Personalized Medicine — How SAWC Builds Your Sinus Treatment Plan

Personalized medicine at SAWC means your treatment plan is built around your specific CT findings, your symptom history, your culture data, your upstream triggers, and what kind of day you are having today — not a protocol applied to everyone with a sinus complaint. No two plans look exactly alike because no two patients are exactly alike.

By Franklyn R. Gergits, DO, MBA, FAOCO · Sinus & Allergy Wellness Center of North Scottsdale · Scottsdale, Arizona

Most ENT practices see several patients in the time it takes us to complete one third of your initial visit. That is not a criticism — it is a reflection of a different philosophy about what a sinus evaluation is for. At the Sinus & Allergy Wellness Center of North Scottsdale, the evaluation is not a step toward a procedure. The evaluation is the foundation of everything that follows. Getting it right takes time. We take the time.

It starts before you arrive — and before we pull up any imaging

Before a patient ever sits across from me, we ask them to complete a more detailed questionnaire and history intake than most practices require. The purpose is specific: we want to identify the pain point that brought you in. Is it ear problems? Cough? Drainage causing throat pain? Globus sensation? Hoarseness? Sleep disruption? Breathing difficulty? Classic sinus pressure and congestion? Allergy symptoms?

These are not interchangeable. Each symptom pattern points toward a different upstream cause, a different anatomical region of the airway, and a different set of questions that need to be answered before any treatment decision is made. The detailed intake gives us a head start on determining what the upstream cause of your airway problem actually is — before you have been examined, before we have seen your imaging, before a single instrument has entered your nose.

Sometimes the picture is straightforward: allergy-induced congestion narrowing already small sinus drainage openings, producing recurrent sinus infections on a predictable seasonal pattern. Sometimes it is complex: chronic dehydration combined with immune dysfunction, silent reflux adding posterior mucosal inflammation, and underlying sinus anatomy that was never able to compensate for the combined inflammatory load. We see both. The intake helps us know which one we are dealing with before the visit begins.

The CT scan on the day of your visit — and the question nobody else asks

At SAWC, the CT scan of the sinuses is typically obtained the same day as your initial visit using our in-office cone beam CT scanner — a specialized unit that reduces radiation exposure to a matter of seconds. Having imaging available during your visit rather than ordering it and scheduling a follow-up changes what we can do with your appointment. But it is the question we ask when you arrive that unlocks the real value of same-day imaging.

We ask: Is today a good day, a bad day, or an average day?

The answer changes everything about how we interpret what we see. If you are having a bad day and your CT shows active infection — that is your acute picture. If you are having a good day and your CT still shows chronic changes — that is your baseline burden, and it tells us what a bad day looks like even when we cannot see it directly. If you are having an average day, we can establish your average sinus burden level with reasonable confidence and track how treatment changes that baseline over time.

This is the foundation of what we call the Sinus Burden Score — a concept we are actively developing at SAWC that would combine existing validated instruments including the SNOT-22, ETDQ-7, TNSS, NOSE score, STOP-BANG, and brain fog assessment into a single composite measure that captures something none of the individual tools captures alone: the distinction between an acute exacerbation spike and the underlying chronic condition, and what your average score looks like across a full treatment plan. A number that can be linked to disease progression or resolution over time. We believe this composite measure — tying how you feel today to what the imaging shows today — represents a more complete picture of sinus disease burden than any single validated score provides.

We also ask you to ask questions. This is not a courtesy — it is a clinical instruction. We want you active in your own care. We want you to understand what we are seeing and why we are recommending what we are recommending. The patient who asks questions is the patient who follows through. And following through is what produces the outcome.

The team behind your evaluation

Personalized care is not something one person can deliver alone. It requires a team that functions as a unit — each member contributing something the others cannot.

It begins before you arrive, with the scheduler who contacts you to complete the intake information and secures your appointment for the day you are not working. On the day of your visit, you are welcomed by a team member whose first tool is a smile. Registration is completed — and if the pre-visit intake was not finished, a team member helps you complete it in the office. A medical assistant then meets you, assesses your symptom pattern, determines whether same-day CT imaging is indicated, and prepares you for examination. Your nose is sprayed with a topical medication that allows complete nasal and airway visualization before the examination begins.

You then meet one of our specialized providers — physician assistants and nurse practitioners who are board-certified, general ENT trained, and then — if they demonstrate the clinical foundation required — advanced through our rhinology training program. We currently employ three of these providers. Our practice is a recognized training site for other PAs and NPs seeking this level of highly specialized rhinology training. After the encounter, a diagnosis or set of diagnoses is established, a treatment plan is developed, and every question you have is answered before you leave. You also receive a link to our most common patient questions and a direct contact for questions that arise after your visit.

The team also includes our allergy testing specialists, our insurance authorization team, our billing and management staff, and our marketing specialist — all of whom make the clinical work possible by keeping the practice functioning around it. And then there is what happens after hours: our physician assistants and I meet to review the day’s complex and unique presentations. We look at the unusual findings, the upstream triggers that may have been missed elsewhere, the cases where the standard approach is not going to be sufficient. That is where the personalized plan truly takes shape.

