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Michael K. Kim, M.D., F.A.C.S. Surgical Director, OC ENT SINUS & Associates.

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3801 Katella Avenue
Suite 414
Los Alamitos, CA 90720
Phone: 562-430-6065
Fax: 562-430-6069
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Services and Procedures Details

Conditions

What is chronic sinusitis?

Chronic sinusitis refers to inflammation of the sinus cavities. Often referred to as 'rhinosinusitis' because inflammation of the sinus cavities seldom occurs without inflammation and swelling of the nasal cavities at the same time. You can suffer from sinusitis without having an infection. However, it is thought that there are many potential triggers for this chronic inflammation - allergies, bacterial infections, and fungal infections to name a few.

What are polyps?

Polyps are outgrowths of the natural lining of the sinuses due to inflammation. They are part of chronic rhinosinusitis. Unfortunately, there is little understanding of why they develop and why some people develop polyps others don't.

There is one group of disorders which are always associated with sinonasal polyps. This is known as Samter's Triad or Aspirin Triad. It is the diagnosis of aspirin sensitivity, asthma, and sinonasal polyps. The aspirin sensitivity refers direct correlation between the ingestion of aspirin and the development of airway symptoms - throat and chest tightness with difficulty breathing and severe asthma attack.

Sinonasal polyps are distinct from polyps found in other parts of the body. They are not known to lead to cancer.

How do you treat chronic rhinosinusitis and polyps?

Your doctor will often prescribe various medications to try to control the inflammation - topical nasal steroids and sometime oral steroid pills. Traditionally, antibiotics taken orally have also been used for up to 3-4 weeks. In chronic rhinosinusitis, excess mucus production by the nose and sinuses often occurs. As such, nasal saline mists and irrigations are often recommended for nasal hygiene

Treatment with medications is the mainstay of treatment. Sinus surgery may be considered to assist with decreasing the burden of sinus disease when it is not responding to medical therapy alone. Surgery also relieves obstruction of the sinuses.

The goal of surgery is to decrease the burden of disease, improve the natural function of the sinuses, and assist with ongoing medical therapy. Surgery often leads to better control of sinus disease and fewer courses of acute medical therapy such as antibiotics in the long-term. It is important to understand that surgery will not completely relieve these problems and that the patient would likely remain on maintenance medical therapy.


Balloon Sinuplasty

What is "sinuplasty"?

"Sinuplasty" is the term that is sometimes used to refer to the Relieva Balloon Sinuplasty™ devices that your surgeon may chose to use during your FESS procedure.

What is "Balloon Sinuplasty™"?

The words, “Balloon Sinuplasty™,” when used together, describe the use of a sinus balloon catheter to surgically repair the sinus ostia during a FESS procedure. FESS is a minimally invasive surgical procedure to open up air cells and sinus ostia (openings) in patients suffering from chronic sinusitis. FESS involves the insertion of an endoscope into the nose for a direct visual examination of the openings into the sinuses. Using the endoscope and a combination of surgical tools, e.g., curettes, forceps, powered micro-debriders, powered shavers, and / or sinus balloon catheters, surgeons enlarge the patient’s sinus openings to clear passageways in order to restore normal sinus ventilation and drainage.

Watch Balloon Sinuplasty Video Watch video

 

Sinus Balloon Sinuplasty diagram Balloon removal diagram
Gain Access to the Sinus.
To gain initial sinus access, a sinus guide catheter is introduced into the nasal cavity to target the sinus ostia under endoscopic visualization. A sinus guidewire or a sinus illumination system is introduced through the sinus guide catheter and gently advanced into the target sinus.
Inflate Balloon Across Ostium. The sinus balloon catheter is introduced over the sinus guidewire or sinus illumination system and positioned across the blocked ostium. The position of the sinus balloon catheter is confirmed and the balloon is gradually inflated to open and remodel the narrowed or blocked ostium. Deflate and Remove Balloon. The sinus balloon catheter is then deflated and removed, leaving the ostium open allowing the return of normal sinus drainage and function. There is little to no disruption to mucosal lining.

What are the Balloon Sinuplasty™ devices?

