Xlear Nasal Spray with Xylitol, 1.5 fl oz (Pack of 3)

ENDOSCOPIC SINUS SURGERY (ESC)

What is Endoscope and Endoscopic Sinus Surgery (ESC)?

The endoscope is an instrument with light and optical lenses at the end, allowing you to see the image directly from one end to the other. Endoscopes of different thickness and length are used in many branches such as ENT, Gastroenterology, Urology, Orthopedics, General Surgery, Gynecology and Thoracic Surgery. In ENT, 4 mm and 2.7 mm diameter endoscopes are generally used. There are endoscopes with 0º, 30º, 45º, 70º, 90º and 120º angles depending on the placement of the lens at the end of the endoscope. Endoscopes provide a clear view of dark cavities, normal anatomical structures and pathological tissues that we cannot see directly in the nose. Endoscopes are combined with a camera system, the image is simultaneously transferred to the computer and monitor. Images can be enlarged and recorded in HD quality when necessary. Endoscopic sinus surgery using endoscopes for the sinuses around the nose is called surgery. It has been widely applied all over the world and in our country for many years.

When are Endoscopy and ESC Applied?

Endoscopes are used in the diagnosis and surgical treatment of many diseases of the nose, sinus and their neighbors. These; has been widely applied all over the world and in our country for many years.

Endoscopes are used in the diagnosis and surgical treatment of many diseases of the nose, sinus and their neighbors. These;
. Chronic Sinusitis (Unresponsive to medication)
. Recurrent Sinusitis
. Nazal Polip
. Antrochoanal Polyp
. Concha Reduction (Nasal meats reduction)
. Sinus Mucocele
. Nasal and Sinus Tumors
. Brain-Spinal Fluid Leakage (Cerebrospinal Rhinorrhea)
. Orbital Decompression (Recovering from oppression in thyroid ophthalmopathy)
. Optic Nerve Decompression
. Dacryocystorhinostomy (Opening of the obstructed tear duct)
. Koanal Atresia Repair
. Removal of Foreign Bodies in the Nose
. Nose Bleeding Control
. Pituitary Gland Tumors
. Skull Base Surgery
. Septal Crest (Endoscopic Septoplasty)
. Eustachian Tube Problems

What are the advantages?

Endoscopes can be performed completely through the nose without any incision in the nose and face. In addition, endoscopes can be reached more easily in areas that we cannot reach or do not see well by classical methods. It provides surgical intervention only for diseased tissues without damaging healthy tissues. Endoscopic surgery reduces the risk of complications and shortens the recovery time.

How To?

Operation; general anesthesia, local anesthesia or sedation can be performed without a complete anesthesia. The duration, scope, risks and preference of the patient is important in the selection of anesthesia. For example, in case of generalized nasal polyp or tumor, general anesthesia is applied, while nasal foreign body or septal crest can be treated with local anesthesia. Before the operation, an anesthesiologist's examination and some tests are used to determine whether there is an obstacle or risky condition. Before the operation, the patient's sinus tomography is taken and suppressed and hung in the operating room where the surgeon can see at any time. If necessary, tomography is performed during surgery to check our position in the nose and to avoid complications. In the operation, the endoscope is entered through the nostril and the necessary procedures are performed by seeing the tissues directly with the sensitive instruments developed for endoscopic surgery. The scope of the procedure depends on the disease and its extent. For example in chronic sinusitis; clogged sinus canals are opened, diseased tissues are cleaned without damaging intact tissues. In the nasal polyp; All polyp tissues that fill the nose and sinuses are cleaned without touching the healthy mucosa. In tumors, tumor tissue is removed with some intact tissue. Duration of surgery varies according to scope. For example, surgery for chronic sinusitis lasts approximately 1.5 hours. In endoscopic surgery, systems other than classical instruments can be used to shorten the duration of the surgery and increase the safety. Of them;

In microdebrider system; the tissues are shaved on the one hand and vacuum removed on the one hand. It is frequently used especially in common nasal polyps because it reduces both the operative time and the bleeding.

Surgical Navigation (Image Guidet Surgery); We can think of it as a navigation device used in vehicles. Just as the navigation device shows where we are constantly, we can see the location of the surgical instruments used in the nose in endoscopic sinus surgery in three dimensions. Electromagnetic and optical (infrared) system, there are two systems. In surgical navigation system; Before the operation, the patient's sinus tomography (to be more than 1 mm sensitive) is taken and loaded into the system, a special cap is placed on the patient's head during the operation. This allows us to monitor the position of our surgical instruments more accurately than 1 mm on the monitor during surgery. The most important advantage of surgical navigation is to reduce the risk of damaging these structures while cleaning diseased tissues close to the skull base and brain, eye and visual nerve, and large vessels, and therefore reducing serious complications. Surgical navigation is not required in routine endoscopic sinus surgery. Personal surgical navigation; I use it when necessary for recurrent nasal polyps, skull base and near the eye sinus tumors, repair of cerebrospinal fluid leakage, optic nerve decompression, and pituitary surgery (with brain surgery). The disadvantage of surgical navigation is that it prolongs the time and increases the cost due to preoperative preparation.

What happens after the recovery and what should be considered?

