Nasal & Sinus Problems
ENT specialists see a wide variety of nasal disorders that cause, obstruction, infections bleeding, drainage issues and others.
There are 4 sets of sinus cavities in the facial skeleton, Maxillary (cheek), Ethmoid (between the eyes), Frontal (forehead) and Sphenoid (behind the eyes). In the healthy state, they drain and ventilate into the nasal cavity and are filled with air. They drain through specific sites called “ostia” into the nose.
Sinus infections generally start when there is an occlusion of the normal sinus ostia, causing retained secretions and bacterial contamination. It may be initiated by a viral cold, allergies, or other sources of inflammation. If there is a pre-existing narrowing of the sinus ostia, they may become more easily blocked with any additional swelling from inflammation. A “vicious cycle” can be set up whereby swelling leads to obstruction of the already narrow sinus ostium, which leads to infection, which causes more swelling and inflammation, and so on. Sometimes, medications alone are not enough to break this cycle. When sinus infections occur 4 or more times per year, or become chronic (continual symptoms for 3 months or longer), a procedure to open the sinus ostia may be considered.
Functional Endoscopic Sinus Surgery (FESS)
Sinus Surgery is performed with small fiberoptic endoscopes with the main advantage of precision and being minimally invasive. These small scopes allow the surgeon to accurately identify the sinuses involved and avoid injury or manipulation of other sinuses or structures. The surgery is "functional" in that the natural openings to the sinuses are enlarged by using small cutting instruments to remove tissue, rather than creating new or unnecessary openings into the sinuses. This technique preserves the function of the sinuses. In some cases, this surgery may be done in conjunction with Image Guidance, which requires a special high-resolution CT scan. This allows precise real time localization of instruments within the nose on the patient's CT scan. This technology may improve the safety of the procedure, especially in revision surgery or with severe nasal polyps. Typically, this surgery is done as an outpatient and rarely requires any packing, with the exception of some absorbable packing that dissolves with the use of saline spray. Recovery ranges from 3 -7 days. There are some important risks of sinus surgery, especially when it involves the ethmoid, sphenoid or frontal sinuses, such as bleeding, eye/orbit injury or injury to the brain or cerebrospinal fluid (CSF) leaks. Fortunately, serious complications from sinus surgery are exceptionally rare.
A deviated septum is a very common abnormality and often causes chronic obstruction, sinus infections or nose bleeds. It is usually caused by some previous trauma and heals “crooked”. Many times also causing increased mouth breathing and snoring as well as severe post nasal drip that fails to resolve. This is a common problem corrected by a simple outpatient procedure.
Septoplasty (fixing deviated septum): The septum is part cartilage and bone. The surgery involves making some small cuts or breaks in the septum and removing some pieces to place it back in the midline with the goal of attaining symmetric airways on each side, and improving nasal drainage. This is done under general anesthesia and usually takes about 30 minutes in an outpatient setting. There should be virtually no bruising or swelling. There is some mile-moderate nasal congestion and discomfort that might require some pain medication. Rarely is packing used, instead some small thin soft plastic splints are place in the nose to hold everything in place and are removed easily in the office in about a week. Septoplasty can be performed at the same time as other nasal/sinus operations. Complications (while rare) include bleeding, infection, perforation (hole in septum), poor healing and recurrence of obstruction.
The nasal turbinates are soft tissue structures with a thin bone inside (concha) that line the lateral (sides) of each nasal cavity. They are very efficient at regulating airflow. When enlarged for various reasons, such as allergies, irritants or infections, they can be very obstructive and lead to severe post nasal drip, headaches, sinus infections and nasal discharge. A simple look in the nose with a fiberoptic scope can help determine the cause. There are several medications and options to “shrink” these down to resolve these symptoms, i.e. nasal steroid sprays. Sometimes surgery is the best option.
Turbinate reduction is designed to reduce the size of the inferior turbinates which can be very obstructive and lead to chronic mouth breathing, drainage issues, snoring and sinus infections. They can become enlarged over time with chronic allergies, irritation exposure or of unknown origin. When medications such as nasal steroid sprays, decongestants and saline irrigations fail to improve the obstruction, then reducing the size may provide a long term improvement. The reduction is done in a number of ways, including Coblation, which shrinks the turbinates down while preserving the mucus membrane and the main function of the turbinates which are to warm, filter and humidify the inhaled air. This can also be accomplished with a small cutting instrument called a microdebrider that is inserted into the turbinate to remove excess tissue. Post op care is minimal and involves allergy management, saline irrigations an spray and gentle blowing.