Sinusitis is a common but often difficult problem affecting 37 million Americans each year, at great cost to patients and society as a whole. Studies have shown sinusitis affects patients just as much as coronary artery disease, COPD/emphysema and low-back pain.

Regardless of cause, the endpoint of sinusitis is inflammation of the mucus membranes (surface tissue) in the nose and paranasal sinuses. This results in any combination of the following:

• Nasal Congestion or Obstruction
• Runny Nose
• Decreased Sense of Smell
• Facial Pain or Headache
• Fever and Generalized Malaise
• Post-Nasal Drip and Cough
• Bad Breath
• Tooth Pain

Making an accurate diagnosis of the actual cause is the key to getting well. The first step is a careful and thoughtful interview, getting at the exact nature of your symptoms. Next, an examination is focused on the lining of the front of the nose and the throat, as well as any swelling or drainage.

What makes an ENT examination of sinusitis truly specialized is a view further back in the nose with an endoscope. Examining the nose with a “scope,” or flexible camera, allows us to see areas not visible from the front. The exam is usually brief and care is taken to make it as easy as possible with the use of a topical decongestant/local anesthetic spray. With the addition of these sprays, the endoscopic exam can be comfortably tolerated right in the office.

Imaging of the sinuses is another useful piece of data, though diagnosis is never made by a scan alone. The nasal anatomy often does not allow a view into the sinuses themselves. CT scanning is the standard means of assessing for inflammation within the sinuses that may not be evident within the nose. Examining the two-dimensional and three-dimensional structure of the sinuses can also provide evidence for why some people have recurrent problems.

The treatment of sinusitis usually begins with medication. The mainstay of the medical treatment is antibiotics. Oral steroids, nasal steroids and nasal saline irrigations may also be added. We are dedicated to operating only when medical management fails, and we continue to develop new and innovative methods of non-surgical topical treatment.

Balloon Sinuplasty is a breakthrough procedure that relieves the pain and pressure associated with chronic sinusitis for patients who are not responding well to medications. In a procedure similar to angioplasty, a balloon is used to open blocked arteries. This procedure is less invasive than traditional sinus surgery and enables most patients to return to normal activities quickly. For more information about this procedure, please visit www.balloonsinuplasty.com.

The inside of the nose is an elegantly arranged channel of multiple bones and cartilages, all covered and lined by tissue called mucosa. The nasal septum stands vertically in the center of the nose, separating the right from the left nasal passage. While the septum ought to be fairly straight, it may develop curvatures or spurs that block the passage of air. This is frequently called a “deviated septum.” 

In contrast, the turbinate bones are curled or comma-shaped bones which originate from the sidewalls of the nose and project inward into the nasal passage. Their presence actually helps create a smooth flow of air through the nose. In certain diseases, such as allergic rhinitis, the turbinates may enlarge or become poorly oriented within the nose, obstructing airflow. 

Obstruction to breathing through the nose can be a real detriment to your daily life. Mouth breathing is uncomfortable and unsightly, interferes with eating and leads to a dry mouth, chapped lips and a sore throat upon waking in the morning. 

Secretions may become stuck in obstructed areas of the nasal airway. Outflow from the paranasal sinuses may become blocked, leading to recurrent sinusitis. Orthodontists, oral surgeons and ENT surgeons alike recognize that nasal obstruction and chronic mouth breathing in your formative years can even result in abnormal facial growth. 

Nasal obstruction and mucosal inflammation may be evident upon simply looking into the front of the nose. However, a deeper view into the nasal passages may be required to better diagnose nasal pathology or to more carefully understand the exact point of obstruction. In these cases, an endoscope, or fiberoptic camera, may be useful for examining the internal nasal anatomy. The exam is brief and, with the use of topical anesthetic/decongestant spray, well tolerated in the office. A computed tomography (CT) scan may also assist in further understanding diseases that result in nasal obstruction. 

Often, diseases of the nasal mucosa, such as allergy or infection, result in swelling of the surface soft tissues that may conspire with otherwise minor deviations of the septum to cause obstruction. In these cases, medical management is often effective at reducing just enough swelling in the nose, that despite minor septal deviation, obstruction is relieved. 

In other cases, however, swelling of the surface tissues is not the key issue. The obstruction is simply a matter of anatomic structures. In these cases, surgery is indicated. Straightening the septum and reducing the size of the turbinate bones relieves the obstruction in most patients. 

Septoplasty is an outpatient procedure performed under general anesthesia. It involves an incision inside the nose and the correction of the deviated portions of the nasal septum. The external appearance of the nose remains unchanged from a septoplasty, but breathing can be greatly improved. Inferior turbinate reduction can be accomplished through a variety of means, the choice of which is based on individual variables. 

Septoplasty and inferior turbinate reduction procedures may be performed together. If more extensive reconstruction of the nasal framework is necessary, such as to correct functional collapse of the nasal “valves,” a septorhinoplasty may be required. 

Because the nose stands projected from the central aspect of the face, and because it is an important part of our airway, its form and function are key aspects of ENT health. However, its location also makes it a common point of facial trauma. A nasal fracture may result in misshapen nose and in a blocked nasal airway.

Increasingly, we have found that deep sedation and general anesthesia are no longer required to set displaced nasal bones, or even to correct a crooked nasal septum. Carefully administered local anesthetic, sometimes in conjunction with a mild sedative pill, allows us to manage displaced nasal bones and even a displaced nasal septum in the office setting. The risks and downtime of deeper anesthesia are avoided and patients benefit from the convenience of the private office setting.

Chronic nose bleeds are an increasingly common problem. As more and more people are treated with blood thinning medications chronic nose bleeding has increased in frequency and severity. Treatment of nose bleeding can range from simple moisturization to temporary packing to cauterization. Our practice can perform electrical cauterization (the most powerful form), in the office under local anesthesia.

It is frequently necessary to improve the external contour of the nose to completely correct nasal and sinus disorders. We offer cosmetic surgery of the nose when combined with surgery to improve nasal breathing or sinus function. This can frequently be covered under most insurance.

The anterior skull base can be thought of as the roof of the nose. This area is composed of the junction of the brain, pituitary gland, olfactory nerves (sense of smell) and the nose. Tumors can grow in this area that can be either benign or malignant (cancer). Patients who have had traumatic head injuries or complications from sinus surgery may present with clear fluid drainage from the nose – usually one side; this may be a spinal fluid leak (CSF). CSF is the fluid that surrounds your brain to protect it from injury. If a CSF occurs, patients will often have headaches. it is important to repair this in order to resolve the headaches and more importantly to prevent meningitis.

In order to address problems in this area our team approach provides patients with many options. Members of the team include otolaryngology (Dr. Hoff and Dr. Akervall) as well as neurosurgery for benign tumors and spinal fluid leaks. For malignant tumors our multidisciplinary head and neck cancer team also includes radiation oncology, medical oncology, pathology, radiology, all coordinated through our nurse navigator.

Tumors of the nose and sinus are rarely occurring and can be benign or malignant. These can cause pain, bleeding, or loss of sense of smell and taste. These tumors frequently require imaging studies, nasal endoscopy and biopsy for diagnosis. Treatment may include surgery, radiation treatment and or chemotherapy.

Reduction in the sense of smell and taste are common as we get older. It can also be due to head trauma or drug side effects. Sometimes the loss of smell and taste represents nasal or sinus obstruction, sinus polyps or infection and can potentially be corrected. Evaluation requires a full nasal examination and sometimes imaging studies.