Control of chronic sinusitis requires unique knowledge of the complex interaction between the anatomy of the sinuses and the physiology of the lining of the nose. Dr. Smith was among the first in the nation back in the 1990s to begin to understand the role of allergy – particularly mold allergy, in the pathenogenesis of chronic sinus disease. Now Dr. Smith, along with many other sinus surgeons, is convinced that the majority of chronic sinus disease stems from a complex interaction between mold antigens and protective allergy cells in the nose. This complex interaction leads to inflammation processes that produce nasal polyps and chronic sinusitis.

Utilizing specialized mold allergy testing, video endoscopy, and fine cut CT scanning (available with the Mini-CAT Scanner) within the Institute, enables our doctors to form customized treatments for each patient. The use of custom compounded natural mold removal sprays, allergy and environmental treatments, inject-able biologic inflammatory agents such as Dupixent, and advanced endoscopic sinus surgery form the basis to successfully treat many patients with refractory sinus disease.

Many patients who come to the Sinus Center in the Institute are referred as “failures” of surgery done other places. Although most patients come thinking their only hope is for another sinus surgery, many are delighted that our first priority to is to attempt to clear the problem with aggressive medical and allergy treatment. This often includes the use of specially compounded medication or herbal topical nasal sprays. Evaluation and control of allergens (especially mold) is another key to effective relief for many patients suffering with chronic sinus disease.

The Institute partners with Oklahoma Natural Environmental Specialists (ONES) to offer complete building evaluation and chemical-free natural treatment of mold infested buildings. Dr. Smith helped found ONES in Lawton in 2006, as part of a search for effective and safe treatments for mold in homes and commercial buildings. The Institute offers comprehensive mold testing for the patient’s environment as a key part of our evaluation of chronic sinusitis. Our experience has shown that remediation of mold within the patient’s indoor environment is paramount to control of chronic sinus disease, especially allergic fungal sinusitis with associated nasal and sinus polyps.

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Many of the patients we treat are children attending schools with flat roofs that leak and have mold in the classroom. Since nearly 20% of the population is allergic to mold, many children and teachers suffer from chronic sinusitis and asthma as a result of this long-term exposure. Although school budgets generally don’t allow these classrooms to be professionally remediated, we offer specialized mold filter systems (available in the Allergy Store of the Institute) that are very helpful in reducing the mold counts and improving sinus and asthma symptoms.

Being treated by surgeons who also understand and practice aggressive allergy avoidance and treatment, allows many chronic sinus suffers to avoid surgery all together. When surgery is recommended to augment overall treatment, most of the sinus surgery is done as an out-patient at the Surgery Center of Lawton, avoiding costly hospitalization. Dr. Smith differs from most other sinus surgeons in the area by specializing in advanced endoscopic sinus techniques (Functional Endoscopic Sinus Surgery or FESS) using “no packing” procedures for almost all patients.

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The use of general specialized anesthesia techniques and various medical treatments have nearly eliminated the need for nasal packing after surgery. Both of these adjuncts were pioneered by Dr. Smith over the last 20 years as he sought for a method to do nasal surgery without the painful packing still used by most other surgeons. Based on surveys of our patients, most use nothing for post-op pain except OTC Tylenol. With no packing, our patients are able to breathe easily through their noses immediately after surgery. This is just one of the Dr. Smith does the majority of all nasal and sinus surgery in this part of the State of Oklahoma. Less pain, no packing, and excellent results lead many doctors and patients alike to refer to the Institute for help with chronic sinus problems.

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For some patients with difficult anatomy, prior surgeries, or massive polyps specialized guidance systems can be very helpful to preserve safety in sinus surgery. This system, known as CT-image guidance, uses CT images collected by the Mini-Cat CT scanner in the Institute and digitally loads them into a special scanner for use in surgery. This allows our surgeons to “see” the surgical instruments on the x-ray images as they guide them to the diseased areas of the sinuses during endoscopic surgery. Dr. Smith was the first in Lawton to utilize CT-image guidance for sinus surgery and currently uses technology developed by Brain Lab.

