Advanced Rhinology & Complex Sinus Surgery in Utah
Some sinus and nasal conditions require more than routine treatment. Symptoms may persist despite appropriate medical therapy, return after previous sinus surgery or involve difficult-to-treat areas such as the frontal or sphenoid sinuses.
The Ear, Nose and Throat Center of Utah provides specialized evaluation and treatment for complex disorders of the nose and sinuses. Benjamin F. Bitner, MD, is a fellowship-trained rhinologist and endoscopic skull base surgeon with advanced training in complex and revision endoscopic sinus surgery, inflammatory sinus disease and disorders of the nasal airway.Â
Patients may benefit from evaluation by a rhinologist when the diagnosis is uncertain, symptoms have not improved with previous treatment or additional expertise is needed to determine whether medical therapy, surgery or another approach is most appropriate.
Benjamin F. Bitner, MD
Specialized Care for Difficult Sinus and Nasal Conditions
When should you see a rhinologist? A fellowship-trained rhinologist specializes in complex disorders of the nose and sinuses and may be helpful when symptoms persist despite treatment, recur after surgery or involve difficult anatomy or an uncertain diagnosis.
A subspecialty rhinology evaluation may be appropriate when:
- Sinus symptoms continue despite appropriate treatment
- Sinus infections repeatedly return
- Symptoms persist or recur after previous sinus surgery
- Nasal polyps return after medical or surgical treatment
- CT or MRI imaging shows complex frontal, sphenoid or skull base disease
- Symptoms predominantly affect one side of the nose or face
- Sinus problems began after a dental infection, extraction, implant, root canal or other dental procedure
- A fungal sinus condition is suspected
- Smell loss persists or remains unexplained
- Nasal obstruction involves several structural problems
- A nasal or sinus mass has been discovered
- The diagnosis or appropriate next step remains unclear
Dr. Bitner evaluates the underlying cause of persistent symptoms before recommending additional treatment. Not every complex sinus problem requires surgery.
Complex and Revision Sinus Surgery
Patients may continue to experience symptoms after previous sinus surgery because of recurrent inflammation, nasal polyps, scar tissue, persistent infection, difficult anatomy or disease involving sinuses that remain inadequately ventilated or accessible.
Revision sinus surgery can be more complex than an initial procedure because normal anatomical landmarks may have been altered by prior surgery, inflammation or scar tissue.
Evaluation may include review of previous treatments and operative records, nasal endoscopy and detailed imaging. Dedicated CT imaging of the sinuses and skull base is available within our clinic and can often be performed the same day when additional imaging is needed. This allows Dr. Bitner to evaluate sinus anatomy, previous surgical changes and areas of persistent disease as part of the rhinology assessment.
The goal is to determine why symptoms or disease have persisted before considering another operation.
Dr. Bitner has fellowship training in advanced and revision endoscopic sinus surgery, including management of complex frontal and sphenoid sinus disease. When surgery is appropriate, treatment is tailored to each patient’s anatomy, underlying disease and previous procedures while preserving healthy tissue whenever possible.
Odontogenic Sinusitis
Odontogenic sinusitis is inflammation or infection of the sinuses caused by a dental condition. It commonly involves the maxillary sinus above the upper teeth and may occur with a dental infection or following a tooth extraction, dental implant, root canal or other dental procedure.
Possible symptoms include:
- One-sided nasal drainage or congestion
- Foul-smelling drainage or unpleasant taste
- Facial pressure concentrated on one side
- Recurrent infections involving the same sinus
- Symptoms that do not respond to typical sinus treatment
- Sinus symptoms beginning after dental treatment
Evaluation may include nasal endoscopy and review of dental and sinus imaging. Dedicated sinus CT imaging is available within our clinic and can often be obtained the same day, helping evaluate the relationship between the upper teeth, maxillary sinus and surrounding sinus disease.
Odontogenic sinusitis is different from routine chronic sinusitis. Depending on the cause and extent of disease, successful treatment may require addressing the dental source, the sinus disease or both.
Dr. Bitner works with dentists, endodontists and oral surgeons when coordinated treatment is needed.
Chronic Sinusitis, Recurrent Sinusitis and Nasal Polyps
Chronic rhinosinusitis is persistent inflammation involving the nasal cavity and sinuses. Some patients develop nasal polyps, inflammatory growths that can contribute to nasal obstruction, drainage problems, recurrent infections and loss of smell.