The Balloon Sinuplasty™ devices are FDA-cleared, endoscopic, catheter-based tools specifically designed to be used in sinus surgery. The Sinus Balloon Catheter is gradually inflated to gently restructure the previously blocked nasal passage, maintaining the integrity of the sinus lining and restoring normal sinus drainage and function.

Does surgery with the Balloon Sinuplasty™ technology work?

Clinical studies have indicated that using Balloon Sinuplasty™ technology is safe and effective in dilating sinus openings.

Are the Balloon Sinuplasty™ devices safe?

While use of any surgical instrument involves some risk, clinical research has indicated the Balloon Sinuplasty™ technology to be safe. Furthermore, balloon catheter technology has been used successfully in other medical procedures such as balloon angioplasty for the heart.

How long does it take to recover from a typical surgery using the Balloon Sinuplasty™ system?

Because the system is minimally invasive it is typically used in an outpatient setting. While recovery time will vary from patient to patient, many people can return to normal activities within 24 hours after surgery.

Does surgery with Balloon Sinuplasty™ devices limit my treatment options?

No. Balloon Sinuplasty™ devices are endoscopic tools used within FESS and may be used with other medical therapies. They do not limit future treatment options for patients with progressive disease.

Are Balloon Sinuplasty™ devices right for me?

If you suffer from sinusitis, and medical therapy has not been effective in relieving your symptoms, you may be a candidate for surgery using the Balloon Sinuplasty™ devices. Talk to your doctor about whether use of these FDA-cleared, endoscopic, catheter-based tools are right for you.

Who uses Balloon Sinuplasty™ devices?

Ear, Nose, and Throat physicians who have been qualified on the Relieva Balloon Sinuplasty™ system. Information courtesy of Acclarent, Inc.


Endoscopic Frontal Sinusotomy

Where is the frontal sinus?

The frontal sinus is the sinus located behind your forehead and drains into your nose through the ethmoid sinus, the sinus between your Endoscopic Frontal Sinusotomy Sinus and Nasal Allergy Center. Not everyone has the same number of frontal sinuses. You may have two (right and left), one (right or left), or none.

Chronic frontal sinusitis can be due to persistent inflammation in the sinus. The sinus can be blocked because of swelling since the opening to the sinus is much smaller than the sinus proper. It can also become blocked due to polyps, tumors, mucoceles, or bony overgrowth of the opening.

If the pathway for drainage is blocked, prescription medications are usually the first line of treatment in attempts to clear the sinus. Sometimes, surgery is helpful along with medications.

What is endoscopic frontal sinusotomy?

Endoscopic frontal sinusotomy involves the use of telescopes and cameras through the nose to reach the anterior ethmoid sinus, and then the frontal sinus above. These areas are opened and disease is removed. The natural opening to the sinus is widened to assist with the natural function of the sinus such as making and clearing mucus.

If possible, just the natural opening to the sinus is surgically widened. If you have had surgery in this area before, additional procedures may be indicated to open and keep this area open.


Endoscopic Resection of Sinonasal and Skull Base Tumors

What is a tumor?

Endoscopic resection of sinonasal and skull base tumors. A tumor is an abnormal mass lesion with progressive, uncontrolled growth. It serves no function in the body. Tumors are characterized as benign (non-cancerous) or malignant (cancerous).

These can occur anywhere in the body including the nose, sinus cavities, and at the skull base (the bony division between the brain and the sinus and nasal cavities). Because of progressive growth, a tumor can invade the brain, eyes and other vital structures next to the sinuses.

What is endoscopic resection?

Endoscopic resection involves the use of telescopes and cameras through the nose the reach the tumor and remove it. This type of surgery is used to avoid disfiguring external skin incisions to remove the tumor.

Dr. Kim is dedicated to the use of minimally invasive procedures to treat sinonasal and skull base tumors.

When you are seen, we may schedule you to undergo radiographic studies such as an MRI or CT scan. You may also be seen by a Neurosurgeon, Ophthalmologist, Endocrinologist, Radiation Oncologist, or Hematologist-Oncologist for further work up of the tumor. Once we have the information we need, we will devise a treatment plan best suited to you.


Functional Endoscopic Sinus Surgery

What is functional endoscopic sinus surgery?