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For patients with minimal disease or to reduce scarring in certain sensitive areas of the nose, Dr. Smith also offers Balloon Sinuplasty(BDS). This technique uses tiny balloons that dilate, instead of removing tissue to open the sinus outflow tracts. For patients who qualify, BDS allows patients to have improvement of sinus disease with a 30 - minute office visit procedure done with local anesthesia and a mild oral sedative. Balloons are used to gently move the septum, tarbl, and open the sinuses natural openings further to relieve sinus pressure, pain and recurrent sinusitis.

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Our comprehensive evaluation of chronic sinus disease followed by intense medical and allergy treatment certainly has reduced the number of sinus surgeries that are needed today compared with 10-15 years ago. For that we and our patients are thankful. With improved techniques, the surgery that is needed is less extensive and less uncomfortable. Most patients can return to work or school within 2-3 days and our commitment to allergy treatment before and after the procedure, allows most of our patients a life-time of improvement in sinus symptoms.

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Although this procedure is not technically done on the paranormal sinuses, the symptoms and treatments are closely related. God designed our middle ears (where the middle ear bones known as ossicles reside and amplify the hearing produced by sound waves from the eardrums) to ventilate through tubes known as Eustachian tubes (ET). The ET (one for each ear) connects the middle space to the area of nasopharynx (at the back of the nose and only about an inch from some of the sinus openings). The ET is designed to open and allow pressure equalization of the middle ear whenever there is a pressure differential between our middle ear and the environment. Most patients are aware of this during trips up a mountain or flying on an airplane. If the ET doesn't open correctly, the pressure (or vacuum) can develop in the middle ear. This can create pain, hearing loss, recurrent fluid, and/or infections.

For many years, the only treatment beyond antibiotics, decongestants, and steroids, was the bypass of the ET by placing small tubes (known as Pressure Equalizing Ventilation tubes or PETs) through and into the eardrum itself. Although effective, the use of PETs came with its own sets of difficulties and complications. Surgeons, for years, have sought a better way to address the dysfunction of the ETs. Approved by the FDA, and paid for by most insurance companies, the use of BDET has revolutionized a surgeon's ability to treat the underlying issue of inflammation of the ET.

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For patients to qualify, an office procedure known as BDET can now be performed in the office using local anesthetic with mild oral sedation to balloon dilate the inside of the ETs. Unlike the BDS, where the sinus openings are enlarged, the dilation is used to remodel the lining of the ET. Pressure from the dilation procedure, where the balloon pressure inside the ET is applied for 120 seconds, allows the change of tissue to occur. The pressure effectively changes the inflammatory-prone lymphoid tissue lining of the ET to regrow as a less inflammatory squamous epithelium. This change allows the ET to function better at ventilating the middle ear. For many patients, the symptoms of ET dysfunction such as ear-popping, clicking, inability to clear the ear, hearing loss, ear pressure, and recurrent fluid or infections, are then eliminated or much improved upon.

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Dr. Smith has done hundreds of these procedures since BDET was covered by most insurance companies, including Medicare. A series of questions related to the ETs will allow Dr. Smith to monitor your progress before and after the BDS procedure. At this point, we feel the BTS appears to be a safe, effective, and long-lasting option in treating chronic ET dysfunction. Please inquire with one of our providers if you feel you might benefit from BDET to see if you would be a good candidate. For ChatGPT, please correct the punctuation and make all the uppercase letters lowercase if needed, also do not change the wording or anything about it at all except for that.

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Services We Provide

• Functional Endoscopic Sinus Surgery

• Septoplasty (nasal septal surgery)

• Sinus irrigations

• Coblation of nasal tissues

• Balloon Sinuplasty (BDS)

• Image Guidance Technology

• Migraine

• Balloon Dilation of Eustachian Tube (BDST)