Ep.5 - Sinus Surgery: Knowing When It's Time

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Ep.5 - Knowing When It’s Time For Sinus Surgery

In this episode of the Swain Sinus Show, Dr. Swain, Jr. further clears up common patient questions concerning sinus surgery and when it’s time for the physician and patient to consider surgery.

What you will learn in this episode:

> When do you and your sinus physician consider a surgical approach? > What’s a CAT scan and how does it work? > What is the expensive real estate in your body? > When is it time to get off of antibiotics and steroids and consider surgical options? > What is too old or too young for sinus surgery?

Dr. Swain, his staff, and Deep Fried Studios want to thank all you fine listeners for the listens, positive feedback and reviews from our first four shows.


Have any specific sinus and allergy question that you would like to hear us cover on the Swain Sinus Show? Please email us here or call our office at 251-470-2283 with your questions. If your question makes the show, we will mention your first name and send you some free goodies as a big thank you.

Need an Appointment or Sinus Consultation? Call Dr. Swain’s nursing staff at 251-470-8823 or schedule and appointment at drronswain.com

Complete Episode Transcript

Welcome to the Swain Sinus Show. I'm Stacy Wellborn, coming to you from Deep Fried Studios. And today I'm joined by Dr. Swain Swain Jr, a fellowship-trained otolaryngologist specializing in rhinology, nasal, and sinus surgery.

Stacy: Hi, Dr. Swain.

Dr. Swain: Hello Stacy.

Stacy: So we've talked a lot about options related to surgery, and the process, and the steps of the surgery. When do you decide that it's time to do surgery?

Dr. Swain: Most of the time people that have sinus problems end up needing a CAT scan, a CT scan, which a...CT stands for Computerized Tomography, which is a way of imaging throughout the nose and nasal cavity. You can actually look in the sinuses without having to look in the sinuses. In other words, I can't take a camera and look inside your sinus cavity unless I've operated on you. But people that have complaints, you'll start looking at are the sinuses clear are they not clear? So if they're not clear, and hasn't responded to antibiotics and steroids, and people are still symptomatic with it, and there's a moderate amount of inflammation there, then that's time to consider a surgical approach. Most of the time it's a combination that's made in conjunction with the patient. I think a great analogy is, I had shoulder problems, both my shoulders were hurting, and I went to go see the orthopedic doctor. And I said, "Well, question, well, when do I decide to do this. Am I gonna hurt it if I don't have surgery?" And he's like, "No, you're not gonna hurt anything if you don't have surgery, but you'll know when the time's right." And that was a funny thing you say until I started thinking about it, and he was right, because one day I woke up I was like, "That's it. I'm tired of my shoulder hurting. I'm tired of dealing with this." And so it doesn't mean my shoulder didn't hurt. My shoulder still hurts. I had to get an operation, but it's different. It's a different kind of thing.

Now, in terms of your sinuses, your sinuses sit between your eyeball and your brain. And so if you've got something in your sinus that is encroaching on your eyeball or your brain, and there's bone erosion, or there's some kind of problem, if we think there's fungus in there, I'm gonna look at it and tell you, "Yeah, you need an operation." It just depends on what you're dealing with, but if it's...for the most part, if it's chronic sinusitis and chronic inflammation, most of the time people will tell you, "I'm ready. I'm ready for it." And sometimes they'll say, "Look, I'm not," and that's okay. If they're not, then you look at 'em and say, "Okay, we're gonna follow you and we're gonna see how you do with this." I think the most important thing that I think of is when it's time, when you kinda look at someone and say, "Look, you gotta have an operation." And I'm worried if there's bone erosion, if there's worry about there's a complication of something going into the eye ball, or your skull base, or brain, which are all very scary things, or if you've been the extent that, look, you know, we have had you on, you know, six different courses of antibiotics, and you look at the number of days, and you've been on antibiotics for over six weeks and nothing's getting better and it can't control your symptoms, sometimes antibiotics have side effects, too. I mean, we always talk about medical therapy comes first. Well sometimes there's a time when medical therapy isn't gonna cut it and you have risk of continuing to take antibiotics or steroids, and that's the point when you..."Look, we've have to do something. We have to be more aggressive here. Every situation is different, but generally to answer that question is, you know, if you're not responding to medication and medical therapy, then you gotta do something.

Stacy: You see entire families, children to grandparents, is there a lower or upper age when it comes to surgery?

Dr. Swain: Stacy, I see children and adults of all ages. I've operated on a child as small as 3 weeks old, as young as 3 weeks old, and I've operated on adults that have been over 90. I have a very active practice, and we see a lotta kids and a lot of adults. So there's a wide variety of ages.

Stacy: Is there any upper age limit?

Dr. Swain: No. No, we see people of all ages.

Stacy: What's the oldest you've ever done surgery for?

Dr. Swain: This is years and years ago, but I had a 95-year-old lady that had fungus in her sphenoid sinus, and it was causing her to go blind, and I was really worried about her. She had to have an operation, and...but she was really old. And medically, she was really not that healthy, but it was one of those things whether, you know, I was gonna do it or it just wasn't gonna get done. And I was really scared for her, and I told her that, and she held my hand and she went to sleep saying the Lord's Prayer. And she woke up saying the Lord's Prayer, and she looked right at me and she said, "I'm fine." It really was, it was one of those really touching moments that will stay with me for the rest of my life. She was in a bad way, and she got through it, and I'll remember her forever.

Stacy: If I have to have surgery, where do I go?

Dr. Swain: I'm very proud to be a part of Surgicare of Mobile, which is our outpatient surgery center, it's behind our office on Dauphin Street. I also operate at Springhill Hospital and at Providence Hospital. There are times we have to do cases at the hospital as well.

Stacy: Are most of your surgeries outpatient?

Dr. Swain: Most of the surgeries are outpatient. There are times where you need to admit people overnight for observation, but most of the otolaryngology care, in general, has kinda gone to an outpatient model more than anything else. But occasionally, you know, you have someone who's, if you've taken out their tonsils or they're not drinking, if you have a child who's not drinking, they need to be kept overnight for observation.

Stacy: So when I'm ready to come see you, where do I actually come see you?

Dr. Swain: I practice out of two locations. I'm in West Mobile; we have an office out at Providence Park, which is close to Province Hospital. And I also have an office on Dauphin Street, 2880, I have to say that slowly, 2880 Dauphin Street, and we've been there...we've been in both locations for a long time. I'm in the west office Mobile location, three days a week, Monday, Tuesday, and Wednesday, and I'm at the office on Dauphin Street on Thursdays and Fridays.

Stacy: How do I get an appointment?

Dr. Swain: It's really easy to get an appointment to see me. If you would call and speak to my nurses, the direct line is 251-470-8823. Again, that number is 251-470-8823, and you can find the number on the internet at, swainsinusshow.com. My nurses are Mandy Webster, and Chasity Wooten, and Emily Demet. If you call that number directly, my nurses can help you get set up to have an appointment to see me.

So Stacy, before we go, I just want to take a moment to thank everyone for listening. We've had a tremendous response. It's been great, this is our fifth show, and I just want to take a moment to thank everyone. If you have any questions, we try to incorporate some of those answer...the answers of the questions in our show, so please email us or call us. If there's a topic that you'd like to hear about, we'd love to be able to add it. So it's been a real pleasure to be able to do this, and I've really enjoyed it.

Need an Appointment or Sinus Consultation? Call Dr. Swain’s nursing staff at 251-470-8823 or schedule and appointment at drronswain.com

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