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Nose (Rhinology)
Rhinology includes disorders of the nose and sinuses including: sinusitis, nosebleeds, nasal congestion and loss of smell. Our Otolaryngologists are specially trained and experienced in treating these conditions.
Nosebleeds (Epistaxis)
Nosebleeds are a common problem especially during the winter months when the air is particularly dry. Causes of nosebleeds include: allergies, infections, dryness, and trauma.
Nosebleeds can be broken down into 2 types: anterior and posterior. Anterior nosebleeds are common during the winter months when heated, dry, indoor air dries out the nose. Dryness results in crusting, cracking, and bleeding. Posterior nosebleeds are more likely to occur in older people with high blood pressure and can be quite severe and usually require immediate medical attention.
Treatment of nosebleeds. Nosebleeds can be prevented by lubricating the nose with an emollient such as Vaseline®, Ponaris®, or Bacitracin® ointment. Saline nose sprays (Simply saline®, Rhinaris®, Ocean® or Ayr®) are also very useful in humidifying the nose. It is also important to humidify your home with either a tabletop or central humidifier. If the nosebleeds persist, you should make an appointment to see one of our physicians. After a thorough nasal examination, cauterization (sealing) of the bleeding vessel may be required.
Sinusitis
About 35 million people develop sinusitis each year, making it one of the most common health complaints in America. Sinusitis is inflammation and infection that occurs in the thin lining of the sinuses. If the infection continues for more than 3 months or recurrent episodes of acute sinusitis occur more than four to six times per year, the infection can become chronic.
Symptoms usually include: a head cold lasting more than 10 days, thick yellow-green nasal drainage, post-nasal drip, sore throat, cough, bad breath, headache, facial pain or pressure, pain in the upper teeth, swelling around the eyes and face. Not every headache is the result of sinus problems. Migraine or tension headache may cause sinus pain without actually being a sinus infection. These conditions need to be properly diagnosed and treated.
Treatment of sinusitis usually includes: antibiotics, nasal decongestants and topical nasal sprays for stuffiness. Nasal saline drops or sinus rinses can be very useful in washing out infected mucous.
If you experience recurrent sinus infections or are developing a chronic infection, you should see one of our physicians. Medical or surgical treatment of the sinuses may be required depending on the evaluation.
Post-Nasal Drip
The mucous glands in your nose and throat continuously produce mucus which moistens and cleans the nasal membranes, humidifies air, and traps inhaled foreign matter. The feeling that mucous is accumulating in the back of the throat or dripping down the back of your nose is called post-nasal drip. Post-nasal drip often leads to a sore, irritated throat.
Post-nasal drip can be caused by colds, infections, allergies, cold temperatures, certain foods, and pregnancy.
Treatment for post-nasal drip is dependent on the cause. Viral colds are managed conservatively while bacterial infections are treated with antibiotics. Allergies are managed by avoiding the cause if possible, antihistamines, nasal sprays and allergy shots (immunotherapy) if indicated. Sometimes a cause for post-nasal drip cannot be found and the nose produces excessive mucous known as vasomotor rhinitis. This is usually treated in a similar fashion to allergic rhinitis. Surgery may also be indicated in cases where there is an anatomical obstruction causing nasal congestion and thus post-nasal drip. Correcting a deviated septum (septoplasty), shrinking enlarged inferior turbinates (BITR) and sinus surgery may be required for complete treatment.
Snoring and obstructive sleep apnea (OSA)
Snoring is more frequent in males and those who are overweight but can occur in anyone. Snoring sounds are caused when there is an obstruction to the free flow of air through the nose and/or throat. Diagnosis usually involves a thorough airway exam by one of our otolaryngologists and a sleep study.
Treatment is recommend based on these findings. This can include: sleep positioning change, weight loss and if OSA is diagnosed, Continuous Positive Airway Pressure (CPAP), a mask used to improve breathing during sleep. Surgery may be necessary in certain patients depending on the type of obstruction (nasal or throat). Nasal procedures include straightening a deviated nasal septum (septoplasty), inferior turbinate reduction (BITR), sinus surgery (FESS) and removal of nasal polyps if they are present. Throat procedures include: surgery on the palate (Pillar implants®, stiffening the palate with Coblation® and Uvulopalatopharyngoplasty (UPPP) to remove redundant tissue), surgery on the tonsils and adenoids (T&A) may be needed is these structures are enlarged and obstructing.
Nose and Sinus Surgery
Nasal surgery is usually performed for functional purposes (relieving nasal obstruction or opening blocked sinuses) but it can also be combined with cosmetic surgery to remove a nasal hump, straighten a crooked nose or change external features. Our Otolaryngologists are specialists in nasal airway surgery as well as in facial plastic surgery. This combination ensures that excellent nasal breathing is as important as the external appearance.
Deviated nasal septum
Nasal obstruction may be related to structural abnormalities inside the nose such as a deviated nasal septum. The nasal septum is a cartilage and bone wall that separates the nose into right and left halves. If this wall is crooked or bent due to abnormal growth or injury, it can cause obstructed breathing which can cause: nasal congestion, frequent nosebleeds, snoring, increased episodes of sinus infections, postnasal drip or worsen allergy symptoms.
A deviated septum can be corrected with a surgical procedure called a septoplasty where the crooked or bent septum is straightened. Cosmetic changes to the nose can be performed at the same time. The procedure section discusses these procedures in more detail.
Inferior turbinate hypertrophy
The turbinates are bony structures lined with expansile tissue that regulate nasal airflow and produce mucus. Sometimes the turbinates are enlarged causing nasal congestion and obstruction. Inferior turbinate reduction surgery may be necessary to make the turbinates smaller and expand the nasal airway. The procedure section discusses this procedure in more detail.
Nasal fracture (Broken Nose)
Bruises around the eyes and/or a crooked nose following injury usually indicate a fractured nose. The nose will usually become very swollen and ice packs to the nose and eyes are recommended for the first 24 hours. The swelling will mostly resolve in 3-5 days and evaluation by one our otolaryngologists will then be necessary to determine if treatment is needed.
It is important to evaluate whether or not the nasal bones have been fractured and displaced, rather than just fractured and nondisplaced. Displaced fractures can be treated within 2 weeks of the initial trauma when the bones are still mobile. This is done so that the bones will not heal crooked. A closed or open reduction procedure may be necessary for correction. In a small percentage of cases, additional surgery may be necessary one year later after the nose has fully healed if there is some displacement remaining.
Sinus Surgery
Surgery should be considered in sinusitis patients if medical treatment fails or if there is a situation that cannot be corrected with medications such as nasal polyps or chronic sinusitis. Functional endoscopic sinus surgery (FESS) is usually recommended. The procedure section discusses this procedure in more detail.