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Is it Time for Sinus Surgery?

Question

Hello, First off, thanks for taking the time to read and answer.

I have been having sinus issues for about 6-7 years now. At first I just dealt with it—runny nose, sinus infections, etc. Rarely took anything, just figured it was normal colds.

Sinus Surgery For Sinusitis So after 3 years or so, I noticed my left nostril would be blocked. It ended up being blocked about 95% of the time. I went to see an ENT. They took a CT scan. Said I had mucus filling all my sinus cavities. They also said I had a deviated septum.

Not real bad except in one area where they said “Severe deviation”. They prescribed Flonase at the time. I tried it, worked OK, but whether it was the medicine, or me just getting worse, my sense of smell and taste really started to go away. I still had a faint sense, but it wasn’t nearly as good. I quit the medication for fear it was the issue.

After another 2 years of suffering and taking allergy pills which seemed to help (Alegra), I went to my allergist. I could hardly smell at all anymore and I was getting very depressed about it.

These people were 100% more caring and helpful. They looked at my old CT scan, told me it showed infection, which the ENT never said anything about. They tested me for environmental allergies, and I was basically allergic to everything, pets, grass, dust, mold, trees, etc. But, I rarely get itchy eyes, its just congestion and constant clear bubbly mucus.

I blow it out, more there, blow it again, more there. They prescribed Prednisone and an anti-biotic to see if we could improve anything. I was also given a nasal inhaler (Q-Nasl). I took the medication and for the first time in years I could smell!! I almost started crying I was so happy.

Blowing noseWell, that only lasted for about as long as the prednisone. I got another CT scan, and they said it was better, but not really much had changed. I still had mucus build up and the infection. Over the course of the last year I have taken Q-nasal daily. My sense of smell is now essentially nill.

I can’t taste food and I am at the end. I can’t take it any longer. Over the last 3 weeks I have been taking nettle leaf capsules to try and help with allergies if that is my issue.  I have even gone through nasal irrigation and the “Friggy Flip Turn” sinus rinse method, Google it if you have never heard of it.

That seems to help clear out all sorts of gunk, but my left side is still persistently closed off. I can breathe easier for sure since my visit last year. Lets call it 50% blockage of airflow now on the left side. But my smell is gone still.

But keep this in mind…when I eat food, or want to smell something, If I blow out of my left nostril, I can usually pick up on smells and tastes. So it’s not gone. It came back with prednisone, so I know its still there. After I blow my nose on the left side, you can even hear like pressure releasing and squeaking. I can feel it happen. Its like no room for things to go. Like a big build up with only a small opening but lots of pressure. But why can I hardly smell out my ride side? I would figure with 1 nostril I could still smell a little, but not really.

Question is, is it time for surgery? What else can I do? Will it help bring my smell and taste back? I know there are no guarantees, but is there a good chance that I just have a blockage with my septum, that causes excess mucus and blocks air from traveling to the olfactories? I am thinking of going back to a new ENT and giving them the run through and go from there. At this point it’s hard to enjoy life.

Answer

I would suggest that you carefully research the sinus specialist you ultimately choose to do your surgery, if it is indicated.

Unlike many other types of surgery, different individuals do sinus surgery very differently. I would suggest seeing someone who practices the most up-to-date type of endoscopic surgery, and has a great deal of experience.

Some otolaryngologists are still performing older types of surgery, which are much less successful and in fact can ultimately lead to more problems than you already have.

I hope this helps.

Scott Gold MD

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Developed Sinusitis After Lafort Procedure

Question

I had a Lefort 3 procedure for TMJ and a maligned jaw in October 2014.

Almost immediately after surgery, I felt a tract from my nose running into my cheek, and my cheek on that side was definitely more swollen.

Lefort Procedure ComplicationsThen I developed sinusitis and have been on numerous courses of antibiotics since then with little or no relief. I have seen 2 ENT surgeons. I had two endoscopy sinus biopsies and both were negative.

I now have pressure and pain on my nasal bridge. I still just don’t feel well and have sinus headaches.