There may be slight pain after the operation and can be easily relieved with painkillers. In endoscopic surgery, there is no change in nose shape, swelling or bruising. At the end of the operation, self-melting pads are placed on the operation site and the nostrils remain open. However, if one or more procedures such as rhinoplasty (nasal esthetics), septoplasty (deviation surgery) and turbinate surgery are performed together with endoscopic surgery, flexible pads made of soft silicone are put into the nose (doyle splint). The middle of these pads are tubular, and if they are not obstructed by dried slime or clot, they can be breathed through the nose while buffered. If only septoplasty has been performed, tampons are removed after 2-3 days, if interventions to the nasal flesh (turbinate surgery) or if performed with nasal esthetics. Removal takes 10-15 seconds and is painless. You can stay in hospital for 1 day according to your follow-up. There may be bleeding from the nose for 1-2 days after the operation, the next few days mixed with slimy currents, followed by crusting in the nose. Depending on the scope of the operation, it may take 2-6 weeks. These shells can be cleaned by softening with saline. Frequent control and intranasal dressings in this process are crucial for a healthy recovery. Resting 7-10 days postoperatively is recommended. However, if you do a job that does not require effort and did not experience any postoperative problems, you can work after the 5th day, you can travel.

What are the results?

The results of endoscopic surgery vary according to the disease. Success in chronic or recurrent sinusitis is between 80-90%. Nasal polyps tend to recur, only 20-30% in polyps and 70% in polyp + asthma + aspirin allergy (sampter syndrome). Repetition time varies from person to person. In some patients, polyps may recur within 6 months after surgery, while in others it may recur after 5 years. The mean success rate of antrochoanal polyp is 95%. In addition to the disease, the experience of the surgeon is very important.

What Complications Can Be Seen?

The nose and its surrounding sinuses are anatomically adjacent to the eye and tear canal on the sides, the brain membrane and brain tissue on the ceiling, the carotid artery leading to the brain and the optic nerve leading to the eye. Because of these neighborhoods, there is a possibility of damage in endoscopic sinus surgery. The complications are divided into major and minor according to their severity. The probability of complications varies depending on the extent of the disease and the experience of the surgeon.

Major Complications:

. Orbital hematoma (accumulation of blood in the eyeball), Optic nerve (visual nerve) damage; loss of vision and blindness

. Damage to the eye muscles; Double sight

. Tear drainage due to tear duct damage (Epifora)

. Damage to the brain or brain tissue; Cerebrospinal fluid leakage (CSF fistula) (the most common major complication), Meningitis, Brain abscess, Cerebral hemorrhage, Air leakage into the brain (Pneumocephalus)

. Major vascular injury and bleeding

Minor Complications:

. Edema around the eyes, bruising, air leak

. adhesions; most common minor complication

. Nose bleeding

. Odor loss

. Infection

What is balloon synuplasty and when is it applied?

Balloon synuplasty is the procedure of opening narrowed sinus canals with the help of a catheter like balloon angioplasty applied to open the vascular occlusions. The balloon at the end of the catheter is placed in the sinus canal and inflated to expand the canal and allow the sinuses to drain. The procedure can be performed endoscopically with general or local anesthesia. However, general anesthesia is preferred. It can be combined with traditional endoscopic sinus surgery techniques. It can be applied in chronic sinusitis affecting the frontal (forehead), maxillary (cheek) and sphenoid (skull base) sinuses. There is no activity interaction in polyps or other diseases affecting the sinuses. After the procedure there is not much bleeding, you can go home on the same day and return to work the next day. Crusting, which occurs after endoscopic sinus surgery and lasts for several weeks, does not occur in this application. The disadvantage of balloon sinuplasty is that it can be applied only to certain sinuses and sinusitis cases and it brings additional cost. I personally prefer this method for isolated frontal sinusitis that does not respond to medication.


34AXX
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Neti Pot Sinus Rinse Bottle Nose Wash Cleaner Pressure Rinse Nasal Irrigation for Adult & Kid BPA Free 300 ML with 30 Nasal Wash Salt Packets and Sticker Thermometer

Sinusitis Surgery

Patients whose sinuses are very often inflamed and who do not improve despite repeated and long-term treatments are candidates for sinusitis surgery. It should be emphasized that everyone who has previously been referred to as sin you have sinusitis medi does not require surgery. On the other hand, there is no need to rush the decision of sinusitis surgery, except in some rare complicated situations. Some treatments that may be applied before may solve the sinusitis without surgery, and may reduce the scope and risks of the surgery that may be necessary. In the sinusitis, it is very important for the physician to control the patient's clinic in every aspect in order to make the decision of surgery. It may be misleading to decide whether to perform sinusitis surgery with only one film or one examination. However, if a surgical decision is made based on the correct diagnosis and follow-up, a sinusitis surgery performed with the right technique will yield positive results.
Sinusitis may not be typical symptoms in all patients. Sometimes nasal discharge may be the only complaint. However, in the inflamed period, usually yellow-green nose and nasal discharge, as well as nasal congestion, headache and face pain can be. In our endoscopic examination, we can diagnose intranasal causes that may lead to sinusitis. The thin endoscopes we use show the areas where the sinus canals are opened and the disorders that prevent them. In sinusitis patients who do not benefit from sinusitis treatment over and over again, we map the nose and sinuses with computed tomography and make an operation plan accordingly. Sinusitis surgery for the treatment of sinusitis is a very technical issue; requires endoscopic experience, sinus knowledge and precise study. When sinusitis surgery is performed accordingly, if the patient does not have a genetic / hereditary disorder, the sinusitis of the patient is negligible.

