Imagine breathing freely, with an improved sense of smell and far less drainage at the back of your throat. Fortunately, this scenario can exist. One of the ways we do this is with a fast and relatively easy treatment known as balloon sinuplasty. This procedure improves the drainage of the sinuses while preserving normal anatomy and mucosal tissue. And it's ideal for many patients who suffer from chronic sinusitis.

Although the reasons for chronic sinusitis can be many, it's generally related to inflammation of the tissue in the sinus cavities, making it extremely difficult to remain clear.

Balloon sinuplasty (BS) aims to restore normal sinus function and provide patients with relief from chronic sinusitis. It's a minimally invasive treatment that uses a small, flexible catheter and sinus balloon. The balloon is inflated after being inserted into the nostril and gently opens the sinus passageway. This moves the surrounding tissues, and unlike medications that merely treat symptoms, BS provides a lasting solution to chronic sinusitis. Because of the complex nature of chronic sinusitis, it is difficult to know if the results will be permanent. However, many clinical trials have shown that many patients do not require any additional procedures.

BS earned FDA approval in 2005 and has since been used to restore normal sinus function, including proper drainage, in tens of thousands of patients. The treatment can often be performed in the office without general anesthesia. It boasts an excellent safety profile and, because it doesn't cut into bone or tissue, may have fewer side effects than endoscopic sinus surgery in carefully selected patients. For instance, patients tend to have:
​

• Minimal pain after the procedure 
• Little to no blood loss
• No bruising 
• No swelling

We begin by using a small camera and inserting that balloon catheter into the nostril. The balloon is gently guided into one of the sinus cavities, allows us to gain access to the blocked sinus passageway. Once the balloon is inflated, a saline solution may be sprayed into the nostril to flush out further blockages.

​After ensuring the nasal passage is cleared, we deflate and withdraw the balloon. The entire process can usually be completed in under an hour, and patients often resume their normal activities the following day. Even the recovery is straightforward with simple methods to care for your nose and nasal passageways. For instance, you'll need to give your body enough time to recover - a minimum of 12 to 24 hours.

You'll also need to resist blowing your nose for at least 24 hours. Your tissues will need a little TLC, and blowing only serves to cause irritation. We may provide a nasal spray to use at home that will help safely rinse your passageway. Doses are typically administered every four hours, but we'll tailor treatment to meet your specific needs. Last but not least, if we provide prescription medications, it's important you follow them as directed.

Sinusitis impacts 37 million Americans every year. While medications offer relief for some people, it's not a cure-all. Many patients require additional therapy to address their symptoms, and this is where balloon sinuplasty can provide much-needed help. The treatment can be especially beneficial to Louisville, KY patients who have endured years of sinus and allergy problems.

Our staff will discuss in greater detail your candidacy for BS. Generally speaking, those with the following symptoms feel much better after treatment:

• Recurrent sinus infections
• Chronic nasal problems
• Difficulty breathing through the nose
• Weakened sense of smell

​Balloon sinuplasty is a good option for many patients. Your doctor has the experience and expertise to provide recommendations from a variety of sinus procedures, including surgery involving an endoscope and balloon sinuplasty.

In endoscopic sinus surgery, a thin camera rod with a light at the end is used to magnify sinus tissues and specialized instruments can then be used to remove blockages, including scar tissue and nasal polyps.

Multiple clinical studies confirm BS provides lasting relief from the many symptoms that accompany sinusitis. We're talking about concerns like sore throat, headache, facial pain, stuffy or runny nose, and cough. And the patient success rate associated with this treatment is around 95%.
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These same studies show BS opens sinus cavities without causing unwanted side effects like facial bruising and significant discomfort. Equally important, patients do not have to pack their noses with gauze after the treatment.

​Studies further show us that patients who undergo BS have substantial improvements to their quality of living. An analysis of 45 different studies revealed that up to 97% of all patients feel relief after treatment. They experience fewer headaches, breathe better, and enjoy improved sleep. They also lead healthier lives thanks to a reduction in recurring sinus and throat infections.

​We encourage patients to get answers to their questions before moving forward with treatment. To illustrate, many people want to better understand the exact nature of sinusitis. Let's begin by describing the sinuses, which are four paired cavities in the head. They're connected by narrow channels that help drain the mucous they create. That drainage is important - it keeps the nose clean and free of harmful bacteria.