Because allergy and other inflammatory conditions can contribute to persistent nasal and sinus symptoms, some patients benefit from additional evaluation of the underlying inflammatory process.
Allergy testing is available within our clinic and can often be coordinated with the rhinology evaluation. When appropriate, the results can help guide treatment of environmental allergy alongside management of chronic sinus inflammation or nasal polyps.
Treatment may include:
- Nasal saline irrigations
- Topical or oral medications
- Allergy or immune-system evaluation
- Biologic medications for selected patients with severe nasal polyps
- Endoscopic sinus surgery
- Long-term management to reduce recurrence and recurrence
Patients with recurrent nasal polyps may also have asthma or aspirin-exacerbated respiratory disease (AERD). Identifying these related inflammatory conditions can influence long-term treatment.
Patients with recurrent nasal polyps may also have asthma or aspirin-exacerbated respiratory disease (AERD). Identifying these related inflammatory conditions can influence long-term treatment.
Dr. Bitner treats both routine and difficult chronic rhinosinusitis, including patients with recurrent polyps, severe inflammatory disease or persistent symptoms following previous medical or surgical treatment. He has also contributed to published research involving chronic sinusitis.
Complex Frontal Sinus Disease and Mucoceles
The frontal sinuses are located above the eyes and behind the forehead. Their narrow drainage pathways and proximity to the eye and skull base can make frontal sinus disease particularly challenging, especially in patients who have had previous surgery, trauma or long-standing inflammation.
A sinus mucocele is an expanding, mucus-filled cavity that develops when normal sinus drainage becomes obstructed. As a mucocele enlarges, it can place pressure on nearby structures, including the eye and skull base.
Symptoms may include:
- Forehead pressure or pain
- Swelling around the forehead or eye
- Changes in vision
- Recurrent infections
- Persistent symptoms following previous sinus surgery
Because frontal sinus anatomy can be complex, detailed imaging is often important when evaluating persistent or recurrent disease. Dedicated sinus and skull base CT imaging is available within our clinic and can often be performed the same day, allowing imaging to be reviewed directly as part of the rhinology evaluation.
Treatment depends on the anatomy, location and extent of disease. In appropriately selected cases, advanced endoscopic techniques can provide access to complex frontal sinus disease through the nasal passages without an external facial incision.
Encephaloceles and Meningoencephaloceles
An encephalocele occurs when brain tissue protrudes through an abnormal opening in the skull. A meningoencephalocele includes brain tissue and its surrounding protective membranes.
When these defects occur along the anterior skull base, tissue may extend into the nasal cavity or sinuses and may be associated with a CSF leak.
Symptoms depend on the location and size of the defect. Some encephaloceles are discovered during imaging, while others may be associated with:
- Clear nasal drainage
- Recurrent meningitis
- Nasal obstruction
- Headaches
- Neurological symptoms
- An abnormality discovered on CT or MRI
Evaluation typically requires detailed imaging and may involve collaboration between rhinology and neurosurgery.
Selected anterior skull base encephaloceles can be repaired through an endoscopic endonasal approach, while the location and extent of other defects may require a different or combined approach.
Severe and Refractory Epistaxis
Most nosebleeds are minor, but some are severe, recurrent or difficult to control. Refractory epistaxis refers to bleeding that continues despite standard treatments such as pressure, topical medication, cautery or nasal packing.
Further evaluation may be appropriate when nosebleeds:
- Are heavy or difficult to stop
- Frequently return
- Require emergency treatment or hospitalization
- Begin primarily from one side
- Occur while taking blood-thinning medication
- Are associated with a nasal mass or other concerning symptoms
Nasal endoscopy can help identify the location and possible cause of recurrent bleeding. Treatment depends on the source and severity and Dr. Bitner may treat nose bleeds in-office or, for selected severe cases, endoscopic surgical control of the responsible blood vessel including ligation of the sphenopalatine artery and anterior ethmoid artery.
Dr. Bitner has also contributed to published research involving severe and refractory epistaxis.
Fungal Sinusitis
Fungal sinus disease includes several distinct conditions that differ substantially in their treatment and urgency.