Can you suggest anything and possibly consider a 2nd opinion? I have had edodontist care to check my root canals and they are fine.

My 2 CT scans were apparently negative. Please help!

 Answer

I would suggest another ENT and possibly OMFS consultation/opinion. If you are in the New York area I suggest seeing Dr. Robert Pincus or myself at our practice. If you are not in the New York area we might be able to suggest an expert closer to you.

Hope this clears things up!

Scott Gold, MD

 

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I had punctured sinus from left molar extraction. Can an MRI show if my sinus has healed properly?

Question:  

Had punctured sinus (during left molar extraction).  Socket was not closed properly.  Had to have repair work done 4 days later to close socket.
Had bouts of nasal congestion, burning sensation in nasal cavity, light headedness.Tilting my head back seems to help sometimes.

I am not sure my sinus healed properly.  Have had pulling sensation in left nostril.  Noises in left ear have been diagnosed as eustachian tube dysfunction.

First problem with ear was suctioning sound when I yawned (socket had sealed).  Then clicks when  congested.  Now clicks randomly.  Popping sound when I burp sometimes and the most recent is pressure in ear as if underground on train.

Can an MRI show if my sinus has healed properly?  Any image that is not radioactive?

Answer:

First of all, thank you for your question.  The roots of several teeth- especially our molars, can be quite close or actually within the maxillary (cheek) sinus.  Infections in the tooth roots or dental extractions can spread infection into the sinus- and are typically difficult to treat as the oral bacteria are often quite virulent.

Treating odontogenic (dental caused) sinus infections involves appropriate antibiotics- usually best based on an actual culture- and treating the dental problem.

Today, we will often use balloon sinuplasty- opening up the sinus with a balloon in the office- to drain the sinuses if needed.

The best way to see if a sinus infection has resolved is with CT scanning.   Low dose scans can be done, and while the radiation is less than with typical scans, there still is some radiation.  MRI’s use electromagnetic waves rather than radiation, but do not show bone- and tend to over read sinus problems.  They are much less useful, but a normal sinus MRI would probably be enough to avoid using CT scanning.

I hope this clears things up.

Robert Pincus MD, FACS

Co-director NY Sinus Center

 

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have nasal polyps and need sinus surgery

Question:

I have diagnosis of polyp of 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 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 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

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Is bloody mucus a sign of a sinus infection?

Question:  I have this head cold and blow my nose there is blood in the mucus which I think is a sinus infection.

Answer:

Bloody mucus is a sign of irritation in the nose.  This can come from trauma, dryness (quite common in cold weather with the heat on), chemical inflammation,  infection- viral or bacterial, and least likely from a tumor or other growth.  While it is quite common with a sinus infection, there are other causes and if you have this persisting, it should be evaluated by an Ear, Nose and Throat Doctor or Sinus Specialist, using a lighted telescope in the nose to evaluate.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

What could be the cause/reason for on/off nose bleeds from 1 nostril frequently?

Question:  What could be the cause/reason for on/off nose bleeds from 1 nostril frequently?

Answer:

First of all, thank you for your question.  Recurrent nose bleeds (epistaxis in medical terms) is quite a common problem.  We see this most often during the winter when the heat is on.   If we heat room air from 30 to 65 degrees, the humidity drops down to levels one sees in the desert.  The mucous membrane lining of the nose then can dry out and crack, causing a nose bleed.   It there is a prominent blood vessel on one side- or if the septum- (center wall of the nose)  is deviated (twisted)- then there can be a prominent point on the wall that the air hits and dries out faster-   Both of these will cause nose bleeds to be more common on one side.

If you are taking aspirin (even baby aspirin) or a blood thinner- then the bleeding can often become more problematic- as these medictions delay the forming of a clot- or scab-

When the lining of the nose is more swollen (from a cold, allergies or a sinus infection- among other causes)- then there is a greater blood flow to the nasal lining and that also makes people more susceptible to nose bleeds.

