Nasal & Sinus Conditions

Chronic and Recurrent Sinusitis

Over 35 million people in the United States suffer from chronic or recurrent sinus infections, making it one of the most common conditions people have. It has an adverse effect on the quality of our lives. When the sinus outflow tracts get swollen and obstructed mucus and pus builds up and the sinus linings become inflamed. Common symptoms include sinus pressure and pain, thick nasal discharge, nasal congestion and obstruction, diminished smell, post-nasal drainage, cough and sore throat.

A viral infection often precedes sinusitis. Other predisposing conditions include allergies, deviated nasal septum and polyps.

There are different types of sinus infections:

  • acute (less than 4 weeks)
  • subacute (4-12 weeks)
  • chronic (greater than 12 weeks)
  • recurrent (greater than 4 episodes/year)

Treatment is directed at relieving symptoms and re-establishing sinus drainage and ventilation. Some infections will resolve with saline (salt water) sprays, decongestants, acetaminophen or ibuprofen. Others might require antibiotics, nasal steroid sprays or perhaps surgery.

Deviated nasal septum

The nasal cavity is separated into two chambers by a vertical structure called the septum. It is made of cartilage and bone and lined by the same mucous membrane of the sinuses, turbinates and eustachian tubes. A crooked or deviated septum can cause nasal obstruction, sinus headaches, sinus infections, post-nasal drainage, noisy breathing during sleep, mouth breathing/dry throat and nosebleeds. Surgery or septoplasty is an operation to fix this problem.

Sinus Headaches

Sinus headaches may occur in or around the face including the cheeks, between or behind the eyes  and forehead. Sinus infections may cause these but other conditions may be responsible too. Deviated nasal septum, allergic rhinitis, polyps, dental infections and other inflammatory conditions my cause these type of headaches. Migraine headaches can also mimic sinus headaches. A complete ENT evaluation including nasal endoscopy can help sort out the cause of your headaches.

Rhinitis

Inflammation of the nasal cavity or rhinitis results in nasal congestion and obstruction, nasal discharge, postnasal drainage, mouth breathing, nosebleeds and altered breathing and sleeping at night. Allergic rhinitis can be seasonal (SAR) or perennial (PAR). Some people suffer with both. Other forms of non-allergic rhinitis may be caused by infection, medications, eating, weather/temperature changes and hormonal changes associated with pregnancy and menopause.

Nasal fractures

A broken nose from trauma may result in swelling or bruising which subsides in about a week. Many times nothing has to be done for this. If the nose looks crooked the bones may need to be realigned within a short period of time before they heal. This golden window to straighten the nose is around 14 days. If you have had recent trauma to the nose make an appointment soon so that proper treatment can be offered in a timely manner.

Nosebleeds

Epistaxis or nosebleeds are very common and extremely annoying. They always seem to occur at inopportune times. Allergies, deviated nasal septum and dry cold air contribute to this problem. Nasal moisturizing sprays and gels can help. Finding the root cause is important to correct this condition. Sometimes the nasal membrane has to be cauterized or the nose packed to stop the bleeding.

Nasal polyps

Polyps are benign growths or swellings of the lining of the nose (mucous membrane) often associated with allergic rhinitis and possibly asthma. Polyps may cause nasal obstruction, loss of smell, and sinusitis. These may be removed in the office or during endoscopic sinus surgery. They may recur later and require additional treatment or surgery.

 

Nasal Procedures & Treatments

In-Office Balloon Sinuplasty

Balloon Sinuplasty (BSP) is a breakthrough technological minimally invasive surgical procedure to treat chronic and recurrent sinus infections. It is a proven and safe alternative to endoscopic sinus surgery (ESS). It is performed in Dr. Coppola’s office. Unlike ESS, which is typically done in the operating room under general anesthesia, balloon sinuplasty is done under local anesthetic and does not require removal of sinus bone or tissue.

A small balloon catheter is inserted into the nose and advanced into the natural sinus opening or ostia. When the balloon is inflated, it restructures and widens the bony walls of the sinus passageway while maintaining the integrity of the sinus lining. Patients are able to return to work the next day and resume normal activities in two days.

Advantages of In-Office Balloon Sinuplasty

  • Done under local and topical anesthesia
  • Fast recovery
  • Done in a comfortable office setting
  • High patient satisfaction
  • Significant cost savings

Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is performed on patients who have chronic or recurrent sinus infections. This is done in the operating room under general anesthesia. Bony partitions and membrane are removed to create an open ethmoid sinus cavity. Other sinus openings are enlarged by removing additional bone and tissue. The goal of ESS is to re-establish ventilation and drainage of the sinuses so they can function normally again. After care involves using saline spray and irrigations for a period of time. Sometimes steroids or antibiotics are added to the irrigation so they can be directly applied to the sinus membranes.

Polypectomy

Polyps can cause severe nasal obstruction and diminished smell. These benign inflammatory growths may be associated with allergies or asthma. They arise from the mucous membranes lining the intranasal structures and can block the sinuses from functioning properly. Polypectomy is the removal of these growths that may be done during sinus surgery or other nasal procedures. Steroid nasal sprays and allergy management are critical to preventing or reducing polyp recurrence. Long-term surveillance is important to monitor and detect recurrences sooner than later.

Septoplasty

A deviated nasal septum can interfere with nasal breathing. Increasing septal deformity results in greater degrees of nasal obstruction. Symptoms include increased respiratory effort at rest or with exercise, nosebleeds, dry mouth, snoring and disrupted sleep, and more stubborn sinus infections. Trauma to the face or nose may result in septal deviation even without nasal or facial fractures. Some people are born with this condition that becomes more noticeable with facial development and growth. Many people with this problem have reduced quality of life because of impaired breathing. A good ENT exam and nasal endoscopy can determine if you have this condition. Call our office to schedule an appointment and get evaluated by Dr Coppola.

Rhinoplasty

Nasal surgery to reshape the appearance of the nose is called rhinoplasty. This is done for cosmetic reasons to make the nose smaller, remove a nasal hump or restructure the nasal tip. Sometimes rhinoplasty can improve nasal function and breathing. Many times this is done with septoplasty or turbinate surgery.

Turbinate Surgery

Each nasal cavity has three pairs of turbinates that originate from the sidewall of the nose. These projections are made of bone and covered with mucous membrane. They warm and humidify the air we breathe and secrete mucus to lubricate our nose and throat. Allergic rhinitis often causes progressive enlargement of these structures resulting in nasal congestion and obstruction. Anatomical deformity of these may also contribute nasal blockage and impaired sinus function. Turbinate reduction is often done with septoplasty or sinus surgery to improve the nasal airway.

Implants

In the last few years, new technologies have been developed including the use of nasal and sinus implants to improve outcomes with nasal and sinus surgery. The Propel implant is a biodegradable device used during sinus surgery and polypectomy to reduce swelling and improve wound healing. As it dissolves, steroid is released into the sinus tissues promoting better healing. The SINUVA implant is a similar device that can be used in the office for recurrent polyps or in patients who have had endoscopic sinus surgery. Finally, the LATERA implant is used to strengthen the sidewalls of the nose. Sidewall collapse or weakness results in nasal obstruction. This technology can be used by itself or done at the same time as septoplasty.