Overview
There are four sinus cavities on each side of our head. They are the maxillary, ethmoid, frontal and sphenoid sinuses. The primary purpose of the sinuses is to moisten and filter the air we breathe. The sinuses secrete mucous that is swept into the back of our throats taking with it any dust, pollens, bacteria or viruses that have been filtered. Disruptions in this process cause sinus infections, sinus headaches, facial pain, nasal congestion, post nasal drainage and a host of other problems.

Symptoms
There are many symptoms of sinus problems. The most common ones are noted below. We should see you if you have 3 or more of the following symptoms:

• Sinus infections that persist for weeks or months
• Discolored nasal drainage
• Nasal congestion
• Mouth breathing
• Lethargy/Lack of energy
• Headaches
• Inability to breathe through one or both sides of your nose
• Facial pain
• Sore upper teeth

Evaluation and Treatment
I will design a treatment plan specific to you and your clinical situation. A thorough and complete treatment plan is key to a successful outcome. The treatment plan provides a logical progression of care, making sure that you and I are both on the same page and that you understand what to expect each step of the way.

Developing a treatment plan involves several diagnostic steps. These steps include:

Medical questionnaire and history
We will discuss you present and past symptoms along with their frequency and severity.  It is important to understand what treatment you have undergone previously and to what extent that treatment helped you. We will continue this discussion as treatment progresses.

Nasal Endoscopy
A nasal endoscope is a small telescope that allows me to look into your nose for obstructions or other abnormalities which might be contributing to your sinus problems.

CT scan
The endoscope allows a limited view of the sinus anatomy. In order to better evaluate your condition, I may also order a CT scan of your sinuses.  This is standard and done after maximum medical therapy, so I can understand what problems remain after medical therapy along with determining underlying structural problems.

Allergy Testing
Uncontrolled allergies can worsen sinus conditions. If you are already seeing an allergist, I will work closely with that physician and keep him/her informed of what our plans are. If you do not already have an allergist, we will perform allergy testing and treatment in order to properly treat your sinus problems.

Medical Treatment
After a diagnosis is made, a custom-tailored treatment plan will be recommended. This may include nasal irrigations, nasal steroids, decongestants, antihistamines and antibiotics.  We will try to break the cycle of inflammation with medications; however, if we are unable to break that cycle we may need to perform surgery.

Surgical Treatment
Abnormal anatomy, either from birth, disease or trauma is often the cause of sinus problems and cannot be corrected with medicines. In those cases, surgery may need to be considered. I have several options available to you from minimally invasive procedures to more aggressive surgical treatment.  A tool available is Image Guidance. Image Guidance is a sophisticated intraoperative computer that provides the surgeon with improved ability to remove all of the disease in less time without doing inadvertent damage. 

Continued Follow-Up
Whether success is achieved with medical or surgical treatment it is important to follow up on a regular basis. Re-examination of your nose on a regular basis can help us detect problems with inflammation, scarring, polyps, etc. before they start affecting you. Providing a long term resource for your sinus problems is part of the solution we offer at Everyone's ENT & Sinus Center, located in Stone Oak, San Antonio, Texas.