The sinuses are normally filled with air but can become blocked. When this happens, they also fill with fluid that encourages the growth of bacteria. This leads to tissue swelling that makes breathing highly difficult.

​Earlier, we said most patients resume normal activities within one day. This includes light exercise like walking. Strenuous activities, however, should be delayed at least a week. We can discuss this more during your consultation, at which time we'll assess your condition and ask about your treatment goals.

​BS dilates sinus openings by pushing aside bones that comprise the sinus ostia. These are the openings that form drainage channels for the sinuses. By physically moving that bone, we're able to remodel the ostia and create wider openings.

​Many patients have a latex allergy that might cause them to initially question BS treatment. But the balloon used is made from a high-strength plastic free of latex. This means it can be safely used even on those with common allergies.

​BS appears to be an effective and safe way to relieve chronic sinusitis symptoms in children. Many health care providers recommend BS for children to open airways and improve breathing difficulties magnified by sinusitis. Several studies have demonstrated low rates of adverse effects.

Minimally invasive functional endoscopic sinus surgery (FESS) has been a standard of care since the 1980s. The idea with FESS is to relieve sinus obstruction and recreate the natural outflow of the sinuses. BS started after biomedical engineers reasoned that just as a surgeon can dilate a blocked artery with a balloon, the same could be done with blocked sinuses. BS evolved from this theory and has become a procedure that can be quickly performed, as an in-office treatment, and doesn't require significant downtime.

BS can provide the sinusitis relief you've been searching for. It clears nasal passages, reduces headaches, and improves quality of life. And these benefits are enjoyed without a long and arduous recovery period. Schedule your consultation today by contacting Dr. Thomas S Higgins, MD, MSPH.

The Difference Between a Pandemic and an Epidemic

Outbreaks of disease have been occurring throughout history for thousands of years. In fact, the first recorded pandemic took place in Athens, Greece, during the Peloponnesian War in 430 B.C.

A ‘pandemic’ is an outbreak of disease that has spread across several countries or continents, affecting a very wide geographical area. An ‘epidemic’, on the other hand, is an outbreak of disease that occurs within one location. While many people use the term ‘plague’ when talking about a pandemic, a plague refers to the spread of an infectious disease caused by a specific bacterium, Yersinia pestis.

A pandemic follows six key phases, as outlined by the World Health Organization:

1. A disease-causing organism (pathogen) circulates among animals. It may or may not be known to infect humans.
2. A pathogen that circulates among animals is known to cause infections in humans.
3. An animal-to-human infection has occurred but has not escalated to a community outbreak.
4. A human-to-human infection has occurred, and community-level outbreaks have been verified.
5. Community-level outbreaks have occurred in two or more countries in one WHO region.
6. A community-level outbreak has been identified in a third country, in a different WHO region. It is at this phase that a pandemic is declared.

How We Have Responded to Pandemics in the Past

Viral pandemics can spread incredibly quickly, infecting millions of people around the world. Here are some examples of how we’ve navigated them in the past.

The 1918 Influenza
Caused by an H1N1 influenza virus, the 1918 influenza was a devastating pandemic that infected an estimated one-third of the world’s population, killing approximately 20–40 million people by 1920. The flu vaccine was not developed and distributed until 1930, so control efforts were limited to non-pharmaceutical interventions, such as social distancing, quarantine, personal hygiene, and limitations on public gatherings.

The 1968 Pandemic
1968 was notable for a multitude of reasons—including manned space travel, the military conflict in Vietnam, and even innovations in heart transplant surgery—but it was also the year of the H3N2 influenza pandemic in the United States. Although the infection and mortality rate was not as high as during the 1918 pandemic, it was responsible for an estimated 100K deaths in the US. Schools were closed across at least 23 states, and ‘normal’ life was significantly disrupted, including delayed package deliveries, economic slowdown, and widespread closures.

The 2009 H1N1 Pandemic
First detected in the US in April 2009, the H1N1 pandemic is perhaps our most recent memory of a viral outbreak. Before the pandemic even reached phase 6, the CDC was recommending social distancing measures and school closures to slow the spread of the disease.

