Nasal / Sinus Disease
Turbinate coblation is an effective treatment that removes the tissue that causes nasal obstruction with radiofrequency technology. Patients who suffer from nasal obstruction have enlarged turbinates that affect their breathing and block the nasal passage. This procedure can also be used to treat chronic nasal congestion, facial pressure and nasal drainage.
During the procedure, which may be performed in the office under local anesthetic, a special wand is inserted into each turbinate to carefully reduce excess tissue, instantaneously decreasing the size of the turbinate.
After the procedure, the turbinate will continue to shrink, relieving nasal obstruction and restoring normal breathing.
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Septoplasty is a surgical procedure to correct defects or deformities of the septum. The nasal septum is the separation between the two nostrils. In adults, it is composed of both cartilage and bone. The nasal septum has three functions: support the nose, regulate air flow, and support the mucous membranes of the nose. The goals of nasal airway surgery include the following: To decrease nasal obstruction and improve airflow through the nose, to control nosebleeds, to enhance visualization of the inside of the nose, to relieve nasal headaches associated with swelling of the inside of the nose, and to promote drainage of the sinus cavities. Nasal airway surgery is done through the nostrils without the need for external incisions.
Patients who undergo septoplasty can usually return home the same day or in the morning after surgery. Risks or complications are relatively rare. Recovery symptoms may include bleeding, swelling, bruising, or discoloration.
A rhinoplasty (nasal reshaping) may be done in addition to a septoplasty when the anatomic cause of nasal dysfunction requires this. We do not perform cosmetic nasal procedures.
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Sinusitis is a condition that refers to an inflammation of the lining within the paranasal sinuses. Sinusitis can be classified by location:
- maxillary, which causes pain or pressure in the cheek area;
- frontal, which causes pain or pressure above and behind the eyes;
- ethmoid, which causes pain or pressure between or behind the eyes; and
- sphenoid, which causes pain or pressure behind the eyes.
Sinusitis can also be classified by duration: acute lasts for four weeks or less, subacute lasts four to twelve weeks, chronic lasts more than twelve weeks, and recurrent, which consists of several acute attacks within a year.
Most acute cases of sinusitis are caused by an inflammation of the sinuses that eventually lead to a bacterial infection. With chronic sinusitis, the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed, possibly due to allergies, nasal polyps, or asthma.
Nasal polyps are benign growths that develop within the lining of the nasal passages or sinuses. If large enough, these growths may block the passages and cause breathing difficulties, sinus infections or other complications.
Nasal polyps are most common in adults, especially those with asthma or allergies. Children with cystic fibrosis are also at a higher risk of developing nasal polyps. They often develop in occurrence with respiratory diseases such as sinusitis and allergic rhinitis or immunodeficiency conditions.
Most patients with nasal polyps may experience nasal congestion, as well as runny nose, headache, facial pain, loss of smell or taste and sinus pressure. Some patients may not have any symptoms if the polyp is small.
Treatment for nasal polyps is often provided through medications that can reduce the size of the polyp or even eliminate it. Medication may be in the form of pills, nasal sprays or allergy shots. Surgery may be required to remove the polyp if medication is unsuccessful, and may include a polypectomy or endoscopic sinus surgery to either suction out the polyp or remove it carefully with tiny instruments.
Endoscopic surgery may be needed when medicine has failed to improve or cure chronic sinusitis. In endoscopic sinus surgery, an endoscope is inserted into the nose, providing the doctor with an inside view of the sinuses. Surgical instruments are inserted alongside the endoscope. This allows the doctor to remove small amounts of bone or other material blocking the sinus openings and remove growths (polyps) of the mucous membrane. The surgery is done under general anesthesia and is usually an outpatient procedure. The procedure often takes 1-2 hours depending on the severity if the underlying problem.
Minor discomfort and bleeding are common during the first 2 weeks after surgery. Weekly visits to the surgeon may be necessary for about 3 weeks after the surgery to have dried blood and mucus removed.
Recovery also may involve:
- Bloody drainage.
- Taking antibiotics.
- Using a nasal spray containing a steroid for 6 months or longer to reduce inflammation.
- Using saltwater washes (saline nasal lavage or irrigation) to keep the nasal passages moist.
- Avoiding activities such as blowing the nose, exercising strenuously, and bending forward for a few days.
- Using a humidifier to keep room air moist, especially in the bedroom.
Endoscopic surgery improves symptoms in about 90 out of 100 people. But surgery does not always completely eliminate sinusitis. Some people may need a second operation.
Surgery is most successful when used along with medicine and home treatment to prevent future sinus infections. A second surgery and future sinus infections may be avoided if antibiotics are taken to prevent reinfection.
As with any surgery, there are always some risks involved. But endoscopic sinus surgery is very safe when performed by an experienced surgeon who has special training with endoscopic surgical techniques.
Minor complications (such as scar tissue attaching to nearby tissue, or bruising and swelling around the eyes) occur in a small number of people who have the surgery. Major complications (such as heavy bleeding, eye area injury, or brain injury) occur in fewer than 1 out of 100 cases. Most complications of endoscopic sinus surgery can be managed or prevented.
Balloon sinuplasty is a minimally invasive procedure used to treat chronic and recurrent acute rhinosinusitis that is causing persistent symptoms despite prolonged medical treatment. This FDA-approved technology has been available for use in the operating room since 2005, and this procedure has been performed in over 300,000 patients nationwide and counting.
This procedure can be performed in the operating room under general anesthesia, but may also be an option for select patients to have this treatment under local anesthesia in the office. The procedure is less invasive than traditional sinus surgery, and equally effective at relieving symptoms of chronic sinusitis. Unlike conventional endoscopic sinus surgery, it does not include removal of bone or tissue from the nose.
When performed in the office, it is similar to a dental procedure. Topical and local anesthetics are applied in a relaxed environment. The sinuses are visualized with an endoscope and camera, while a lighted guide-wire is positioned atraumatically into the sinus to be dilated. The physician then inserts a small balloon, similar to those used for cardiac angioplasty, along the wire inside the catheter. Once the balloon is properly positioned, the doctor inflates it and dilates the sinus opening. As the deflated balloon is removed, the sinus drains. The patient feels a decrease in pain and pressure, and the procedure is over. If necessary, the sinus can simultaneously washed out. There is no removal of tissue, so bleeding is minimal. The procedure is very well tolerated, especially in properly selected patients.
The procedure is also very safe, with very low risk for complications. Return to normal activities is typical 24 hours later. Patients return for a follow-up visit so the dilated sinus openings can be visualized.
Advantages of this procedure include minimal invasiveness with no tissue removal, reduced bleeding, quick recovery and less pain, no nasal packing, no general anesthesia or operating room and the associated costs, and preservation of future treatment options if needed.
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