Yamik procedure, a method for topical treatment of sinusitis The physician performs simultaneous bilateral anesthesia and anemisation of the nasal and nasal pharyngeal mucous membranes using insulation. Since the procedure will not take more than 10 minutes maximum three milliliters of the solution is required for an adequate level of anesthesia The therapeutic approach selected by the physician is topical administration of antibiotics During the treatment procedure the medicine will be introduced directly into all paranasal sinuses simultaneously. The treatment starts with examination of the nasal cavity for anatomical peculiarities to be considered during placement of the Yamik nasal catheter inside the nasal cavity Catheter introduction into the left side of the nasal cavity. It is performed with the patient in a sitting position. The catheter body was pre bent so that the length of the introduced part of the catheter corresponds to the distance between the nasal vestibule and the choana. Balloon inflation Inflated balloons one in the nasal vestibule and the other in the choana seal and isolate the sinonasal cavity from the outer environment. They also restrict the contact area between the drug and the mucous membranes of the nose and paranasal sinuses. Sealing is mandatory for the Yamik procedure In order to provide good visibility of nose wing movements for the physician the patient’s head should be tilted during seal check When the syringe plunger is pulled the nose wing should be drawn in and returned to the initial position synchronous to the plunger movement. For injection of the drug Into the sinuses the patient should be placed in the lateral recumbent position on the same side as the sinuses to be injected. In this position the drug will fill the sinuses due to a balance of gravity and surface tension. A 20 milliliter syringe filled with 10 milligrams of the drug solution should be attached to the working channel of the catheter The physician begins to move the plunger at a 1 to 2 milliliters amplitude This is quite sufficient for the solution to start passing from the syringe into the sinuses such a small pressure change guarantees a painless procedure. The physician performed 90 back-and-forth movements of the plunger as a result 10 milliliters of the antibiotic solution were injected into the sinuses in just 50 seconds. There is no nasal discharge after catheter removal. It means the entire drug stays in the sinuses. During injection there were no signs of the drug getting into the patient’s pharynx This is indicative of the fact that the solution did not proliferate beyond the area restricted by the inflated balloons during procedure. The patient should be placed in a sitting position face down. A slight exhalation through the nose causes secretion to appear from the sinuses only at that side of the nose where the drug solution was injected. It means that the draining function of the left nasal ostiums has been already partially restored in the course of the procedure. It can be explained by the fact that the viscosity of the abnormal content in the sinuses has begun to decrease after contacting the saline injected into the sinuses and the available lumens of the natural ostiums have become sufficiently large to allow for independent evacuation of secretion from the sinuses. A similar procedure performed for the right side of the nose It took the physician only 70 movements of the plunger to inject 10 ml. of the drug into the other side of the nose. Now secretion is released from both sides of the nose while secretion is released from the right side. It indicates that the draining function of the ostiums has been restored even more. Cotton plugs should be inserted into the nose only for hygienic reasons. The patient will remove them himself after 30 minutes So let’s summarize

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