Following the 2009 H1N1 pandemic, the CDC established the Pandemic Influenza Preparedness (PIP) Framework to improve the global response to mitigating the effects of a pandemic, including providing access to resources such as vaccines and supplies.

How We Are Responding to the COVID-19 Pandemic is No Different

Although the world is no stranger to pandemics and outbreaks of disease, COVID-19 took many of us by surprise. The rapid spread and severity of symptoms brought the world to a halt—businesses and schools were closed, and we were all encouraged to social distance and isolate to slow the spread. Face masks have become a fashion statement and hand sanitizer is readily available at the entrance of public buildings.

While the rush to stockpile toilet paper was perhaps a bit out of the ordinary, it’s important to note that the way we are responding to the COVID-19 pandemic is in line with how we have handled pandemics in the past. And just like we’ve seen in our history, the way back to ‘normal’ is by getting vaccinated and following the CDC’s guidelines.

There have been more than 37 million cases of COVID-19 in the United States, with over 620 thousand deaths since March of last year. The world came to a halt in 2020 as we were urged to stay home in an effort to slow the spread of the highly contagious coronavirus. Now, halfway through 2021, hope is on the horizon: major pharmaceutical companies—such as Pfizer, BioNTech, Moderna, and Johnson & Johnson—have developed and distributed vaccines to countries around the world. Here’s what you need to know.

The Benefits of Being Vaccinated

The COVID-19 vaccine will not make you immune to the coronavirus, but it can significantly reduce the severity of symptoms if you do get sick. The vaccine may also prevent you from spreading the virus to others. The virus replicates as it spreads, increasing the risk of vaccine-resistant mutations, so it’s important that we do what we can to stop the spread.
 
At the time of writing this, more than 4.74 billion doses of the vaccination have been administered worldwide, with over 350 million doses given in the United States. Approximately 51% of people in the United States have been fully vaccinated, with around 77% of the population having received at least one dose. Health officials are aiming to reach a total of 70% of Americans fully vaccinated in an effort to achieve herd immunity, which helps protect those in our community with serious medical conditions that prevent them from being able to be vaccinated.

Is the Vaccine Safe?

​Vaccine safety has been a popular topic in recent years, with many people expressing concern and spreading misinformation regarding potential side effects or risks associated with vaccinations in general. The hurried release of the COVID-19 vaccination has led many people to question whether or not it is safe, however, it has been fully approved for emergency use by the Food & Drug Administration (FDA).
 
Healthcare professionals and government officials have gone to great lengths to assure people that the vaccine is safe for use. While vaccines—and most medications, for that matter—do carry a risk of side effects, the overall risk is quite low. For example, the Johnson & Johnson Janssen vaccine carries an increased risk of blood clots (otherwise known as thrombosis with thrombocytopenia syndrome or TTS) but this occurred in only 0.0003% of cases or 42 out of the 13 million people who received the J&J vaccine. Comparatively, the average birth control pill carries a 0.3% risk of blood clots.

Get Your Vaccination Today!

Everyone 12 years of age and older is eligible to receive a COVID-19 vaccine free of charge. Visit the CDC’s website to find a vaccination provider near you, or to learn more about the benefits of being vaccinated.
 
The case rates are climbing again, with an average of 140 thousand new cases every day over the past week. I truly believe that the way back to ‘normal’ is by getting as many people vaccinated as possible. Speak to your doctor or a trusted healthcare professional to learn more about the COVID-19 vaccine, including the risks and potential side effects. 

​One of the strangest and most frustrating symptoms of COVID-19 is anosmia, or the loss of the sense of smell. Losing your sense of smell can impact many parts of your life, including your appetite. For some people, the sense of smell returns after several days or weeks - but for others, losing the sense of smell can be a persistent issue.

​Of all the symptoms related to the COVID-19 pandemic, losing the sense of smell can be a symptom you have to deal with for several weeks or months after you are no longer testing positive for the virus. Just like losing your sense of taste, losing your sense of smell can change the way you live your life, so it's understandable to want to know when you can expect your senses to return back to normal.