When should sinusitis be operated?
Sinusitis surgery may be necessary when sinusitis cannot be treated with drugs. If there is no complication due to sinusitis, sinusitis surgery is not performed in the acute inflammatory period. Sinusitis surgery should be performed in the most healthy period when mucosa cover subsides, blood circulation decreases. In this period, the risk of bleeding decreases in sinusitis surgeries and a larger and cleaner working area is provided by decreasing swelling. In this way, the success of sinusitis surgery increases. The most accurate time in patients with polyp sinusitis is the time when the polyps are reversed as much as possible with cortisone drugs and sprays.

How is sinusitis surgery performed?
Sinusitis surgery is a very sensitive and technical surgery. The bones that make up the sinus cavities and canals are almost paper-thin. Endoscopic sinusitis surgery means cleaning these wispy tissues to restore the functioning of the sinuses. It is a technical operation with very sensitive tools under endoscopic vision. Thin tools for shaving tissues called Shaver, Holmium Yag laser for shrinking turbans, and navigation systems for advanced skull base interventions are technological requirements that can be applied during sinusitis surgery. However, experience and current sinus knowledge are essential in the selection of the vehicle and the operation; the risk of endoscopic sinusitis surgery performed in this way is negligible and its success is high. Sinusitis surgery is performed under general anesthesia. The duration varies from 45 minutes to 1.5 hours depending on the variety of sinuses to be studied. At the end of the surgery, small spongy or fusible pads that we prefer today are placed. These are comfortable applications for the patient. Usually, the patient spends the night in the hospital and is discharged the next day. One week-2 months postoperatively, the patient should come to the dressings and controls regularly.

Does it recur after sinusitis surgery?
Today, unfortunately, the question most patients ask: Does it recur after sinusitis surgery? It is a highly successful operation if the sinusitis is correctly diagnosed, performed in the appropriate period, if the correct techniques and tools are used during the operation, and finally performed in the right hands working intensively on sinusitis. Sinusitis by opening the sinus channels, regulating the secretion flow paths, the removal of secretion vicious cycles is extremely low probability of recurrence. In the long term, these patients do not normally suffer from more than one sinusitis attack per year, which is normally seen in everyone. The only exception is the possibility of recurrence of polyp sinusitis. Sinusitis surgery of patients with nasal polyposis is performed to ensure that the sprays reach the areas with polyps. In patients with polyps, it is possible to control the disease with proper sinusitis surgery and regular follow-up.

What should be considered after sinusitis surgery?
After sinusitis surgery, the patient should rest and not accept many visitors. It should lie in the early period with a slight (20 degrees) orientation. It is enough to spend the night in the hospital and can be discharged the next morning. After discharge, there is no need to go to bed, but it is necessary to avoid any effort that requires heavy lifting and climbing stairs. Because they can increase blood pressure and cause leaks. For the same reason, the patient should not blow and bend. Antibiotics may be used as a preservative to prevent inflammation at the site of operation. Pain usually does not occur, and if it happens, it is often a blunt, insidious pain attached to the tampon, and simple painkillers containing paracetamol are often sufficient. Salt water sprays can also be used to relieve and clean the nose. The patient should never smoke or be exposed to smoke. We prefer to check the patient on the 3rd, 7th and 14th days postoperatively and to follow the first two months. We can adapt a follow-up program for our patients coming from abroad according to the type of sinusitis.


33AXX
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Burun Obstruction, Sinusitis and Treatments

WHAT CAUSES NOSE CONGENATION?

Breathing through the nose is vital for every organ from our brain to our heart, from our hair to our toenails. Not being able to breathe comfortably is a condition that causes headache, tired exhaustion in the morning, waking up in the morning, causing tendency to sleep during the day and chronic fatigue.

It is considered normal that both nostrils are blocked and opened at regular intervals during the day. But the constant nasal congestion points to the problems that need to be solved.

Nasal obstruction due to upper respiratory tract infections, chronic smoking, bad weather, or short-term allergic problems. In these cases, the solution is mostly simple methods such as nasal sprays, allergy medicines, using salted bicarbonate water and swimming in the sea.

Prolonged nasal obstruction is usually caused by the curvature of the nasal mast (deviation), the size of the nasal flesh (Konka), the growth of nasal flesh, nasal polyps (which may be caused by allergies or sinusitis), chronic sinusitis. Long-term allergic rhinitis (rhinitis) may be another cause of chronic nasal congestion. Non-allergies are usually problems that can be solved by simple short operations.

The most common causes of nasal congestion in children are allergic problems and the presence of nasal flesh. The solution is to treat allergy and remove nasal flesh.

WHEN DOES A CLOSED NOSE THREAT OUR HEALTH?

We see that heart and lung problems increase when nasal obstruction persists for many years. We know that chronic upper respiratory tract obstructions can cause snoring, breathing stops during sleep, blood pressure problems, rhythm disturbances, asthma enhancing effects, sexual dysfunctions, heart attacks and brain hemorrhage.

The point that makes the nose so important for the health of all our organs is that it is the organ that transports oxygen, which is the basic substance for the survival of our cells, to our body in a healthy way.

In situations where the nose is always clogged, we may encounter the problems we just mentioned in a period of our lives.

Nasal obstructions that cannot be treated for a long time threaten our health. We have to solve this problem both with medication and surgery.

