The Department of Otorhinolaryngology - Head & Neck Surgery at The University of Texas Medical School at Houston
Department of Otorhinolaryngology

ORL Progress Notes

Summer 2009 Articles

Comprehensive Rhinology Program Offers State-of-the-Art Care for Patients with Chronic Rhinosinusitis Refractory to Standard Treatments

The Comprehensive Sinus Program, a joint effort of Memorial Hermann-Texas Medical Center and the Texas Sinus Institute (TSI) of the Department of Otorhinolaryngology at The University of Texas Medical School at Houston, is founded on four related and interdependent spheres: excellence in patient care, quality education for patients and healthcare professionals, incorporation of new technologies and development of new therapeutics through translational research.

Samer Fakhri, M.D., and his partners, Amber Luong, M.D., Ph.D., and Martin J. Citardi, M.D., form the core of TSI, which offers expertise in the medical and surgical management of sinus and nasal disorders with special focus on fungal and refractory chronic rhinosinusitis. “The population of the southern parts of the country, especially eastern Texas and the Mississippi Basin, is particularly affected by a distinct and aggressive form of chronic rhinosinusitis referred to as allergic fungal rhinosinusitis (AFRS),” says Dr. Fakhri. “At TSI we see a much higher proportion of AFRS due to the nature of our referral patterns.”

AFRS is an aggressive inflammatory process that affects the sinonasal cavity and has the potential to erode into adjacent structures, including the orbit and skull base. The management of AFRS involves surgical intervention followed by medical therapy.

“The objectives of treatment for AFRS mandate comprehensive surgery, even in critical areas devoid of bone along the skull base and orbit,” Dr. Fakhri says. “Our surgical approach is highly precise, minimally invasive, and exceedingly technical so that operative risks are minimized without compromising the surgical goals.”

TSI rhinologists also treat a large number of patients who have not responded well to medical therapies or who have previously undergone surgery. “Patients with persistent symptoms after sinus surgery present a difficult treatment challenge,” Dr. Fakhri says. “If a patient has refractory chronic rhinosinusitis or sinonasal polyposis after initial surgery and appropriate medical therapy, revision surgery may be necessary. The revision procedure, however, entails a higher surgical risk due to the distortion in anatomy from previous sinus surgery and inflammatory disease.” A large proportion of the surgical volume at TSI consists of advanced and revision endoscopic sinus surgeries.

TSI rhinologists also incorporate comprehensive medical management into the treatment regimen. This approach optimizes the long-term outcomes from complex surgical interventions. Patients are evaluated and treated in a state-of-the-art clinical facility, fully equipped with video endoscopy and robust image archiving. They have the option of viewing their own endoscopic examinations on bright flat-panel monitors. “Although not all patients wish to see their own examinations, most patients welcome the opportunity to learn about their nasal and sinus health and to participate more directly in the decision-making process,” says Dr. Fakhri.

Comprehensive imaging and laboratory testing is available on site. A spectrum of treatments is available for TSI patients, including in-office procedures and innovative therapies.

TSI rhinologists are proficient in advanced sinus surgery, revision endoscopic sinus surgery, frontal sinus surgery, endoscopic orbital decompression, endoscopic optic nerve decompression, and endoscopic dacryocystorhinostomy. The surgical suites at Memorial Hermann offer patients the latest technology in true high-definition video endoscopy and computer-aided surgery with image guidance, as well as specialized and powered instrumentation.

Dr. Fakhri, Dr. Luong and Dr. Citardi are also part of the Texas Skull Base Pysicians—a joint program with the Mischer Neuroscience Institute—which offers multidisciplinary expertise for benign and malignant skull base lesions and features minimally invasive approaches for this complex anatomic region.

“We’ve expanded our practice dramatically over the last year as other physicians have become more aware of the services we offer,” Dr. Fakhri adds. “We’re here to support the otolaryngology community as well as other physicians by providing them with high-end clinical expertise in the diagnosis and treatment of very complex conditions.”

To refer a patient to a TSI rhinologist, please call 713.486.5000.

Learn more information about functional endoscopic sinus surgery.

Samer Fakhri, M.D., F.A.C.S., F.R.C.S.(C) is an associate professor and residency program director at The University of Texas Medical School at Houston. Dr. Fakhri received his medical degree from McGill University in Montreal, Canada. He completed his residency training at McGill University Health Center and pursued fellowship training in rhinology at the Cleveland Clinic Foundation. He also completed a research fellowship in allergy and immunology at the Meakins-Christie Laboratories of McGill University.

Dr. Fakhri is certified by the American Board of Otolaryngology and the Royal College of Surgeons of Canada. He is a fellow of the American College of Surgeons, the Royal College of Surgeons of Canada, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Rhinologic Society. He serves as a committee member of the American Rhinologic Society and contributes yearly instructional courses to the American Academy of Otolaryngology-Head and Neck Surgery. In addition, he is on the editorial board and a reviewer for otolaryngology journals.

He is a frequently invited national and international panelist and speaker. Dr. Fakhri has co-authored more than 25 articles and book chapters. His areas of clinical interest include medical and surgical management of refractory chronic rhinosinusitis and sinonasal polyposis, image-guided surgery, endoscopic lacrimal and orbital surgery, CSF leak repair, and minimally invasive skull base surgery.

Martin J. Citardi, M.D., an internationally recognized rhinologist, is professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at The University of Texas Medical School at Houston.

Dr. Citardi received medical degree from The Johns Hopkins University School of Medicine. He completed his residency training at Yale University and then pursued a rhinology fellowship at the Georgia Rhinology & Sinus Center. Dr. Citardi is certified by the American Board of Otorhinolaryngology and is a fellow of the American College of Surgeons and the American Rhinologic Society.

He has more than 75 publications to his credit, and he has edited a textbook on computer-aided otorhinolaryngology. Dr. Citardi has served as director and information technology officer for the American Rhinologic Society. Dr. Citardi's clinical practice focuses on disorders of the nose and sinuses. His special clinical interests include refractory sinusitis, revision sinus surgery, CSF rhinorrhea, computer-aided surgery (image-guided surgery), and minimally invasive anterior skull base surgery.

Amber Luong, M.D., Ph.D., serves as an assistant professor with a joint appointment at M. D. Anderson within the Department of Immunology.

Dr. Luong obtained her M.D./Ph.D. at The University of Texas Southwestern Medical Center at Dallas through the National Institutes of Health-sponsored Medical Scientist Training Program. She earned her Ph.D. under Nobel laureates Drs. Michael Brown and Joseph Goldstein for the identification and biochemical characterization of a novel human enzyme, acetyl coA synthetase. She completed her residency training at UT Southwestern and rhinology fellowship training at Cleveland Clinic.

Dr. Luong has co-authored more than 10 articles and book chapters. Her primary research interest focuses on understanding the pathophysiology of allergic fungal rhinosinusitis as a model for studying the local immune response of the paranasal sinuses. Dr. Luong’s clinical interest parallels her research interest in AFRS as well as the medical and surgical management of refractory chronic rhinosinusitis, sinonasal tumors, CSF leak repairs, and endoscopic orbital and dacryocystorhinostomy surgery.







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