The good news is that time seems to be the answer to reversing anosmia. In a French study conducted on coronavirus patients, researchers concluded that most patients regained their sense of smell after nearly a year after contracting the virus. And yet for others, regaining the sense of smell is something that returns after about two weeks of other symptoms going away.

There's a huge difference between getting your sense of smell back after a few weeks or after a year. While researchers are still trying to figure out why some patients seem to recover their sense of smell more quickly than others, new research may suggest that it has to do with the way the virus affects the cells surrounding the sensory neurons in the nose. Specifically, it has to do with how quickly the cells surrounding the sensory neuron can recover.

For years, physicians have been aware that viral infections can sometimes cause patients to lose certain senses temporarily, including the sense of smell. But because this phenomenon pre-COVID was somewhat rare, there hasn't been an opportunity for much research. Now, research studies about why anosmia happens to COVID patients and how to recover your sense of smell are constantly being conducted.

What scientists have discovered about this particular viral infection is that the virus appears to target specific cells in the body - and this includes the cells that surround sensory neurons in the nasal passage called support cells. Essentially, the virus attacks and damages these support cells, which prevents them from helping the sensory neuron send information to the brain. When the support cells are infected, you lose your ability to smell; when these cells are repaired, your sense of smell returns.

​Long-haulers are the people who had COVID symptoms for several weeks or even months. In general, long-haulers dealt with more exaggerated symptoms than others while their bodies battled the viral infection. Some research suggests that the longer you have symptoms, the longer it will take for some symptoms to go away. This seems to be particularly true for the loss of taste and smell.

Compared to people who had mild or asymptomatic infections, long-haulers seem to have more challenges returning to pre-COVID health. If you battled COVID for several weeks or months, then you may want to see a specialist to do a thorough health check or even participate in post-COVID studies.

​About 80% of patients who have COVID-19 will temporarily lose their sense of smell, and for about 5 to 10% of those patients, this symptom will continue even after patients have recovered from other symptoms and are no longer infected. And while most of those patients can regain their sense of smell after several months to a year, there are still some patients who may have a longer-lasting issue.

The trouble with regaining your sense of smell is that your sensory nerves need to be surrounded by supportive cells, otherwise the nerves die or atrophy. It's incredibly difficult for sensory neurons to repair themselves, so if you are experiencing a persistent loss of sense of smell for longer than a year, then it's possible your sense of smell may never return. That said, experts suggest that maybe patients with persistent anosmia may just need additional time for their sense of smell to return.

This is a question scientists have been trying to answer. Because the virus is thought to affect the function of the sensory nerves, research for how to regain the sense of smell after COVID is focusing on a blend of neurological research and ear, nose, throat experts. One study is working on the association between visual cues and scent to try to retrain the brain.

In this study, participants are asked to smell essential oils or other scents while looking at a picture that represents the scent. In doing so, researchers are trying to figure out if the sensory nerves can re-learn scent associations. According to some, this research is long overdue since a lot still isn't known about viral-associated anosmia. The novel coronavirus has opened new demands in research that can help shed light on how to recover from certain viral infections.

For patients who have regained or partially regained their sense of smell, one of the most hopeful signs to look out for is hints of scents. While you are trying to recover your sense of smell, you may only be able to detect very faint traces of certain scents. But this is a hopeful sign that your sensory neurons and support cells are still functional and that your sense of smell is returning, however slowly.

In the grand scheme of things, if you've survived COVID-19, then regaining your sense of smell may not be one of your top priorities, especially for long-haulers. But your sense of smell, just like any other sense, is important to lead your life safely and independently. In fact, in terms of safety, not having a sense of smell can be dangerous. If you can't smell fire, gas, or something burning without looking directly at it, then you may unknowingly be in danger.

But more than that, many patients feel nostalgic about their sense of smell. Neurologists have known for years that the olfactory senses are closely linked with memory, so the loss of smell may make it difficult to have easier memory recall. Additionally, your sense of smell and your sense of taste are closely tied, and for some people, being unable to smell food makes it difficult to have an appetite, which can negatively impact your overall health over time.

Losing your sense of smell is one of the hallmarks of the novel coronavirus. For many people, losing the sense of smell is one of the first symptoms they experience after fever and fatigue - and this symptom is, unfortunately, one that can persist even after all the other symptoms associated with the viral infection have disappeared. The good news is that time seems to be the key to regaining your sense of smell. For more up-to-date information about recovery from COVID-19, contact Dr. Thomas S Higgins, MD, MSPH at Higgins Sinus in Louisville, KY today.