WHAT ARE THE BIGGEST COMPLAINTS OF PATIENTS?

Nasal congestion, inability to breathe through the nose, headache, snoring or tired exhaustion in the morning, runny nose, runny nose, decrease in work performance during the day, chronic fatigue are the main complaints.

WHICH HEALTH PROBLEMS CAN CAUSE?

Frequent recurrent throat infections and involuntary pharyngitis may occur as a result of continuous mouth breathing.
Snoring and sleep disorders develop.
As a result of breathing stops during sleep, blood pressure and heart rhythm disorder may develop.
Patients with asthma have increased problems.
Morning dry mouth develops.
Sexual dysfunction occurs.
Tendency to the development of psychological problems. These patients complain that they are particularly irritable.
The sound quality deteriorates and nasal speech develops.
Children may have sweating at the neck and sometimes wetting the neck at night
Chronic fatigue syndrome may develop
It can trigger migraine and cause chronic headache problems.

WHICH METHODS ARE APPLIED FOR A COMFORTABLE BREATH?

Primarily, drug treatment tries to eliminate chronic sinusitis, allergic rhinitis, nasal flesh growth problems and eliminate nasal congestion. If there is no improvement, the operation can be applied.

WHEN IS THE CONDITION, WHEN THE DECISION IS DECIDED? HOW IS AN OPERATION APPLIED FOR CONGULATION?
If we cannot solve the nasal congestion due to nasal flesh growth despite drug treatment, we reduce the nasal flesh with radio frequency or laser and open the airway. In cases that do not respond to drug treatment in chronic sinusitis occlusions, balloon, laser, and endoscopic navigation operations can be used to treat sinusitis.

Drug treatment in nasal congestion cases with cartilage inclinations, which we call nose deviation, is unfortunately not working and we can perform endoscopic or classical methods of surgery to open the airway.

Nasal deviation operations have changed considerably compared to the previous ones. In the past, these operations were performed under local anesthesia and were known as painful operations. Very rough instruments were used during surgery. Post-operative tampons were diaper tampons and caused pain when removed. Patients had to stay in the hospital for a few days after the operation.

Today, our operations have become painless operations by taking advantage of the superior comfort of general anesthesia. Now, these operations have taken the form of endoscopic septoplasty using micro instruments under the guidance of endoscopy and have been followed by computer screen and become simple operations with cameras.

When you look at the mirror in the evening after this operation, there is no problem with the appearance of stitching, bruising, shape change, gypsum swelling or blood sitting on the face. So you can see exactly what the face is before the operation and then the same. Bruising is done by breaking because the swelling gypsum stitching happens in aesthetic operation. Although the rhinoplasty operation can be performed without bruising without breaking with the ultrasonic device.

Patients who are discharged on the same day after the operation can continue their work within a few days.

These comfort and painless operation techniques provided by the technology may please physicians more than patients.


32AXX
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Good news for those with chronic sinusitis!

If sinusitis becomes chronic due to difficulty in breathing due to nasal obstruction, permanent treatment can only be possible with surgical application.

If sinusitis becomes chronic due to difficulty in breathing due to nasal obstruction, permanent treatment can only be possible with surgical application.

Ear, Nose and Throat (ENT) Doctor Dr. Dr. Ali Altuntaş, sinuses in the face and head bones, the inner surface of a thin tissue that can secrete covered and normally filled with air, he said.

The condition of inflammation of the sinus covering tissue is defined as "sinusitis", Altuntaş said, noting that this condition may become chronic if not treated. Altuntaş emphasized that the failure of the patient to heal for three months despite treatment means that sinusitis has become chronic.

Altuntaş, sinusitis, nasal congestion, nasal or nasal discharge, pain or pressure on the face and a sense of smell is manifested by a decrease in the symptoms, the slow course of these symptoms may be overlooked because of the disease, he said.

Underlining the need to use antibiotics several times a year due to sinusitis or at least two symptoms should be consulted, Altuntaş pointed out that chronic sinusitis may cause long-term cough or bad breath in children and persistent fatigue in adults.

Altuntaş, sinusitis, deterioration of the quality of life of the person, because the nose is not enough oxygen can not get enough sleep disturbance and insufficient sleep affects the health of the person stressed. Not enough oxygen intake can lead to serious complications from the brain to the heart that express Altuntaş, therefore reportedly must be treated.

Asthma can accompany chronic sinusitis

Professor Dr. Known risk factors for chronic sinusitis include seasonal or year-round allergies, exposure to cigarette smoke or environmental toxins, and virus infections, Altuntaş said.

The disease, the internal structure of the nose and sinuses originating from the abnormalities such as discharge or polyps that are diagnosed with the camera is expressed by the endoscopy method expressed Altuntaş, said:

"Computed tomography of the sinuses can also be performed. Tomography is a fast and safe procedure that takes several minutes, and the resulting cross-sectional radiological images provide valuable information about the structure and content of your sinuses.

Diagnosis of diseases such as asthma and aspirin intolerance associated with chronic sinusitis is also important in the correct treatment of the disease. These additional diseases should also be evaluated by a chest specialist.

The approaches used in the treatment of chronic sinusitis may vary according to the patient and may include multiple drug treatments. "

Altuntaş said that surgery is the case in cases of resistant chronic sinusitis where symptoms persist despite appropriate medical treatment, in cases where there is no response to cortisone-containing treatments, in the presence of structural disorders that may affect the nasal discharge or adequate ventilation of the sinuses.