Functional endoscopic sinus surgery is the use of telescopes and cameras through the nose to reach, open, and clear out the sinuses. As an analogy, a sinus cavity can be thought of as balloon with an aerated portion and a small opening. Sometimes, it is beneficial to widen this opening to aid in the long-term function of the sinus as well as to remove disease and secretions from the sinus.

There are no external facial cuts in this type of surgery. As a result, there is less morbidity associated with this type of surgery as compared to surgical approaches to the sinuses with external facial cuts - no change in the external appearance of the face, faster recovery, and less pain.

In Dr. Kim's practice, the importance of postoperative care and long-term follow up with ongoing endoscopic surveillance of the sinus and nasal cavities is emphasized. In general, medical therapy with antibiotics and nasal saline irrigations and sometimes oral steroids are used in the postoperative period along with weekly or fortnightly endoscopic surveillance and adjustment of medications as sinus inflammation resolves. Thereafter, we follow patients with periodic nasal endoscopic examinations.

So, in addtion to discussing the pros and cons of treatment for your condition, we emphasiz long-term follow up for continued management of your chronic sinusitis.


Endoscopic CSF Leak Repair

CSF leak repairCSF rhinorrhea refers to cerebrospinal fluid ("brain fluid") leakage through the nose. The fluid is usually clear and watery in consistency. This is in contrast to mucus from the nose which is sticky and thicker in consistency.

What is a CSF Leak?

The roof of the nose and sinus cavities is the floor of the brain, called the skull base. It is made of bone. if there is a hole in this bone as well as a tear in the dura - the tough, leathery casing surrounding the brain - then CSF can leak through.

How does a leak happen?

There are several causes of a CSF leak :

  • Trauma - with severe blows to the head, the skull base can fracture and the brain casing (dura) can tear. This will allow CSF to leak into the nasal cavity.
  • Prior surgery - surgery of the sinuses or skull base can lead to a breach of the bone and CSF can leak through the defect.
  • Congenital - there can be congenital defect in the skull base bone
  • Tumors - A CSF leak may be the first sign of a tumor growing in the skull base, nasal, or sinus cavities.
  • Spontaneous CSF leak - A CSF leak into the nose can occur spontaneously and with no obvious explanation. Further investigation may support that this is a variant of benign intracranial hypertension in is which there is an overproduction of CSF. If there is more CSF produced than the drainage system can keep up with, a path of least resistance forms and this may be through the nose.

Endoscopic repair Sinus and Nasal Allergy CenterWhat is endoscopic repair?

Using telescopes and cameras, we can visualize the site of the defect and patch it. This may require placement of a lumbar drain and a stay in the hospital for a few days.

What do I do if I suspect I have one?

See your family physician ASAP and obtain a referral to see a rhinologist.

Until the appointment, do not blow your nose and avoid strenuous activity. Take measures not to catch a cold.


Functional Septorhinoplasty & Septoplasty

Septoplasty and septorhinoplastyWhat is a septoplasty?

The septum is an anatomic structure in the nose; it divides the nose into left and right nasal cavities. Septoplasty and septorhinoplasty. When it is crooked, it is referred to as deviated and can interfere with nasal breathing. This causes a person to complain of nasal obstruction or congestion or the inability to breath through one side of their nose. A septoplasty is a procedure that removes the deviated portion of the septum to improve nasal airway breathing.

What is involved in a functional septorhinoplasty?

A functional septorhinoplasty addresses the structure of the nasal skeleton to improve nasal breathing. Problems with nasal breathing may be due to anatomic obstruction of the nasal passages. A deviated septum is an example of this. In addition to the septum, the nasal skeleton is made up of nasal bones, upper lateral cartilages, and lower lateral cartilages. If any of these portions of the nasal skeleton are crooked or broken, they may cause obstruction of the nasal passages and lead to complaints of nasal obstruction or difficulty breathing through the nose. A functional septorhinoplasty addresses the structure of the nasal skeleton to improve nasal breathing.


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The American Academy of Otolaryngology-Head and Neck Surgery The American Academy of Otolaryngic Allergy American Rhinologic Society American College of Surgeons Facial Plastic Surgery & Reconstructive Surgery Academy The American Medical Association