Question: I have a diagnosis of a nasal polyp of the left nasal passage. I scheduled for a CAT scan and was told will probably need surgery. Most comments from patients who have had this type of surgery have very negative about post-op comfort and length of recuperation. Are there different surgical procedures which would result in less negative feedback? How frequently do nasal polyps grow back requiring repeat surgery?
Answer: First of all, thank you for your question. Nasal polyps are growths in the nose and sinuses that can block both the bleeding and the sinus openings. This can make breathing through the nose difficult, exacerbate asthma and lead to chronic or recurrent sinus infections. We try to get the nasal polyps to shrink down medically so that the symptoms improve. If we are successful then the surgery is not usually necessary. However, when the symptoms persist we do recommend endoscopic sinus surgery as an adjunct to ongoing care. Nasal polyps are frequently caused by allergies but can also be caused just by other recurrent infections or sensitivities. Unfortunately, surgery does not cure the underlying problem and polyps can recur. Postoperative care is quite important to lessen this possibility.
Today, endoscopic sinus surgery is done with minimally invasive techniques. We almost never use packing in the nasal passages today. Often, we can use balloon sinuplasty to open the sinuses which is much less invasive than other techniques. The procedures are done with image guidance- sort of like a GPS for the sinuses- which allows us to see real-time where we are on your CT scan- with submillimeter precision. We are using drugs including stents after surgery in many patients which further improves their course. With such techniques, most patients do not really complain of much pain after surgery.
We would be happy to see you at the New York Sinus Center and review what your options may be.
I hope this clears things up.
Robert L. Pincus MD
Co-director New York Sinus Center
Question: Thank you very much for allowing us to ask questions. I have atrophic rhinitis. Can this be caused by allergies? I have many airborne allergies. Also, how would you culture the bacteria? Mucous? Or swab (this does not seem to work)? I took one month of Levaquin and for that month and the month after I felt great. Then it came back. Is there a better protocol? I saw medical articles that said three months of Cipro, or rifampin or streptomycin injections where curative.
Any guidance would be truly appreciated.
Thanks for your question. Atrophic rhinitis implies that the tissues of the nasal and sinus cavities are damaged and have lost much of their ability to function well. The job of the nose and sinuses is to humidify and warm air (to 98.6 degrees and 100% humidity) by the time the air gets to the back of the nose. The mucous is both a lubricant and catches particles (viruses, bacteria, dust, etc.) and brings them down the back of the nose to the throat where they are swallowed and destroyed by stomach acid.
Atrophic rhinitis is usually NOT caused by allergies- but more commonly by damage to the tissues- either from removing too much during a surgical procedure- or from scarring from infection, caustic nasal medication (cocaine, Afrin abuse) or sometimes an unknown cause. Allergic rhinitis is called Atopic rhinitis- so you just want to be sure of the correct terminology.
Atrophic rhinitis can be best treated often with topical medications in the nose- ointments such as Bactroban placed on a fingertip just on the inside of the nose- and with nasal rinses (Saltaire, NeilMed)- at times with medications such as antibiotics and steroids in the rinse. Alternatively, the use of sinus nebulizers (deliver fine mists) with hypertonic (extra salty) salt water with or without the same medications can be helpful.
Sinus cultures need to be taken off the mucous directly where it comes out of the sinuses to be accurate. This needs to be done with a telescope in the nose (a blind nasal swab is not helpful), and I would expect this to be done by any sinus specialist. While we know the most common organisms causing sinus infections statistically, each individual may have an unusual organism, and it is always best to treat with the most appropriate antibiotics when needed.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
Associate Professor Otolaryngology, NY Medical College
Question: Why do I have a constant pressure from top to bottom of my nose? Also difficulty breathing sometimes with mouth closed. I also think that there is odor from my sinus. Is this one of the symptoms of chronic sinusitis?
Thanks for your question. While it is impossible to say for sure from your description, it is quite likely that you have a sinus infection. Sinuses are spaces around the nose that make mucous and drain into the nose. If the sinus openings get blocked, the mucous cannot drain and one tends to get a secondary bacterial infection. This can feel like a pressure sensation. The swelling of the lining of the nose makes it difficult to breathe freely through the nasal passageways. Bacteria growing in the closed environment of the blocked sinuses can make pus which will have a bad odor.
These are 3 of the cardinal signs of a sinus infection.
This is the section from our website www.nysinuscenter.com that describes the symptoms of a chronic sinus infection:
Symptoms of Chronic Sinusitis
Sinusitis usually causes nasal stuffiness and a feeling of pressure or pain in the face and head. It often causes a thick discolored nasal discharge, cough, even severe asthma, loss of ability to taste and smell, pain in the upper teeth, bad breath, a generalized feeling of fatigue and feeling sick. If you are experiencing any or all of these symptoms, a doctor’s evaluation can help determine the underlying cause. Contact us today for an appointment.
I would suggest you have a medical evaluation by a sinus specialist either here at the sinus center or near you if you’re not in the NY area.
I hope this clears things up.
Robert Pincus MD
C0-Director NY Sinus Center
Question: After always having trouble breathing through my nose (with my mouth closed) when sleeping on my right side, I asked my PCP to check, and he informed me that I have a deviated septum which could explain it. Since I can’t ever remember being able to breathe easily through my nose with my mouth closed while sleeping (and not snoring), I’m writing you to see what may be the issue and if I might be a candidate for some sort of deviated septum correction.
Answer: Thanks for your question.
The most likely cause of your breathing problem is a “deviated” septum. The septum is a wall that separates the nasal airway into two separate passages and is never completely straight. Unfortunately, either from birth or from trauma, this wall may be twisted and block either one or both sides of the nose. First, I would suggest an ENT examination to make sure that is the cause of your symptoms. Other problems, such as nasal polyps (benign nasal growths) can block one side or the other- or both, as well.
If a deviated septum is the cause, this can be readily fixed with a minor surgical procedure. Straightening the septum, by the way, does NOT change the appearance of the nose, nor should you get black and blue from this. Frequently, people have coupled cosmetic surgery (rhinoplasty) at the same time, which does both.
I hope this clears things up. We’d be happy to see you here at the Sinus Center and help figure out how to best improve your breathing.
Robert Pincus MD
Co-director NY Sinus Center
The Wall Street Journal looks at the value of nasal washing and the benefits daily use brings. While there are many different techniques, SaltAire is featured for its ease of use and effectiveness for airline passengers trying to fight off colds caused by germ-filled cabin air. Regular nasal washing can relieve congestion and other symptoms associated with chronic sinus problems and reduce the need for medication and natural brands (with only salt water), such as SaltAire are shown to be as effective as those with added active ingredients, such as xylitol.