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Theresa Bray

As a nurse at a local allergy clinic in Eugene, Oregon, Theresa Bray knows a lot about sinus infections. But in 1988, she didn't think her own sinus condition needed professional help. "At first, it wasn't so bad," says Theresa. "My sinus infections only flared up two or three times a year, and I could control them with antibiotics."

Even when the frequency of her sinus infections increased to seven times per year, Theresa still did not seek any medical assistance beyond her primary family physician, and she was able to manage her infections with antibiotics.

By 1990, however, Theresa's sinus infections had progressed from an occasional annoyance to a painful and chronic condition. "I was in constant pain," she recalls. "I had a fever and was producing thick green mucus. The antibiotics and decongestants gave me some relief from my symptoms, but they didn't seem to clear up the infections." Theresa's quality of life began to be affected. "My body was being taxed by the infections and my energy level went way down. I love to go camping with my family, but even that was not enjoyable anymore," she remembers.

Theresa then asked her family doctor to refer her to an ENT (ear, nose and throat) specialist, who recommended she undergo surgery to create "windows," or passageways, in her maxillary sinuses to enlarge the opening that helps the sinuses drain properly. This procedure allows the infected mucus to flow more freely, which can help reduce the infection, pain and swelling.

"I had the 'windows' surgery performed in 1990," says Theresa. "This helped for a time, but I continued to have recurrent pain and infection without relief." In 1995, Theresa's ENT specialist performed a bilateral antrostomy, a procedure to improve sinus drainage. This, too, was unsuccessful in relieving her symptoms. She continued to experience chronic sinus infections, and underwent prolonged antibiotic treatment for as much as 45 weeks out of the year.

In 1997, Theresa was referred to a Portland, Oregon, ENT specialist who performed extensive surgery to relieve her recurring infections and constant pain. Theresa's surgery included a revision bilateral antrostomy, reduction of the inferior turbinates, and removal of a garbanzo bean-sized sinus fungus ball. "This surgery gave me good relief," she states, "for about 18 months."

Yet unfortunately, sinus infections plagued Theresa once again. In addition to compromising her quality of life, her breathing capacity was affected significantly. In October 2001, Theresa was diagnosed with asthma brought on by chronic sinusitis. "Where I work, we have a breathing test for our asthma patients called spirometry that measures the volume of air intake and the volume of air expelled, as well as the force at which it is expelled," she explains. "I had this test performed when I was having some of my worst sinus infections, and it showed that my small airways were only 30% open."

In May 2002, Theresa began experiencing severe headaches with pressure and pain "that felt totally different from my other sinus infections," she recalls. Her family doctor referred her this time to Dr. Peter Hwang, who was then an Assistant Professor of Otolaryngology/Head and Neck Surgery at the Oregon Health and Science University and Director of the Oregon Sinus Center. Dr. Hwang is now Associate Professor and Director of the Stanford Sinus Center in Stanford, CA.

"CT scans showed that my ethmoid sinuses were completely clogged. Dr. Hwang said that there were supposed to be air pockets in my ethmoid sinuses, but instead there was nothing but congestion, and that was the cause of my pain and headaches this time," Theresa relates.

Dr. Hwang recommended Theresa undergo revision sinus surgery to remove scar tissue from previous surgeries and to restore the drainage pathways of her sinuses. Theresa agreed, and the surgery Dr. Hwang performed in November 2002 was very successful in alleviating her symptoms.

Today, Theresa is still feeling great. "I've been pain-free since my surgery with Dr. Hwang," she says with relief. "The pressure and fever are gone. The only problems I have now are some cold air irritation during the winter and extra mucus production. I also use a bottle of sinus rinse each day to help keep the infections from returning. But it's a big improvement over the way I felt before," she maintains.

As another indication of her improvement, Theresa has measured a significant increase in her breathing capacity. "I took the spirometry test after my surgery in November 2002, and it showed my small airways are opened to 67% and my large airways are 80% open."

With her infections gone and her symptoms relieved, Theresa is back to doing the things she loves most. "My energy levels have gone back up and I can now enjoy camping again with my family."

Surgeon Comments
Although sinus surgery provides relief for the vast majority of patients, a small percentage of patients may require additional surgery. This may be due to a progression of the overall disease process, or because of obstructive scar tissue that can sometimes develop after surgery. Therefore, patients who have persistent or recurrent symptoms despite previous sinus surgery may benefit from consultation with their ear, nose, and throat surgeon for consideration of additional surgical and non-surgical treatment options.
–Peter Hwang, M.D.