Altuntaş explained that "effective endoscopic sinus surgery" is used for the effective treatment of the disease. "In this approach, natural openings such as nostrils are evaluated and an intervention is performed with an endoscopy camera and appropriate surgical instruments without any incision." gave information.

The washing method benefits the treatment of sinusitis

Altuntaş stated that lifestyle changes were effective in the treatment and said that tobacco and tobacco products should be quit, and exposure to smoke and known allergens should be avoided.

Altuntaş, noting that the daily nose washing method is also very useful, said:

"Bulky washings with saline or bicarbonate solutions provide benefit in many cases of chronic sinusitis. Cortisone nasal sprays are highly effective in reducing inflammation in the sinuses and do not have any side effects that affect the whole system, such as cortisone-containing medications taken in the mouth. Although bacterial infection does not usually play a role in chronic sinusitis, in some cases a short course of antibiotics may be required. "


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What is Sinusitis?

Sinusitis; sinus infection / inflammation is the name given.

Congestion in the nose disrupts the emptying mechanism of the sinuses, causing bacteria or viruses to remain in the sinus cavities, resulting in sinus infection.

The most common cause of sinusitis is upper respiratory tract infections. The cause of infection may be bacteria or viruses. Allergy is another cause of sinusitis.

Bacterial sinusitis (bacterial sinusitis) can cause one to feel more ill than viral sinusitis (sinusitis caused by viruses). (In bacterial sinusitis, more facial pain, swelling is felt, and fever may also be observed.)

What are the symptoms of sinusitis?
The most common symptoms of bacterial sinusitis include:

Continuous cough for 1-2 weeks without nasal congestion or runny nose
Bloating and pain around the eyes
Nasal mucus flow (this is observed in both bacterial and viral sinusitis, but continuous and intense discharge is usually a symptom of bacterial sinusitis)
Pain in the cheek bones, tenderness
Pressure sensation
Fire
Increased headache, especially when you tilt your head forward
Pain in teeth and gums
Bad breath
Besides these; dry cough, nausea are also observed symptoms.
How is sinusitis treated?
In the treatment of sinusitis, the use of drugs is generally used. Antibiotics may be used if sinusitis is caused by bacteria, and antihistaminic drugs may be used if allergies are caused.
Various nose openers may also be recommended to relieve complaints.
In the treatment of sinusitis, it is important that your doctor recommends and regularly uses the medications recommended by you. Otherwise, sinusitis may be observed again in a short time. One of the most common mistakes made in our country; patients immediately begin to feel good with antibiotics. However, it is important that you use antibiotics and other medicines for the time your doctor recommends. This is because only the bacteria that cause infection can be completely removed from your body.
In addition, resting and consuming plenty of fluids will help you recover quickly. However; Refreshing and humidifying devices and hot compresses, nose drops can be used to alleviate complaints.

Sinus surgery
Sinusitis surgery with endoscope may be an alternative in the treatment of sinusitis that does not respond to medication or any treatment.
The sinus canals are examined with the help of an endoscope, a thin flexible tube with an illuminated tip. Then the cause of congestion is eliminated. This procedure may include the reduction of a bone causing obstruction in the nasal cavity, removal of a tissue or polyp. In some cases, the narrow sine opening can be expanded to provide flow.

How can the risk of sinusitis be reduced?
Recurrent sinusitis is a disease that reduces the quality of life and causes discomfort to people. It is possible to reduce the risk of sinusitis through some precautions and applications. These are:

Preventing the sinuses from being affected by dry air with the use of humidifying machines (but these machines should be cleaned frequently, otherwise mold-causing allergies may be observed)
Allergy control, avoiding allergens
Frequent washing of hands to avoid diseases such as influenza, colds, colds, avoiding sick people and feeding


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About Sinuses

What is Sinus?
The air gaps in the bones around the nose are called sinuses. There are a total of eight sinuses, four on the right and left sides, which are maxillary (cheek sinuses), frontal (forehead sinuses), ethmoid (the anterior and posterior sinuses between the eyes) and the sphenoid sinus (most behind, the sinus within the head). called.

Only ethmoid and maxillary sinuses are present in neonates, which are considerably smaller than adults. In this period, the frontal and sphenoid sinuses are in the form of mucosal recesses. The development of the sinuses continues depending on the development of the skull and the removal of the teeth and is largely completed at the age of 12-14 years. The final shape and size of the sinuses continues until the age of 22-24. In some people, some sinuses, especially unilateral or bilateral forehead sinuses, may not occur at all.

The secretory glands in the sinus mucosa, which lay the inside of the sinuses and are the continuation of the nasal mucosa, produce 0.5-1 liters of mucus (mucus) during the day. The secretion produced in the sinuses is discharged into the narrow sinus drainage channels called ostium and from here into the nose by the whip-like movements of microscopic hairs (cilia) on the mucosa. Slimy secretion plays a role in the filtration of air by holding particles and allergy agents in the breathing air taken from the nose, in the fight against germs with the substances it contains, and in humidifying the air before it goes to the lungs.

These air gaps around the nose also have functions such as reducing the weight of the head bones, preventing the head trauma from reaching the brain by absorbing shock shock, and making a resonator effect in the final shape of the sound formed in the vocal cords.

