Types of Ear, Nose, Throat (ENT), Skull Base Surgery

This what we call a deviated nasal septum repair through surgery. This procedure is used when the nasal septum (a part of the facial skeleton made up of cartilage and bone) is crooked or malformed in a way that prevents clear breathing, sinus drainage, and may cause snoring and/or sleep apnea. While septoplasty may be a stand-alone procedure, it may also be included in a larger surgical correction to open the sinuses and nasal passages. This is also a specific surgery that uses endoscopic surgical techniques (see above). Septoplasty is usually done under general anesthesia, meaning patients are asleep and pain-free during the procedure.
 
Turbinates are thin bony structures on the inside of the nose that are covered in soft tissue and mucosa. They help regulate the flow of air through the nose. The turbinate soft tissue, mucosa, and mucus blanket warms, humidifies, and filters the air that we breath conditioning it for our lungs.

When the inferior turbinates are inflamed or enlarged (called inferior turbinate hypertrophy), they can block the nasal passage, decreasing air flow and proper nasal and sinus drainage. If the nasal swelling is due to mucus membrane inflammation, non-surgical treatment is usually most helpful. However, when the narrow passageway are due to the bony and soft tissue structures being too large, surgery may be required to reduce the size and obstructive nature of the turbinate.
This is a surgical procedure used to widen sinus drainage pathways or ostia that have narrowed due to chronic sinus disease. Still using an endoscopic technique, an ENT surgeon passes a small balloon over a wire into the sinus ostia during surgery. The balloon is briefly inflated enough to widen the sinus ostia to permit proper nasal and sinus drainage. After the balloon is removed, the opening remains.
Is the removal of nasal polyps, is a common, minimally invasive treatment for nasal and sinonasal polyps if non-surgical approaches have failed. The size and depth of the polyps will determine the approach for removal. Some nasal polyps are near the opening of the nose and easy to reach. These can typically be visualized by the surgeon without an endoscope, and removal is fairly quick and simple. If the polyps are further into the nasal cavity or into the sinuses, a more complete endoscopic sinus surgery may be needed for complete removal. The extent and location of the nasal polyps will also determine the type of anesthesia required, though local anesthesia is often an excellent choice for this procedure.
 
This is the removal of tonsils and adenoids with surgery. Tonsils and adenoids are both soft tissue structures in the throat and nasopharynx composed of lymphatic tissue. They have small cavities or crypts that can be ideal places for bacteria to colonize and grow, causing difficult to treat and recurrent infections. Chronic tonsil and adenoid infections can cause significant pain and can prevent nasal and sinus drainage, so it may become necessary to have them removed to resolve this chronic infectious process. While these procedures are typically associated with younger patients, some adults also need tonsil and adenoid surgery to address chronic or recurrent infections. Tonsil and adenoid removal is a straightforward procedure that is conducted under general anesthesia.
This is what we call surgically implanting temporary pressure equalization tubes (PET) to prevent frequent ear infections, improve hearing, and allow for normal pressure in the middle ear, is another procedure typically associated with children. However, adults who have chronic ear infections may also benefit from decreased ear pressure and the potentially improved hearing that PET’s provide. This brief procedure is brief but quite common and completed under general anesthesia.
Both malignant and benign nasal and sinus tumors can cause nasal obstruction and congestion.  As the only fellowship trained sinus surgeon in the state of Idaho, Dr. Killian is uniquely qualified to diagnose and surgically remove nasal and sinus tumors.  Pituitary and skull base tumors are removed in conjunction with neurosurgeons. These types of tumors are often able to be removed utilizing endoscopic surgical techniques that are less invasive, safer, allow for a quicker recovery and shorter hospital stay then traditional open techniques.
CSF leaks are rare, challenging to diagnose, and difficult to accurately localize. Cerebrospinal fluid protects and nourishes the brain and spinal cord and is vital to the proper function of the nervous system. When there is a hole or crack in the anterior skull base and the dura (outer covering of the brain) CSF may leak and require surgical repair if conservative measures fail. (See our page about CSF leaks for details about CSF leak symptoms. Also note that, since the meninges is involved, CSF leaks and corresponding repair may carry a risk of meningitis.)

When we think about the skull, and especially the skull base, a common assumption can be that it has nothing at all to do with the nose and sinuses. However, the anterior skull base, the portion of the skull base that is closest to the front of the facial skeleton, is very close to the sinuses and nasal cavity. The back of the frontal sinus and the upper border of the ethmoid and sphenoid sinuses comprise a large portion of the the anterior skull base. This is why rhinologists/otolaryngologists are the ideal doctors to perform these repairs.

Once a leak is identified, a skull base surgeon uses endoscopic surgical techniques (see FESS above) to enter through the nose to gain access to the anterior skull base where the CSF leak can be clearly identified and repaired using a variety of techniques.

When such a complex operation is being performed in an incredibly sensitive part of the body, having a surgeon with experience in this exact procedure will give you the best possible outcome.
Dr. Peter Killian at Treasure Valley Nasal and Sinus Center is the only fellowship-trained anterior skull base surgeon in the state of Idaho. He treats patients throughout the region--including patients from Oregon and surrounding regional states because his skill set is unique and his education surpasses that of most ENT physicians.
No patient wants a doctor to utter the dreaded word “surgery”. Most people have a very reasonable unease regarding surgical procedures. However, if you’ve noticed your quality of life decreasing because of your moderate or severe sinusitis, nasal polyps symptoms, or CSF leak symptoms, modern surgical techniques in the hands of an extraordinarily capable and experienced surgeon like Dr. Peter Killian at Treasure Valley Nasal and Sinus Center can help you overcome that anxiety to pursue minimally invasive, effective treatments. Refining procedures, reducing post-operative pain, and decreasing recovery times for patients is the primary ENT goal for Peter Killian, MD.

At Treasure Valley Nasal and Sinus Center, we are focused on helping our patients be educated and informed about their condition and treatment plan.
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We spend time to address patient concerns, and a regular part of our practice includes thorough follow-up after surgery. We are here to help you breathe a metaphorical sigh of relief when you know you are receiving quality care and a literal sigh of relief when your clear sinuses and nasal passages have you breathing better than ever before.

If you live in the Boise, Meridian, Nampa, Eagle, or Caldwell areas, and are looking for expert help with conditions of the ear, nose, and throat, please call (208) 593-4484 today to schedule an appointment at Treasure Valley Nasal and Sinus Center. You can also contact us to learn more about the ways we can help you on the road to a happier, healthier life.
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