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improved significantly over the past decade. Fluoroscopic guidance (which requires radiation) is no longer needed. Instead, transillumination (using lighted tips to see where the device is placed) is used. "With the use of transillumination, we're able to confirm that we're within the sinus cavities and then thread the balloon over the guidewire and inflate that balloon, which in essence opens the sinus," Dr. Reisman explains. "The technology also allows us to vacuum, irrigate, suction and culture material from the sinuses. It's an atraumatic way to deal with many of the issues related to chronic sinusitis, which a large part of our population deals with." "Normally performed in the OR with general anesthesia, this procedure will soon be offered in the office with just local or topical anesthesia," adds Dr. Ponsky. "All that's really needed are larger exam/procedure rooms, which we will have when the new Nose, Sinus & Allergy Center opens at UH Chagrin Highlands Health Center in Orange Village." The most advanced technology available for endoscopic sinus surgery are the ENT image guidance systems, and UH has three of them — at three of the five Nose, Sinus & Allergy Center locations: UHCMC, UH Ahuja Medical Center and UH Westlake Health Center. "Our image guidance systems provide us with a radiographical road map of the sinuses," says Dr. Rodriguez. "Every patient that I operate on receives a CT scan with image guidance protocol prior to undergoing sinus surgery. CT scans are particularity good at clarifying the bony anatomy." He explains that CT technology allows the surgeon to see where his or her instruments are in three planes. "It can show defects or thinness of the bone in the region of the carotid arteries, bone enclosing the eyes and optic nerves. With this knowledge in hand prior to the operation, we can go into the procedure knowing areas that could be of concern and plan accordingly." This improves surgical precision and patient safety. The overall result is more complete removal of diseased tissue with minimal trauma to healthy tissue. For patients with sinonasal tumors, Dr. Rodriguez often works with a multidisciplinary team of specialists which may include neurosurgeons, radiation oncologists and hematologists/oncologists from UH Seidman Cancer Center. He and Dr. Reisman and Dr. Ponsky also work together in the OR if a patient needs multiple procedures that fall within each of their specific training sets. This is not only safer for the patient, who would receive general anesthesia only one time, it also reduces the patient's overall recovery time. The Results All things considered, sinus surgeries today are much easier on the patient than they were 10 or 20 years ago, when a lot of bleeding and pain and a one- to two-month recovery period were the norm. "It's different, of course, for every patient. A lot of it depends on the type of surgery he or she had and other medical problems," says Dr. Rodriguez. "But generally a patient can return to a completely normal level of activity with no restrictions within two to four weeks." The Nose, Sinus & Allergy Center at University Hospitals Ear, Nose & Throat Institute currently has five locations: University Hospitals Case Medical Center in downtown Cleveland, UH Ahuja Medical Center in Beachwood, UH Twinsburg Health Center, UH Westlake Health Center and UH Suburban Health Center in South Euclid. A new center at UH Chagrin Highlands Health Center in Orange Village is expected to open later this year. For more information, visit www.UHhospitals.org/ENT. To refer a patient, call 216-844-6000. ■ Diana Ponsky, MD, specializes in form and function of the nose. Correction for aesthetic and functional breathing improvement, especially when it benefits sleep apnea, is her forte. 2014 JANUARY/FEBRUARY ■ MDNEWS.COM ■ MD NEWS Cleveland/Akron/Canton | 21