What personalized actually means at the CT lightbox

When I am standing in the procedure room with your CT scan on the monitor, personalized medicine is not a philosophy. It is a series of specific clinical decisions driven by what I am looking at.

If I see a complete gray color change filling an entire maxillary sinus and extending into the ethmoid complex and frontal sinus, I am not thinking “sinus infection, treat with antibiotics.” I am asking: what is your dental history? Do you have a tooth that has been treated on that side? Is there a periapical lucency at a root tip adjacent to the sinus floor? Could this be an odontogenic infection — a dental origin that no amount of nasal treatment will resolve without addressing the tooth? If so, the plan includes a MicroGenDX culture, a referral back to your dentist for evaluation of the dental origin, and — if medical therapy fails — a hybrid approach to the maxillary sinus: balloon dilation of the natural ostium, followed by FESS instrumentation to suction and irrigate the cavity, followed by infusion of a culture-directed compounded antibiotic rinse directly into the cleaned sinus. That is not a standard sinus protocol. That is a plan built specifically around what your imaging, your symptoms, and your MicroGenDX data are telling us together.

That level of specificity is what we mean when we say personalized.

The patients whose hearts we carry — the ones the system failed

The patients I think about most are the ones who come to us having already been seen by two, three, or four other ENT physicians. Discharged. Told there is nothing more to offer. Living a life with a high sinus burden score and no pathway forward.

These patients are not difficult cases because their disease is fundamentally different. They are difficult cases because the upstream trigger was never identified. The most commonly missed trigger in my experience is the resistant bacterial biofilm complex — a polymicrobial community of organisms that has established itself in the nasal microbiome over years, protected by biofilm architecture that standard antibiotic courses cannot penetrate at adequate concentrations. MicroGenDX identifies what standard cultures miss. Culture-directed compounded rinses delivered directly into the sinus cavity reach what systemic antibiotics cannot.

Other missed triggers include chronic dehydration — still underappreciated as a driver of mucosal dysfunction; undiagnosed autoimmune conditions like Sjögren’s disease affecting mucosal secretory function; and silent laryngopharyngeal reflux adding posterior mucosal inflammation as the main unknown inflammatory driver within what I describe as a scarred immune system — a sinonasal lining that has been chronically inflamed for so long that it no longer responds normally to treatment and needs a reset before meaningful recovery is possible.

And then there is the patient whose previous surgery removed too much. We were all trained in an era when aggressive mucosal resection was standard — strip out the diseased lining, open the sinuses wide, let it heal. What we know now is that the tissue that grows back into a sinus after aggressive mucosal resection is not normal respiratory mucosa. It is squamous epithelium — the wrong type of lining for a sinus cavity. It cannot perform mucociliary clearance. It may generate chronic inflammatory signals on its own. The patient who had surgery elsewhere and has never felt right since may be dealing with the consequences of mucosal resection that cannot be undone, only managed carefully and progressively over time.

What we want you to walk out understanding

Three things.

First — hope. If you have been lost in the system, told there is nothing more to offer, discharged and left to manage a chronic condition alone — we want you to leave our office understanding that there are still questions that have not been asked and answers that have not been found. That is not a promise of a cure. It is a commitment to keep looking.

Second — partnership. Getting better is not something we do to you. It is something we do with you. That means multiple rinses, dietary changes, increased fluid intake, compliance with referral appointments to specialists who address pieces of the puzzle that fall outside our specialty — rheumatology for autoimmune conditions, immunology for immune dysfunction, pulmonology for lower airway involvement, gastroenterology for reflux, neurology for the autonomic dysfunction that can emerge from years of chronic sinonasal inflammation keeping the sympathetic nervous system in a state of constant activation. You are part of this team. You are the most important part.

Third — a plan. Not a prescription and a follow-up appointment in three months. A complete understanding of what we found, why we are recommending what we are recommending, what the sequence of treatment looks like, and what success looks like over time — measured not by a single post-operative visit but by a sustained, lasting reduction in your Sinus Burden Score toward a baseline where you feel like yourself again.

That is personalized medicine. That is what we build every day at SAWC.

Want to Understand More?

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them series on the Airway & Sinus Wellness Review.

→ What Is a Hybrid Sinus Procedure — and Why Might You Need One?

→ What Is MicroGenDX — and Why Does It Change How We Treat Sinus Infections?

→ Why Do Antibiotics Keep Failing My Sinus Infection?

→ What Is NEUROMARK® — and Could It Stop Your Chronic Runny Nose?

→ Why Your Sinuses, Ears, Drainage, and Sleep Are All the Same Problem

Airway & Sinus Wellness Review — Full Publication

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them series.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is an osteopathic otolaryngologist and otolaryngic allergist with a focus on rhinology with over 30 years of clinical experience treating sinus and airway disease in Scottsdale and the greater Phoenix metropolitan area. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in comprehensive, personalized, office-based nasal and sinus care. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. ORCID: 0009-0000-4893-6332. Preprint DOI: 10.20944/preprints202603.0858.v1.

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This content is for educational purposes only and does not constitute medical advice. Please consult a qualified physician for evaluation and treatment of your specific condition.