As a specialist in ear, nose and throat medicine and facial plastic surgery, Professor Amir Minovi, MD, has specialized in plastic and reconstructive head and neck surgery. At St. Elisabeth Hospital in Cologne-Hohenlind, Prof. Minovi has been head of the Department of ENT Medicine, Head and Neck Surgery, and Plastic Surgery since 2017. For over ten years prior to this, he had already made a name for himself with high-quality treatments across a broad spectrum of ENT conditions – for example, through his expertise in sinusitis, or inflammation of the paranasal sinuses. He is also known nationwide for his innovative microsurgical procedures in middle ear surgery and the use of implantable hearing aids. The Leading Medicine Guide spoke to the empathetic expert about the latest treatment options for chronic sinusitis.
Leading Medicine Guide: Is sinusitis, particularly chronic sinusitis, a condition that significantly impairs the quality of life of those affected?
Prof. Dr Amir Minovi: It may not be widely known, but sinusitis affects one in ten people in Germany every year. Patients suffering from this persistent inflammation of the paranasal sinuses feel severely restricted in their daily and working lives. One study even found that chronic sinusitis is so debilitating that it triggers symptoms of moderate or severe depression.
Leading Medicine Guide: When do doctors distinguish between chronic sinusitis and acute sinusitis?
Prof. Dr Amir Minovi: Acute sinusitis is an inflammation of the paranasal sinuses. It is characterized by a blocked nose with a runny nose and headaches, and sometimes a fever. It is usually treated on an outpatient basis. Depending on the severity, antibiotics, decongestant nasal drops and cortisone sprays are used. If it progresses to a chronic stage – and we refer to this when symptoms persist for longer than twelve weeks – then you should consult a specialist. The paranasal sinuses are hollow chambers in the facial skull; they consist of the frontal sinuses, the maxillary and sphenoid sinuses, and the so-called ethmoid cells. The sinuses serve to moisten, filter and pre-warm the air we breathe. To this end, they are lined with a special mucous membrane and equipped with cilia that can transport dirt particles and mucus. If the mucous membranes swell too much or remain permanently swollen, the sinuses are no longer well ventilated.
Leading Medicine Guide: What could be the cause of this?
Prof. Dr Amir Minovi: Chronic sinusitis can have various causes: anatomical variations such as a deviated nasal septum, narrowed sinus openings where secretions accumulate, or nasal polyps.
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Leading Medicine Guide: How do you examine patients? What equipment do you use?
Prof. Dr Amir Minovi: There is the conservative examination method using a light, or I may use an endoscopic device. Imaging techniques such as a CT scan allow us to see exactly how much of the mucous membrane is affected, while a flow measurement provides further insight.
Leading Medicine Guide: What does the treatment involve?
Prof. Dr Amir Minovi: We start with conservative treatment: saline rinses, cortisone-based nasal sprays, and herbal remedies. We achieve varying degrees of success with these. Depending on the severity of symptoms and the patient’s age, we may recommend surgery. Younger people in particular are not prepared to live with the impairments caused by chronic sinusitis for so long. If the sinusitis is not only caused by adenoids but is also linked to a deviated nasal septum, everything is corrected in a single operation.
Leading Medicine Guide: Could you describe the surgical procedure in a little more detail?
Prof. Dr Amir Minovi: We have been performing surgery using endoscopes for decades; everything is done minimally invasively through the nostrils without any external incisions. In principle, the aim is to reopen the drainage pathways in the sinuses. This is achieved by removing thickened mucous membrane and adenoids. However, it can also be considerably more complex, involving the correction of anatomical variations or even the removal of bony growths. The healthy mucous membrane is left untouched; that would only lead to scarring. For the polyps and the altered parts of the mucous membrane, there is a new procedure, the so-called shaver, which allows the mucous membrane to be removed with precision. In recent studies, the inflamed mucosa has been removed very radically, with the result that the tendency for polyps to recur has decreased. We closely follow the latest scientific developments and tailor our treatment strategies accordingly.
Leading Medicine Guide: What else is new in your field?
Prof. Dr Amir Minovi: One new procedure involves cortisone-coated implants with a lattice-like structure, which we insert at the entrance to the frontal sinus. With these lattices, the wound reactions are significantly less severe. The mesh releases mucosal-decongestant cortisone over a period of approximately three to four weeks and then slowly dissolves. There have also been important new developments in drug-based treatment. We can use so-called biologics, which act directly on the immune system and with which we achieve good results, for example, in type 2 inflammation associated with chronic sinusitis and nasal polyps. Immune cells produce various messenger substances that play an important role in chronic diseases. These messenger substances are actually intended to neutralize viruses and bacteria. However, if production goes into overdrive – gets out of hand, so to speak – then the messenger substances cause tissue damage. This is where biologics can step in and interrupt the inflammatory cascades.
Leading Medicine Guide: That sounds very promising.
Prof. Dr Amir Minovi: Yes, but unfortunately I must dampen those hopes a little. While these drugs can prevent the need for surgery and achieve regression of the polyps, the patient must undergo regular treatment, and unfortunately the drugs are relatively expensive. Not all patients with this condition are eligible for this treatment either; we assess each case individually against a specific set of criteria.
Leading Medicine Guide: At your Clinic for Ear, Nose and Throat Medicine at St. Elisabeth Hospital in Cologne-Hohenlind, you and your team not only adhere to the latest scientific standards, but you also use the most modern instruments – including, of course, forsinusitis.
Prof. Dr Amir Minovi: I have already mentioned the special shaver for the mucous membranes of the sinuses. We also have excellent instruments for removing papillomas in the maxillary sinuses. These are benign tumors that we can remove in such a way that they do not return – and it is particularly important that the structures in the nose can be preserved. In the operating theater, we use a modern navigation system, which is a valuable aid, particularly when dealing with complex anatomical structures. We often treat patients who have undergone multiple operations or those with anatomical problems in the frontal sinus. The navigation system allows us to orientate ourselves with the utmost precision. Even before the procedure, we calculate the anatomical situation with high precision. During the operation, the system provides pinpoint positional data and alerts us to even the slightest deviations from the surgical path, which is very important given the sensitive nature of the head as an operating area. In addition, we naturally have highly efficient drilling systems at our disposal. However, describing our surgical instruments in detail might be a bit too much for the layperson. In summary, it can be said that we utilize all the technical possibilities available to us today in both diagnosis and treatment.
Leading Medicine Guide: The procedure is performed under general anesthesia; what happens after the operation?
Prof. Dr Amir Minovi: After the operation, patients stay in the ward for a few days, after which we continue to look after them on an outpatient basis. It is important to take it easy physically for about three weeks; the nose must be treated with care for six weeks – blowing your nose, for example, is not permitted. Medical progress has not stood still in the area of post-operative care either; today we use self-dissolving, relatively small tamponades, so nothing needs to be removed – only any residual material may need to be suctioned out.
Professor Minovi, thank you very much for this insightful information, which will certainly be extremely useful to many of us.
You can get in direct contact with this renowned specialist, who has also been awarded the Focus seal of approval as an expert in sinusitis, via his profile page on the Leading Medicine Guide.