Some ear conditions are ultimately related to the nose.  Once you think about the intertwined anatomy and physiology of these two body parts, it makes complete sense. The nose is connected to the ear via a functional tube called the Eustachian tube. This tube helps ventilate, drain, and maintain an equilibrium of air pressure in the middle ear. It opens in the back of the nose called the nasopharynx. If something were to block that opening, the system gets backed up, causing increased ear pressure and ear fluid.

We have known that one of the causes of ear infections or persistent middle ear fluid in kids is obstruction of the Eustachian tube from the adenoids, which are in the nasopharynx. Thus, performing an adenoidectomy is one of the treatments for chronic ear fluid in kids.

Our research group set out to see if chronic rhinosinusitis affected ear symptoms in adults and our findings were significant. We found that, in patients with chronic rhinosinusitis, ear symptoms and nose/sinus symptoms were strongly correlated.  So, those with worse sinus symptoms seemed to have worse ear symptoms.

We also looked at how sinus surgery affected ear symptoms. In this study, 80% of the patients had improvement in ear symptoms with sinus surgery alone and 60% had complete resolution (or normalization) of their ear symptoms!

So, we have found it important to ask questions about both nose and ear symptoms because treating the nose is often the answer to solving certain ear problems.    

Dupilumab (Dupixent) and omalizumab (Xolair) are biologics/monoclonal antibodies used to treat nasal polyps and asthma. So, can you take the COVID-19 vaccine while on these medications?

THE TWO FDA-APPROVED VACCINES ARE NOT LIVE VACCINES

The two COVID-19 vaccinations currently available (Pfizer-BioNTech and Moderna) are both non-live, mRNA vaccines. The package insert for dupilumab states that live vaccines should be avoided because it has not been studied with live vaccines. Thus, from this standpoint, both of the medicines can be given.

ANTIBODY RESPONSES PRODUCED WITH OTHER VACCINES IN PATIENTS ON BIOLOGICS

Dupilumab has been studied with other non-live vaccines and the vaccines worked. In a study of atopic dermatitis adults on dupilumab, both the meningococcal polysaccharide and tetanus vaccines showed similar antibody responses in both placebo-treated and dupilumab-treated subjects.

NEITHER MEDICINE HAS IMMUNOSUPPRESSIVE EFFECTS

Dupilumab and omalizumab "modulate" or change the behavior of the immune system, but neither medicine has been shown to reduce the immune system in studies.

JOINT STATEMENT FROM EXPERTS 

According to a Joint Statement by the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) and the American Academy of Otolaryngic Allergy (AAOA), dupilumab (Dupixent) and omalizumab (Xolair) should not be given on the same day but otherwise can be administered on the normal schedule.

CONCLUSION
​
Experts are currently recommending that patients continue dupilumab (Dupixent) and omalizumab (Xolair) when getting the COVID-19 vaccine as long as both the biologic and vaccine are not administered on the same day. Neither medication has been found to lower the immune system and the current vaccines are non-live. Always consult your treating physician for individual medical advice.   

Cheers,
Thomas S. Higgins, MD, MSPH

Father. Husband. Sinus Nerd.

Source: https://www.entnet.org/content/allergic-reactions-related-covid-19-vaccinations-allergic-patients

Medscape.com asked me to give them a Case Challenge. I had a good one for them.

​"A 35-year-old man with a history of adult-onset asthma has had nasal obstruction and smelling loss for 4 months. He also reports postnasal drainage, cough, runny nose, and facial pressure. He has no history of asthma or allergies as a child. He also has no history of previous nasal or paranasal sinus surgery. His symptoms worsen after drinking certain beers and also after using ibuprofen or aspirin."

This is a CT scan of his sinuses. White is bone. Black is air. Soft tissue is gray. The sinuses are supposed to contain air (black)!

There is not much black, meaning they certainly are filled up. No wonder he couldn't breathe!
Anyway, I was able get him better and he can even drink some beer now.

Read more here.

Watch this video about how we're returning to clinics and surgery.