What is Sinusitis?
The inflammation of the mucosa that covers the sinus cavities is called sinusitis. The most important factor that causes sinusitis is the secretion of mucus produced by the sinus mucosa and accumulation in the sinuses. The most common causes of this condition are obstruction of the sinus emptying canal, disruption of the system that carries the secretion to the sinus emptying canals, and changes in the content or consistency of the outbreak.

The proliferation of microbes in the secretion accumulated in the sinuses as a result of the presence of one or more of these causes leads to inflammation of the sinus, ie sinusitis.

Other conditions that may cause sinusitis; microbes come directly into the sinuses through blood, as a result of penetrating trauma or fractures of the facial bones, or inflammation of the cheek sinus subspecies, which are relatively rare.

Sinus inflammation can also be called inos rhinosinusitis anlam in terms of nasal and sinus inflammation because the mucosa covering the sinuses is embryologically and anatomically consistent with the mucosa within the nose and responds similar to medical and surgical treatment.

Sinus inflammations are divided into four groups according to the disease process;

· Infections that start abruptly and end with complete disappearance of symptoms within 4 weeks, acute rhinosinusitis,

· Infections lasting more than four weeks and ending before 12 weeks, subacute rhinosinusitis,

· Recurrent (recurrent) acute rhinosinusitis in the event of infection that lasts at least 7 days in four or more years,

· Infections (symptoms of acute rhinosinusitis may occur in cases where symptoms and symptoms last for more than 12 weeks) are called chronic rhinosinusitis.

Factors Causing Sinus Infection
Sinus infections occur as a result of the interaction of patient and environmental factors. Upper respiratory tract infections caused by viruses are the most common cause of sinusitis. During the infections caused by viruses, narrowing of the narrowing sinus discharge channels due to swelling and thickening of the mucosa covering the nose and sinuses, as well as the deterioration of the function of the system that carries the secretion to the channels due to the same infection, and the outbreak become thick and thick. It happens. If this does not improve within a few days, secondary bacterial growth and acute bacterial sinusitis occur.

The second most common cause of sinusitis is the occlusion of sinus emptying canals as a result of mucosal edema due to allergic reactions. Anatomical disorders such as nasal curvatures (septum deviation), polyps, nasal flesh growth (concha hypertrophies), which narrow or block the sinus emptying can also cause sinusitis. Rare conditions, such as cystic fibrosis or ciliary movement disorders, disrupt mucus production and or transport, resulting in HIV infection (AIDS), chemotherapies, the use of drugs that suppress the body's defense system, insulin-dependent diabetes, and certain connective tissue diseases that can cause sinusitis by adversely affecting immune functions.

What are the symptoms of sinusitis?
Symptoms encountered in nasal and sinus infections are divided into two groups as major and minor.

Major: Feeling of pain and pressure on the face, swelling and fullness on the face, nasal congestion, inflamed discharge from the nose and nasal passages, reduction in smell (hyposmia) and fever are the first-degree complaints and findings in diagnosis.

Minor: Headache, bad breath, indulgence, toothache, cough, ear pain are second-degree complaints and findings in diagnosis.

Complaints are more pronounced at night and in the early hours of the morning due to the increase in the amount of blood and edema in the sinus and nasal mucosa depending on the body position and the secretion transfer being adversely affected.

Long-term and chronic inflammation usually reduces the severity of the complaints and it is difficult to diagnose only with history. The most significant complaints in this group of patients are behind the nose, from the nasal to the throat with a thick viscous discharge and a feeling of tenderness on the sinus of the facial bones. In people with a history of allergy, mild complaints and examination findings should suggest allergy before sinus inflammation.

During the examination of patients with sinusitis, general ENT and head and neck examination as well as swelling of the face, redness and edema (especially around the eyes), lymph node enlargement and inflammatory discharge behind the nose should be carefully examined. Nasal examination of patients with sinusitis; Anatomical disorders such as swelling and redness of the mucosa, inflamed crusts, inflamed discharge, flesh growth that may cause obstruction in the nasal opening of the polyps or sinus canals may be observed.

In the diagnosis of chronic sinus inflammation, it is particularly important to see a dark, inflamed discharge in the posterior part of the nose (nasopharynx) during the examination. Endoscopic examination of patients with no pathological findings detected by simple examination of the nasal side wall of the sinus emptying canal areas can be detected by inflammation of the sinuses that discharge.

How is sinusitis diagnosed?
Laboratory tests have limited value in the diagnosis of sinus inflammation. Especially for the differential diagnosis of allergic rhinitis mixed with mild sinusitis, blood or skin tests for allergies may be performed in cases with high Ig E levels and suspected allergies. Microscopic examination of the nasal secretion, and the presence of intense white blood cells (leukocytes), viral or bacterial rhinosinitis, eosinophil, plasma and mast cells can help in the diagnosis of allergic rhinitis.

In case of suspicion of some rare special diseases, mucosal biopsies should be performed, frequent recurrent resistant inflammations as well as other ear and neck infections such as middle ear infections, tonsillitis, pharyngitis, skin infections, familial, drug related or HIV infection (AIDS) related immune system deficiencies should be investigated. Recurrent infections are observed with encapsulated microorganisms in congenital or acquired antibody deficiencies, fungi and viruses in T-lymphocyte disorders and gram negative microorganisms in compulsive system disorders. Complete blood count, sedimentation and serum immune globulins should be considered as basic tests in these patients.