Lastly, and thankfully least commonly, there can be a growth- benign or malignant tumor- in the nose that causes bleeding.

Try to keep the nasal passages moist in the winter-  use topical saline sprays, ointments to the tip of the nose, humidifier if you can keep clean,-

If you have a nose bleed-  put some cotton in the nose- with afrin(oxymetazoline 0.05%) if you have- and find a clock.   Then pinch the bottom of your nose for 5 minutes (about the time it takes to form a clot in most people)- but longer if you are taking a blood thinner.

If the bleeding persists, you need to seek medical care-   And if you continue to have bleeding from one side of the nose, even if it stops- it is important to have your nasal cavities evaluated to make sure there is no worrisome cause, and to see if there is a blood vessel that needs to be cauterized.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Will Surgery for a Deviated Septum Help?

Question:  

 

I wanted to know if surgery for a deviated  septum would solve my nasal and sinus passages. I have difficulty breathing due to mucus blockage.  It has gotten so bad it effects the pitch/tone of my voice.

 

Answer:

Thank you for your question.

The septum is a wall that extends from the front of the nose to the back and divides the nose into two passageways.   It is never completely straight, but sometimes will be twisted from side to side so that it blocks the nasal passages.  If is causing enough of a problem in breathing,  your ENT doctor or sinus specialist may recommend straightening the “deviated” septum.  A deviated septum may cause you to sound clogged and may predispose you to sinus infections. (sinusitis)

This is a surgical procedure, done through the inside of the nose.  The surgeon will make a small incision in the lining covering the septum and lift the lining off the cartilage and bone that make up the septum.  Some bone or cartilage may need to be removed, and the rest is placed back in the midline- so as to improve the airway.   There is NO change in the way you look after septal surgery and you should not get black and blue-  That occurs when one gets a rhinoplasty (cosmetic surgery to change the appearance of the nose) at the same time.

I can’t tell for sure that the septum is your problem without an exam.  There are many other causes of nasal obstruction, such as allergies, polyps or even temporarily as you know with a bad cold.  Additionally, one can have the straightest septum in the world, but yet have the nose blocked from any of those problems.  If you don’t have any of the other problems and septum is blocking, it is quite likely that straightening it should improve your breathing and the change in your voice that comes from not breathing well through your nose.

I hope this clears things up.

Robert Pincus MD, FACS

Co-Director NY Sinus Center

Associate Professor Otolaryngology

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have atrophic rhinitis. I felt great after one month of Levaquin, then it came back.

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 levequin 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  3 months of cipro,  or rifampin or streptomycin injections where curative.
Any guidance would be truly appreciated.

Answer:

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 finger tip 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 of 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

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have constant nasal pressure, difficulty breathing through my nose and a bad odor

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.

Answer:

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

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Will balloon sinuplasty help my runny nose and deviated septum?

Question:    

I was diagnosed with a chronic runny nose due to having a small nasal opening for drainage and a deviated septum. Am I a candidate for Balloon Sinuplasty?

Answer:   

Thanks for your question.

Balloon sinuplasty is a wonderful new technique for opening the sinuses.  Sinuses are small air filled pockets around the nose that drain into the nose.  If blocked, we can get recurrent infections of the sinuses.  Balloon sinuplasty is a non-surgical technique in which we find the opening of the sinus, thread a small catheter into the opening, and then briefly inflate the balloon- widening the drainage site.  We then remove the balloon.  The results have been excellent with this procedure.  There is no down time and sinuplasty  is done in the office with just a local anesthetic.

You can read more about this on our web site- below

http://www.nysinuscenter.com/2011/01/balloon-sinuplasty/#more-535

Unfortunately, to date, we have not been using balloons to straighten a twisted (or deviated) septum.  The septum is the center wall of the nose, and while it is never straight, a significant bending or twisting can block up the nasal passages or even make one more susceptible to sinus infections.

If the sinuses are sinuses are blocked, then sinuplasty may have a role in your care.

If you’re in the NY area, we’d be happy to evaluate you for balloon sinuplasty, here at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

212-889-8575

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