpose of this podcast is to help you understand if sinus surgery might help the issue that you're suffering from. You may have already done some research on the internet or have been to a doctor and they told you a few things, you may have forgotten some stuff or want a second opinion, and that's what we're going to find out. We're going to find out some basic information if sinus surgery is going to help your issue.
We're with Dr. Richard Orlandi. He's an expert in this thing at University of Utah ÐÇ¿Õ´«Ã½care. Before we get into how do you know it's right for you, let's talk about how does the surgery change people's lives that do need this type of surgery?

Dr. Orlandi: The surgery can have a really big impact on the overall quality of life, not just the sinus problems. We know that patients with chronic sinus problems have a quality of life that's similar to someone in heart failure, way worse than diabetes, high blood pressure, things like that. And so what we're looking at is the overall picture, not just the sinus problems, but just not just the sinus symptoms, and so we're looking at sleep issues and the disorders in sleep.
Another thing that really affects quality of life is loss of sense of smell. We see that commonly with patients with sinus problems and the reason that's such a big deal is not only can you not smell spoiled food, natural gas, things like that, but much of what we perceive as sense of taste is really sense of smell. So when we lose our sense of smell, we really lose our ability to appreciate the food we're eating. We're looking at fatigue and we're looking at depression. These are things that are much higher in patients with sinus problems than our regular population and we're looking to really target those.

Interviewer: So people with sinus problems, not having a great life right now.

Dr. Orlandi: Absolutely not. It really impacts people in a much bigger way than we often think.

Interviewer: What sinus issues can sinus surgery help? Let's start right there.

Dr. Orlandi: Most of the time we're doing sinus surgery for people with chronic sinus problems or chronic sinusitis. It's a long-standing inflammation of the sinuses. Most people will feel symptoms of congestion, pressure in the face and in the sinuses, they're having frequent infections, those are the things we're mostly targeting.

Interviewer: Yeah. And a patient comes in generally for the infections, or is it the pain, or is it kind of all the above? Is there any one thing that they . . .

Dr. Orlandi: It's really all of the above. A lot of times we see patients because they've been to their primary care doctor over and over again for sinus problems and they're looking for a better long-term solution.

Interviewer: Okay. Are there some issues that this type of surgery won't help?

Dr. Orlandi: Yeah. I think the one that we most typically see is when patients are referred for facial pain or headaches and it's really not their sinuses. So clearly we're not going to be able to help them in that situation.

Interviewer: But in some instances that is caused by their sinuses, it sounds like.

Dr. Orlandi: It is, and so it takes doing some looking into it with an examination, with questioning, with sometimes a CAT scan to really be able to find out what's going on.

Interviewer: Yeah, and you're the expert in doing that.

Dr. Orlandi: One of them here, yes

Interviewer: One of the experts. Fair enough. All right. So beyond what issues it can help and it won't help, are there some people who are better suited for this procedure than others?

Dr. Orlandi: We usually try medications first to try to avoid surgery, and I think that's an important point. We go through people's medications, their history, what they've been on, what has worked, what hasn't worked, and really try to target different solutions for their problem. When those things have failed, then we start looking at surgery.

Interviewer: Now, are there questions somebody should ask before they consider a procedure like this or if they are?

Dr. Orlandi: I think that definitely they want to make sure that all their options have been exhausted. Obviously, surgery is an option, it's not the option. So we want to make sure that a patient is really going through all of those different options and making sure they've exhausted them. Now having said that, there is interestingly some evidence coming out more recently last year, too, about delaying surgery too long may lead to not as great an outcome. We don't know that yet and I don't think we're ready to jump into surgery, but we don't want to delay forever either.

Interviewer: I think you're showing right now again why somebody should come to a specialist such as yourself who has dealt with this before. You know, the research, the literature on that sort of thing. So, how would somebody move forward with this surgery? They've been to a specialist. What would be the next step, then?

Dr. Orlandi: Once they've been to a specialist, had a thorough evaluation, looked at all the options, and they decide to have surgery, then we go ahead and schedule that and we get everything ready ahead of time. We want to make sure that the medication is optimized at that point. Even though it's failed and they're requiring surgery, we want to do everything we can to try to reduce the inflammation prior to surgery and that, we think, leads to a better successful outcome.

Interviewer: Interesting. Are there some other things, other considerations people should think about that I haven't hit on?

Dr. Orlandi: No, I think you've hit on all of them. We really just want to get a thorough evaluation of all the options and then make a decision together. We try to make sure the patient, at least at our office we really want to make sure they understand all of the different options, the pluses and minuses associated with those, and that they really understand what the surgery is all about, what they can expect from it. Sinus surgery is not a cure. It's not like getting your appendix out. It's not like getting your gall bladder out. It's really important to understand that the surgery's important, but it's a part of their overall management. Unfortunately, sinus problems are a little bit like high blood pressure, diabetes. We manage it, we don't cure it.

Interviewer: All right. Any additional resources . . . I know somebody that might be considering this might want to learn a little bit more information. Do you have any good ones you could drive them to?

Dr. Orlandi: We've got some great information on our website here at the University of Utah at University ÐÇ¿Õ´«Ã½care. We've got a number of different diagrams. Some people learn more visually, some people more reading through it, and so we have a lot of the explanations about the surgery risk, benefits and alternatives, those sorts of things there.

Interviewer: And how would they find that website? If you just go to Google and Google . . .

Dr. Orlandi: University of Utah sinus surgery, you're going to find it.

Interviewer: Going to get you right there. All right, well thank you very much. Appreciate that.

Dr. Orlandi: My pleasure.

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