A fungal ball is a localized accumulation of fungal material within a sinus. Allergic fungal rhinosinusitis is an inflammatory condition that may be associated with thick mucus, nasal polyps and extensive sinus disease.
Acute invasive fungal rhinosinusitis is very different. It is an uncommon but serious infection that occurs most often in patients with significant immune suppression or certain uncontrolled medical conditions and requires urgent evaluation and multidisciplinary treatment.
Evaluation of suspected fungal sinus disease may include nasal endoscopy, CT or MRI imaging and examination of tissue or sinus contents. Treatment depends on the specific type of fungal disease and may involve surgery, medical therapy and management of an underlying inflammatory or medical condition.
Dr. Bitner has also contributed to published research involving fungal sinusitis
Disorders of Smell: Anosmia, Hyposmia and Parosmia
Smell disorders can occur after a viral illness, chronic sinus inflammation, nasal polyps, head trauma, medication exposure or other medical and neurological conditions.
Anosmia refers to complete loss of smell, while hyposmia describes reduced smell. Parosmia occurs when familiar odors become distorted or smell different than expected.
Evaluation of smell disorders begins with determining whether the problem is related to nasal or sinus inflammation, obstruction, a previous viral illness, trauma or another underlying condition.
Formal smell testing is available within our clinic to objectively measure olfactory function. Testing can help document the degree and pattern of smell loss and provide a baseline for monitoring changes over time.
Evaluation may also include nasal endoscopy and imaging when indicated. Treatment depends on the underlying cause and may include treatment of sinus inflammation or obstruction and structured olfactory training.
New or unexplained smell loss warrants evaluation, particularly when accompanied by persistent one-sided nasal obstruction or bleeding, facial numbness, visual symptoms or other neurological changes.
Advanced Rhinology Care with Dr. Benjamin F. Bitner
Benjamin F. Bitner, MD, is a fellowship-trained rhinologist and endoscopic skull base surgeon specializing in complex medical and surgical conditions involving the nose, sinuses and anterior skull base. He uses evidenced-based treatment plans and has published extensive research influencing today’s treatment guidlines.  Â
His clinical interests include:
- Advanced and revision endoscopic sinus surgery
- Chronic rhinosinusitis and recurrent sinus infections
- Nasal polyps and advanced inflammatory sinus disease
- Odontogenic sinusitis
- Frontal and sphenoid sinus disease
- Fungal sinus disease
- Smell disorders
- Refractory epistaxis
- Complex nasal airway obstruction
- Endoscopic anterior skull base surgery
Patients with cerebrospinal fluid leaks, encephaloceles, sinonasal tumors or other conditions involving the anterior skull base can also be evaluated through Dr. Bitner’s skull base practice.
Complex Nasal Airway Obstruction and Functional Septorhinoplasty
Not all nasal obstruction is caused by sinusitis or a deviated septum. The nasal septum, turbinates, internal and external nasal valves, previous trauma and prior nasal surgery can all affect airflow.
A comprehensive nasal airway evaluation helps determine where obstruction is occurring and whether treatment should address the septum, turbinates, nasal valves, sinus disease or a combination of factors.
When structural correction is necessary, treatment may include septoplasty, turbinate surgery, nasal valve repair or functional septorhinoplasty depending on the individual anatomy.
Advanced Diagnostic Testing Available in Clinic
Many patients with complex sinus and nasal conditions benefit from additional testing to clarify the diagnosis and guide treatment. The Ear, Nose and Throat Center of Utah offers several specialized diagnostic services directly in the clinic, allowing testing to be coordinated with the rhinology evaluation when appropriate.
Available services include:
- Dedicated sinus and skull base CT imaging, which can often be performed the same day as the office visit
- Allergy testing, available in clinic for patients in whom environmental allergy may be contributing to nasal or sinus inflammation
- Formal smell testing to objectively evaluate loss, reduction or distortion of the sense of smell
Having these services available within the practice can help streamline the evaluation and reduce the need for separate appointments at multiple facilities.
Schedule an Advanced Rhinology Evaluation
If sinus or nasal symptoms have continued despite previous treatment, returned after prior surgery or involve an uncommon or complicated diagnosis, evaluation by a fellowship-trained rhinologist can help clarify the cause and available treatment options.
Contact the Ear, Nose and Throat Center of Utah to schedule an evaluation with Benjamin F. Bitner, MD.
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