Which Imaging Techniques are Used in Sinusitis?
In classical sinus x-rays, full sphenoid sinus in the cheek, forehead and head, air-fluid level and mucosal thickening exceeding 6 mm in children and 8 mm in adults are significant for the diagnosis of sinusitis.

However, the anterior ethmoid sinus region, which is usually the first starting point of sinus infections, and the ostiomeatal complex where the discharge channels of the sinuses that play a key role in the formation of infections, cannot be evaluated as sufficient with normal x-ray films. For this reason, paranasal sinus computed tomography (CT) is usually preferred in the diagnosis of chronic and severe acute inflammations and in the planning of the treatment.

How is sinusitis treated?
The main components of medical treatment in sinus infections are preventive measures, supportive treatments and drug therapies.

Preventive measures against sinus infection:
Measures to prevent the formation of sinusitis can be considered as the first step of treatment. In addition to factors such as lack of oxygen in the respiratory air, air pollution, allergens and cigarette smoke, which have a negative effect on the functions of the sinus mucosa, upper respiratory tract infections due to viruses are rapidly spreading in crowded and poorly ventilated environments and are an important factor in the formation of sinusitis. Therefore, well ventilated living and working environments and non-smoking in these environments play an important role in the prevention of sinus infections.

Dry air breathing increases the risk of sinusitis due to the darkening of the nose and sinus secretions and the negative effect of the delivery system which provides the discharge of the secretions from the sinuses. For this reason, it is recommended to control the moisture content of the air conditioners and central ventilation systems and humidify the air with additional precautions when necessary. In case of inadequate fluid intake or excessive water loss, it may be beneficial to consume at least 2 liters of warm water per day, especially in cases of fluid loss, as it provides the basis for sinus infections by reducing the viscosity and viscosity of mucus secretion. Since tea, coffee and cola drinks other than water increase the excretion of water from the kidneys, it is necessary to increase water intake along with these drinks.

Preventing the patients with diagnosed nasal allergies from the environment that causes the allergies, taking the precautions such as house plants containing high amounts of allergens, removing the long hairy carpet-like sources from the living areas will contribute to reducing the risk of developing sinusitis due to swelling in the nasal mucosa.

Influenza (influenza) vaccine, pneumococcal vaccine and oral vaccine vaccines are useful in decreasing the number of recurrent infections in patients with frequent sinus infections or chronic sinusitis.

Applications supporting medical treatment:
In addition to medical treatment, the most important parts of the supportive treatment are providing a moist environment in the nose and cleaning the accumulated crust and inflamed secretions. Pressure sprays containing the appropriate concentration of saline are the most commonly used agents for this purpose. Antimicrobial drugs can be added to these washing solutions in case of infection and bacterial carriage which cannot be prevented by antibiotics.

Drugs used in the treatment of sinusitis
Mucolytics: Drugs that reduce the consistency of mucus secretion and increase the flowability of these drugs are used to prevent mucus accumulation due to deterioration in cilia activity carrying the mucus from sinuses and dark mucus production.

Decongestants: Decongestant drugs that reduce the swelling of the intranasal mucosa can be used by the nose (spray) and orally. Drugs in this group are intended to open or expand the sinus ostia as a result of contraction of the vessels in the nose and sinus mucosa and thinning of the mucosa, and to provide sinus emptying and aeration. It is recommended not to use the medications used as a spray for more than 4-5 days due to its swelling increasing effect and irritating effects on the mucosa. Oral decongestants can be used safely for 7-10 days in patients who do not have high blood pressure, heart disease, rhythm disorders or prostate enlargement.

Antistamines: They are used to prevent mucosal edema due to allergic reactions, but they have effects that increase mucus density and make sinus emptying difficult. Therefore, they are not recommended for use other than patients with allergic origin sinusitis and known allergies.

Steroid-containing nasal sprays: Chronic sinus inflammation and allergic conditions, mucous edema and inflammation-induced reactions are used to reduce. Especially since the last generation of spray steroids into the bloodstream are extremely low, they can be used in pregnant and infants in cases where there is no other treatment option.

Steroid use in the form of pills or injections: The use of steroids orally or injections prior to surgery in allergic patients and especially in chronic sinus inflammation with polyps may facilitate surgery due to shrinkage of polyps and reduction in tissue reaction. Such treatments should be administered with caution and under the supervision of the specialist specialist of diseases in patients with high blood pressure and or diabetes.

Anti-bacterial drugs (Antibiotics): In acute infections that are not characteristic, treatment is generally applied without taking culture. Antibiotic resistance in the community, compliance of patients with drug dose ranges, hypersensitivity to drugs, changeable side effects and drug interactions for each antibiotic affect antibiotic selection. Since the microbes that cause more than 60% of acute sinus infections are pneumococci or H. influenza, it would be appropriate to select antibiotics effective against these agents in acute infections. The duration of antibiotic use in acute infections is 10-14 days. Drugs with a long half-life can be used for shorter periods.

In the absence of improvement in symptoms and symptoms in five to seven days, it should be considered that a drug effective against bacteria proliferating in oxygen-free environment should be added to the treatment. Especially in patients with a history of failed antibiotic use, antibiotics should be chosen to be effective against microorganisms known to be resistant.

