Nov 15, 2021, 17:05
by
GoodHealth Magazine
Sansum Clinic’s ENT Department
Enhances Patient Care with New Treatment
Take a deep breath through your nose and mouth. Let
it out. Listen to the sounds around you. Smell the
air. Make a vocal sound. We may sometimes take
these abilities for granted. But people of all ages can develop
conditions that affect
normal functioning of the ears, nose
and throat. Medical conditions that affect these areas impact
the quality of life for patients and for those around them. An
otolaryngologist, also known as an ear, nose and throat doctor
or ENT, treats these conditions. Many common disorders can
be successfully treated in the office or in outpatient surgery
facilities without hospitalization or general anesthesia.
Rabindra A. Braganza, MD, FACS has been practicing as an
ENT doctor at Sansum Clinic since 1992. Dr. Braganza and a
team of physicians, audiologists and staff provide patient care
at the ENT/Otolaryngology Department and at Sansum Clinic
Foothill Surgery Center at Sansum Clinic in Santa Barbara.
Dr. Braganza and his family immigrated to the United States
from Goa, India when he was 11. At age 18, a return trip to
India to visit his grandfather who was a doctor there shifted his
focus from engineering to medicine. “I had been accepted into
the college of engineering at U.C. Berkeley,” he says. “I was
interested in knowing how mechanical things work. But as I
browsed through my grandfather’s medical books, I felt it would
be much more interesting to learn how human physiology and
biology work. That motivated me to shift my educational path.”
A double major in biochemistry and psychology at Berkeley,
he graduated with highest honors. In his first year, the
intricate anatomy of the head and neck got him interested in
ENT. Later at medical school, Dr. Braganza learned about
different specialties. When he did his clinical rotation in
otolaryngology, he saw the wide range of patients who were
helped by ENT specialists, which further motivated him to
become an ENT surgeon.
Dr. Braganza estimates that he has performed more than 9,000
surgeries in his career. New techniques and technological
advances improve outcomes and help surgeons provide
minimally invasive approaches to treatment. “We treat children
and adults for a wide variety of conditions,” he says. “In
pediatrics, we treat chronic ear infections with ear tubes and
perform tonsillectomies and adenoidectomies when they are
blocking a child’s airway or causing recurrent infections. We
also treat a lot of surfers’ ears where cold water and cold air
cause bony growths known as exostoses that block the pathway
of the ear canal. We drill those off using a microsurgical drill under an operating microscope to restore the normal ear canal.
This prevents water trapping and recurrent infections.”
The doctors at the ENT department also treat tumors of the
head and neck, which can be life threatening if cancerous.
Many of those require a surgical procedure such as a biopsy
or removal of a cancerous growth to initiate treatment. They
work closely with colleagues at the Ridley-Tree Cancer Center
as patients may have to go on to receive chemotherapy or
radiation therapy.
New Techniques Improve Outcomes
Chronic Nasal Congestion
Sinusitis and allergic rhinitis involve inflammation of the
mucous membranes that line the sinuses, and are among the
most common conditions for which people see their primary
care doctors. Most people have experienced these conditions,
and know them as chronic nasal congestion, post-nasal drip, or
simply a chronically runny nose. Nasal congestion is commonly
caused by allergies, but there are non-allergic causes as well.
Exposure to cigarette smoke, perfumes, fuel fumes, and other
irritants can cause a runny nose, sneezing, and other symptoms.
Allergy testing in those situations would show negative results,
despite symptoms.
New technologies vastly improve today’s treatment options
for chronic nasal congestion. “We have benefitted from a
new technique called image-guided surgery,” Dr. Braganza
explains. “The sinuses are located between the eyes and the
brain and are operated on with an endoscope. These days a
high-resolution CT scan performed on the patient prior to
surgery and used during surgery with a tracker device tells us
exactly where the bony partitions that separate the eye and the
brain from the sinuses are located. It allows us to perform more
complete sinus surgeries with a greater margin of safety.”
Other technological advances in the treatment of nasal
congestion and drainage include radio frequency (RF) therapy
and cryotherapy. With RF therapy, surgeons use heat generated
by RF to shrink the tissues in the nose to open breathing
pathways. RF is similar to microwave energy, but in a different
area of the electromagnetic spectrum. RF therapy can also be
used to ablate or block specific nerves along the brain/nose
communication pathway to stop signals that generate mucus
production. This can also be performed with cryosurgery,
which uses very cold temperatures to zap the target nerves and change the communication pathways so less mucus is
produced. Success rates for these new techniques are generally
high, with approximately two-thirds of patients experiencing
significant benefits.
Dr. Braganza says these procedures can often be done
in the office, depending on the specifics of the patient’s
anatomy. “Since the COVID-19 pandemic, we have moved
more procedures into our office setting, with all the proper
precautions,” he explains. “Because of the pandemic, many
operating rooms were shut down for months. For many
procedures, patients don’t necessarily have to go to a hospital
operating room or undergo general anesthesia. This is more
cost effective for the patients, and they can get back to their
usual activities within a few days.”
Snoring
Snoring is another common disorder that can be treated with
an in-office procedure. “This is a surgery that has a very high
success rate for improving the quality of life for a patient and
also for the people around them,” Dr. Braganza says. “Patients
thank us because they can return to sleeping in the same bed
with their partner and both can get a good night’s rest.”
Snoring surgery is focused on the soft palate
and the uvula. “Patients must be selected
appropriately,” Braganza continues. “Most
snoring comes from the palate and uvula, the
flimsy narrow piece of soft tissue that hangs at
the back of the throat. Under local anesthesia,
we use a carbon dioxide laser to make cuts
that decrease the size of the uvula and create
cuts in the soft palate that generate beneficial
scarring to stiffen the palate. For properly
selected patients, we get about an eighty-five
percent success rate from this technique."
Balloon Sinuplasty
Patients diagnosed with chronic sinusitis
may be candidates for balloon sinuplasty, an
innovative procedure used for the treatment
of blocked sinuses. Balloon sinuplasty does
not require incisions or the removal of bone
and tissue. “A medical balloon is used to
dilate the opening between certain sinuses
and the nose to allow the sinuses to drain better,” Dr. Braganza
explains. “In selected patients it may be done as an office
procedure in an outpatient setting, using local anesthesia.
However it can’t be used in all the sinuses nor is it used if there
are polyps.” The success rate for this procedure is similar to that
of traditional endoscopic sinus surgery that is performed in an
operating room
Photo caption: Dr. Andrew Mester, Dr. Ashley Dunn and Dr. Rabindra Braganza