Nose and Sinus
Nose and Sinus
What is sinusitis?
What are nasal polyps?
How is sinusitis treated?
When
should I have a sinus CAT scan?
When is a CT scan needed in the evaluation of sinusitis?
When is surgery useful for sinusitis?
Does sinus surgery always work?
Explain sinus surgery and the recovery
Are there any new advances in sinus Surgery?
Will sinus or nasal surgery help me?
How are allergies treated?
Do allergies cause recurrent sinus infection?
Septum/Turbinates/Nasal Congestion
What does a deviated septum imply?
What do large turbinates imply?
Is there a way to shrink the turbinates to
breathe better?
What
can be done for my nasal congestion/stuffiness?
What causes nosebleeds?
What is the best way to stop a nosebleed?
What is sinusitis?
Sinusitis is inflammation of the sinuses caused by infections (bacterial, viral, or fungal) and/or allergies. Acute sinusitis is very common and usually lasts less then 2 weeks, where chronic sinusitis can last months and is much more difficult to treat.
What are nasal polyps?
Nasal polyps are grape-like outpouchings from the nasal sinus linings that are usually indicative of an allergic component to the sinus disease. They often obstruct the normal sinus drainage and airflow creating more congestion, infections and decreased sense of smell.
In general, the treatment of sinusitis depends on the duration and severity of the symptoms. Most often multiple medications such as an antibiotic(fights bacterial infections), decongestant (allows drainage), mucolytic (thins mucus), corticosteroid (reduces inflammation), and nasal irrigation are prescribed. There are many appropriate medications in each of these categories and the best treatment plan must be individualized. Infrequently, sinus surgery is needed for acute uncomplicated sinusitis.
When should I have a sinus CAT scan?Sinus CAT scan or CT is used to evaluate patients with recurrent or chronic sinus symptoms who are not responding to medical treatment. These symptoms may include nasal congestion, sinus drainage, facial pain or pressure and headaches. Your doctor may also order a sinus CT if an abnormality is identified in physical examination. A sinus CT provides detailed information about sources of nasal obstruction, sinus drainage pathways and the presence of infection. Specific anatomic abnormalities' which may be causing sinus symptoms can be easily identified. The information obtained from a sinus CT is critical to effective treatment. Changes in medical therapy or safe, well-tolerated outpatient surgery to correct anatomic abnormalities often lead to improvement in your symptoms. With the latest technology, your sinus CT can be linked with a computer-guided system that makes surgery even safer and more effective.
When is a CT scan needed in the evaluation of sinusitis?
CT scans are very helpful in patients with chronic refractory sinusitis, complications of sinusitis and suspected malignancy. In addition, it is helpful for the evaluation of anatomy prior to sinus surgery.
When is surgery useful for sinusitis?
Surgery is most beneficial in symptomatic patients with mechanical obstruction to sinus drainage and those with persistent infections that have failed medical therapy. More urgent sinus surgery may be indicated when the eye or brain (which surround the sinuses) are affected by the sinus disease.
Does sinus surgery always work?
When the above indications are met, sinus surgery usually has a dramatic impact on the patients’ symptoms. The patient may still require medication and irrigation to prevent further inflammation and the re-development of sinus obstruction. In the unusual case where the symptoms are not relieved or they recur quickly, the ENT surgeon may investigate other causes such as allergy or Immune-system problems that may be underlying these refractory cases.
Explain sinus surgery and the recovery
The majority of contemporary ENT sinus surgeons use a technique in which small telescopes are placed in the nose for precise visualization of the sinus obstruction, removal of the diseased tissue, and opening of the natural sinus drainage holes, with less trauma to the normal tissues, allowing quicker healing, less packing, and no facial incisions, as compared to traditional sinus surgery.
Surgery is often ambulatory, pain is usually minimal, and most patients return to work in less than one week. Nasal cleaning and irrigation are done frequently for about the first month after surgery until the nasal lining is clean and well healed.
Are there any new advances in sinus surgery?
Endoscopic sinus surgery has advanced the treatment of many nasal problems without external incisions and with little or no packing needed. New CT scan guided visualization systems have been developed to more safely visualize and treat more advanced or difficult sinus problems. Charleston ENT Associates are the first physicians to have this technology available in the Charleston area.
How are allergies treated?
Based on your ENT evaluation, history,
examination, x-rays, and other positive things in your environment your doctor
has suggested that allergy is probably a major cause of your problems.
Therefore, a complete allergy work-up and allergy management program needs to be
started for you.
The first phase of testing is a prick test. A multi-prick device is used on your
forearms. It will test you for 32 of the most common allergens in our area. This
test takes 20-30 minutes.
The second phase of testing is called IDT (Intradermal Titration). This test is
done on your upper arms using tiny needles that go right under the top layer of
skin. This test takes approximately 1 hour to complete. It will tell us how
sensitive you are to the positive antigens. If your doctor determines you are a
candidate for allergy shots, this information is needed to make the serum for
you. After testing is completed, treatment for your allergies can begin. This
process takes time to work and may often be continued for years, but will often
bring long lasting relief.
Other treatments are less specific and include antihistamines, decongestant, and
corticosteroid medicines that fortunately today are very safe and effective when
used appropriately.