The duration of antibiotic treatment should be at least 2-3 weeks in chronic sinus infections. In these infections, the choice of drug according to the results of endoscopy-guided intranasal cultures may be preferred considering the increased rate of resistance to antibiotics, the possibility of microorganisms proliferating in more than one bacterial or oxygen-free environment at the same time and the long treatment period. Antibiotics should be selected according to culture and antibiogram in all types of sinus infections in patients with immune system failure or in hospitalized infection.

In patients treated with chronic sinusitis, appropriate doses of antibiotics and cortisone nasal sprays should be used for 2-3 weeks before computed tomography. Even if there are no sinusitis findings on tomography in patients without significant complaints, it would be appropriate to follow up the patient and check the complaints before making a decision for surgery. Surgical treatment should be considered as an alternative in patients whose complaints do not improve or recur.

How is sinusitis surgery performed?
Today, the current technique used in the treatment of sinusitis is endoscopic sinus surgery (ESC). Information about this surgical technique is shared under the title of oskop Endoscopic Sinus Surgery ”.




29AXX
Alkalol Solution Original Nasal Wash, 3 Count -16 fl oz

Vicks Sinex Severe Original Ultra Fine Mist Sinus Nasal Spray Twin Pack, 2 x .5 Fl oz, Total 1 Fl oz

What is maxillary sinus?

The maxillary sinus is an air-filled anatomical cavity symmetrically located on the upper jawbone on both sides of the nasal cavity. The Maxillary sinus, also known as the Highmore Cavity, first described by Nathaniel Highmore, begins to form in the womb. It grows downward and forward into the jawbone and becomes pyramid form until it becomes adult after birth. The maxillary sinus, which is close to the oral and posterior teeth, has tasks such as contributing to the sound resonance, reducing the pressure and weight in the skull, heating and humidifying the inhaled air.

HOW DO THE MAXILLES OPEN AFTER SINUSAL TEETH EXTRACTION? / Oroantral Fistula
In the upper jaw, the roots of small and large molars are sometimes in the sinus. During shooting, the sinus floor is opened and an opening is formed between the sinus and the oral cavity. There is no improvement in the attraction cavity due to the inability to clot and there is an opening. This phenomenon is called oroantral fistula. The treatment is surgical closure.

WHAT IS OROANTRAL FISTULA, CLEARANCE, PERFORATION?
Maxillary sinus opening during extraction is one of the most common complications encountered by dentists. Because the molars in the upper jaw and the big molars are adjacent to the maxillary sinus, the barrier between the sinus and the oral cavity is lifted and pathological convergence occurs after the tooth extraction. This is called an oroantral fistula (oroantral opening, oroantral perforation). If an oranthral fistula occurs, the food consumed by the patient during eating may escape into the nasal cavity. So it must be closed without wasting time. If it is noticed during the shooting, treatment is simple and easy, but surgical treatment is required to close it in the late period.

OROANTRAL CLEARANCE, HOW TO TREAT FISTULES?
The oroantral fistula caused by traction will heal spontaneously if the patient's sinus is healthy and smaller than 1-2 mm. However, surgery should be performed if there is a larger patency. Various methods have been developed for the closure of Oroantral fistulas. These methods can be classified as distant flaps, local flaps and grafting. Local flaps are used in small openings, distant flaps and graft materials are used in large openings. The most commonly used closure methods are buccal flap and palatal flap. Palatal islet flap is used most frequently in our clinic. It is a very successful technique and there is no problem with the prosthesis to be made in the future when there is no constriction of soft tissue on the cheek side of the fistula. Other techniques for the closure of oro-central fistulas are;

Closure with Interseptal Alveolectomy (Modified DEAN Technique)
Closure Method with Monocortical Bone Graft
Autogenous Graft Method
Closure with Fibrin Adhesives
Closure with Lyophilized Dura Mater and Faysa Lata
It is the use of Intraoral Membranous Bone Grafts.

WHAT SHOULD BE CONSIDERED AFTER THE OPENING OF THE OROANTRAL OPENING?


- During the healing process, the hygiene of the operation area should be paid attention, the teeth should be brushed and gargled with a soft brush (except the first day).

- In order to reduce postoperative edema, ice compresses should be performed on the first day at intervals of 5-10 minutes.
The first 48 hours should not be consumed, hot food and drink should not be consumed, alcohol, spicy, acidic foods should be avoided, absolutely no smoking

- No water should be drawn into the nose, nose cleaning should not be done with pressure, sucked, mouth open sneezed, valsalva maneuver should not be done. (Valsalva maneuver, squeezing the nostrils is the process of squeezing.)

- Shower should not be taken on the first day, bathing at high temperature for 2 weeks. There should not be a bath and sauna.

- You should not travel for 2-3 weeks

- No sports, no swimming and no swimming in the first week

- No diving for 2-3 weeks

- Medications recommended by the physician should be used regularly.

OROANTRAL CLEARANCE, FISTULAR OPERATING PRICES WHAT?
For more information about orantral opening, fistula closure treatment fees, you can contact us at +90 216 363 36 36 for Bağdat Street Clinic, 0 212 280 88 00 for Levent Clinic, 0 216 485 90 30 for Acarkent Clinic. For more information, please send your e-mail address in the E-Newsletter section below.


28AXX
Vicks Sinex Severe Original Ultra Fine Mist Sinus Nasal Spray Twin Pack, 2 x .5 Fl oz, Total 1 Fl oz