Nose and Sinus

Sinusitis is defined as inflammation of the sinus cavities, but often involves the lining (mucosa) of the nose and throat as well. The vast majority (90%) of sinusitis is viral and resolves within 7-10 days. However, a certain subset of patients will have longer-lasting symptoms for multiple weeks or recurring symptoms multiple times a year. This is best evaluated by an ENT. Additional testing may include nasal endoscopy (looking in the nose with a small camera) and CT scans of the sinuses. This can help determine whether medical or surgical therapy is best suited to treat your symptoms.

Also known as posterior rhinorrhea, this condition is primarily characterized by the sensation of excess mucus in the back of the nose and/or throat. Oftentimes, patients report frequent throat clearing, which can cause irritation of the throat and vocal cords. An ENT can help evaluate the root cause of this condition, which includes allergies, reflux, chronic sinus inflammation, and non-allergic rhinitis. Treatments are usually medical in the form of nasal sprays or antacids, but depending on the etiology, there may be several surgical procedures available to help treat your symptoms.

Difficulty breathing through your nose can be a serious detriment to your quality of life. Common causes include infections, allergies, and obstructing anatomy such as a deviated nasal septum or enlarged adenoids. This is best evaluated by an ENT. Additional testing may include nasal endoscopy (looking in the nose with a small camera) and CT scans of the sinuses. This can help determine whether medical or surgical therapy is best suited to treat your symptoms.

Injuries to the nose can be quite painful and can sometimes result in fractures to either the nasal bones or the nasal septum. It is important to have these evaluated within 7-10 days of the injury by a trained ENT or facial plastic surgeon to determine if surgical correction is indicated. In children, since they tend to heal more quickly, evaluation within 3-5 days is preferred.

Bleeding from the nasal lining (mucosa) is very common in patients of all ages. Common factors which contribute to nosebleeds include dryness, high blood pressure, blood-thinning medications, and trauma. More severe or recurring nosebleeds lasting longer than 10 minutes may require evaluation by an ENT. If necessary, the bleeding vessels can be cauterized in our office under local anesthesia.

Sleep apnea is a condition in which the upper airway (nose and throat generally) becomes obstructed frequently during sleep. This can lead to daytime fatigue, morning headaches, and difficulty focusing on school/work. In adults, if left untreated, this can lead to increased stress on the heart and lungs. In children, potential consequences include hyperactivity, behavior issues (often mis-diagnosed as ADHD), and delayed cognitive development. Both medical and surgical options exist to treat sleep apnea, but evaluation by an ENT is critical to determining the proper treatment plan. Typically, a sleep study will be ordered (either at a sleep medicine facility, or in the comfort of your own home) to help determine the severity of the sleep apnea.

Modern sinus surgery to remove obstruction or infection from the sinuses is typically performed endoscopically with small cameras through the nose. This type of procedure can also safely remove polyps and other sinonasal masses. In certain cases, your ENT might also leave dissolvable stents or packing in the sinuses, which can help prevent recurrence of polyps and/or scarring.

Surgery to correct nasal septal deviation is quite “straightforward.” Typically, the incisions and dissolvable stitches are all placed inside the nose. Deviated portions of the septum, including both bone and cartilage, are either removed completely or straightened and replaced before the end of the surgery.

The turbinates are cylinder-shaped pieces of tissue inside the nose that help to filter particles out of the air we breathe. Occasionally, the turbinates are overly large and can impair nasal breathing. These turbinates can be reduced in size, often in combination with other nasal surgery (e.g septoplasty), in order to maximize nasal airway size.

One often-missed component of nasal breathing is the lateral nasal sidewall, which corresponds to the creases in the side of the nose. This can be tested at home using Breathe-Right strips. If you experience improvement in breathing, there are several interventions available to help prevent collapse of those tissues, ranging from minimally invasive to more complete nasal valve expansion (usually in conjunction with rhinoplasty).

Balloon sinuplasty is a minimally invasive procedure performed in the office to help treat sinus headache and nasal/sinus congestion. Using an endoscope to help see inside the nose, a small (6 mm) balloon is inserted into the sinus openings to expand the drainage pathways. This can be an equally effective alternative to sinus surgery.

Intranasal cryotherapy is a minimally invasive procedure performed in the office to help treat post-nasal drip. Using an endoscope to help see inside the nose, a small device is placed next to a nerve cluster in the nose that supplies the mucus glands. Liquid nitrogen is passed through the device, which freezes the surface of the nerve cluster, and over the next 6-8 weeks, eventually causes decreased nasal mucus production, without causing excessive nasal dryness.