The best treatment for allergies is avoidance of the particular pollen, mold, dust, food or chemical that is causing the problems. Unfortunately, avoidance is easy to prescribe but not often practical. Self-help suggestions such as frequent changing of air filters, wearing pollen masks, enclosing mattresses in plastic barriers, keeping windows closed during heavy pollination seasons, removing feather pillows and wool blankets, ridding home of indoor plants that grow mildew. Some more difficult but important measures include avoidance of tobacco products and animals that produce dander.
Do allergies cause recurrent sinus infection?
Allergies can lead to infection. When the lining inside the nose is exposed to substances, to which a person is allergic, the lining swells. The swelling blocks the drainage openings of the sinuses, leading to mucous accumulation. As mucous lies trapped, it becomes infected, leading to sinusitis. Controlling allergies with medicines or allergy shots can treat the symptoms and may prevent sinus infections. In addition, an office-based procedure, radiofrequency turbinate reduction, can
improve the nasal congestion caused by allergies. People who have suffered with long term allergies may have tissue damage that leads to chronic sinus infections. In this instance, Sinus Surgery can
remove thickened obstructive tissue which prevents nasal drainage. The newest technology utilizes computer-guidance sinus surgery, significantly increasing the safety and effectiveness of this procedure.
Septum/Turbinates/Nasal Congestion
What does a deviated septum imply?
A "straight" septum is rather unusual, where a deviated septum is very common. It becomes a matter of degree of deviation and severity of nasal symptoms for which we consider fixing a deviated septum. Difficult nasal breathing, snoring, excessive drainage, sinusitis, headaches, nosebleeds and decreased sense of smell may be partly caused by septal deviation and can often be relieved by your ENT surgeon removing the deviated portion of the septum. The surgery is usually ambulatory with quick recovery and minimal pain.
What do large turbinates imply?
The nose has 3-4 turbinates on each side. Their function is to humidify, warm and "filter" the air we inhale on its way to our lungs. Sometimes due to allergies or other inflammatory processes they become congested and swell to take up a lot of our nasal airway space. Often removal of the offending inflammatory cause will relieve this swelling, but if medical therapy fails surgical reduction of the turbinates may be needed. This can be performed by your ENT physician as an ambulatory procedure with minimal pain and recovery time.
Is there a way to shrink the turbinates to breathe better?
A new procedure "radiofrequency reduction of the turbinates" has been developed recently to shrink the volume of the turbinates. By working under the surface of the turbinate, this can be safely performed in the office with little, if any, bleeding or pain, and the patient can go back to work the same day.
Surgery Center of Charleston is a JCAHO (the organization that inspects and accredits hospitals) accredited ambulatory surgery facility utilized for outpatient ENT surgical procedures such as ventilation tube placement, sinus surgery, ear surgery, tonsillectomy and adenoidectomy and throat and vocal surgery.
The facilities and equipment have been specifically designed to provide complete otolaryngology care in an efficient, "state-of-the-art" center.
The "InstaTrak" sinus technology for the surgical treatment of advanced, more difficult sinus disease is available in the Charleston area only in this facility.
What can be done for my nasal congestion/stuffiness?Nasal stuffiness is caused by infections, allergies or anatomic blockages. Often the swelling inside the nose is temporary and symptoms improve. Decongestants, nasal sprays and nasal-opening, adhesive strips can help. If the congestion is constant or recurs, an evaluation by an Ear, Nose and Throat specialist is recommended. The anatomical blockage could be related to a fixed obstruction like a deviated septum that maybe corrected as an outpatient procedure. Packing is no longer used, so the procedure is less uncomfortable. Polyps and chronic sinus disease can often be helped with new computer guided sinus surgery. (More details in upcoming articles.) Finally, congestion could include being related to allergies, recurrent infections or environmental sensitivities that cause swelling of the turbinate tissue in the nose. A newer procedure, Radiofrequency Turbinate Reduction, can be performed in the office in about 15 minutes, and you can return to your regular activities immediately.
Will sinus or nasal surgery help me?
Before considering sinus or nasal surgery, patients need to have appropriate complaints, symptoms or structural abnormalities. Most should have been unsuccessfully treated with decongestants, antihistamines, antibiotics or nasal sprays. Prior to considering surgery both a complete endoscopic examination and CT scan evaluation of the nose and sinuses are imperative. At the SC Sinus Institute, we take your surgery seriously. Most nasal and sinus surgery is performed at our own accredited Surgery Center of Charleston, with state of the art instrumentation, including a computer guided surgery system and using only board certified anesthesiologists. Due to the precision of endoscopic surgery, usually no packing is needed, and patients often return to their normal routine in a few days. If you feel we may help you, please contact one of our offices.
What causes nosebleeds?
Nosebleeds are caused most frequently by the common irritants (colds, sinusitis, dryness, nose-picking, for nasal medications, trauma). High blood pressure is a very common cause in the elderly. Bleeding disorders, foreign bodies and malignancies are much less common causes, but can be serious if not diagnosed and treated correctly.
What is the best way to stop a nosebleed?
The first thing to realize is that most nosebleeds will stop easily without losing a harmful amount of blood, even though it looks like a lot of bleeding. Start by pinching all the soft parts of your nose together between your thumb and two fingers, press firmly towards the face, compressing the pinched parts of the nose against the bones of the face. Keep head upright (not leaning back as this will cause blood to be swallowed which is irritating to your stomach) and pinch for at least 5 minutes. If bleeding persists clear the nose of the clots by sniffing forcefully, apply Afrin or Neo-Synephrine decongestant spray and pinch again for another 5 minutes. If this is not successful call your doctor and continue to hold pressure.