By Thomas S. Higgins, MD, MSPH
Dad. Husband. Physician. Sinus Nerd.
Looking into the patient's nose, I say to my assistant, “Please document there's a right-sided severe nasal septal deviation” to which the patient exclaims, “Is that normal?”
Well, let's talk about a deviated septum. The nasal septum divides the nose in the midline. It is made of portions of cartilage and bone that help direct the airflow through the nose. A part of the septum also has olfactory fibers on it to help with the sense of smell.
It's been shown that up to 80% of people have a deviated nasal septum. So this begs the question: since most people have a deviated septum, is it actually normal to have a deviated septum? It kind of is, in general, but there are a few factors that should be taken into account. One is the severity of the deviation. A mild deviated septum may not cause any problems, but a severe deviated septum can greatly impact the nasal airflow. So to answer whether or not it's normal depends on if it's causing any problems.
"Up to 80% of people have a deviated septum..."
The most common problem from a deviated septum is blockage of the nasal breathing. A deviated septum can also contribute to recurring nosebleeds because the air you breathe dries up the lining, causing tiny blood vessels to burst. Other symptoms include crusting from dryness and decrease in smell because of lack of the ability of air to reach the olfactory nerves.
So, nasal septal deviations are not necessarily abnormal; however, those causing symptoms may benefit from surgical correction. There's not really a medicine that can correct a deviated septum because it is an anatomic anomaly. Sometimes topical sprays can help with the symptoms of obstruction by decreasing the inflammation around the deviated septum. If you are having nasal congestion, ask your doctor about it. You likely have a deviated septum (well, because most people do); an expert can help determine if it’s contributing to your issues.
By Thomas S. Higgins, Jr., MD, MSPH
Dad. Husband. Physician. Sinus Nerd.
Getting rid of a sinus infection depends on the cause, so anyone who lists only one way to get rid of a sinus infection is not informed. Here is a list of remedies to consider based on the cause.
4 Treatments for 4 Different Sinus Conditions:
1. For a snotty nose that just started, the cause is likely a viral "cold" and humidification, decongestants, and saline nasal rinses, are helpful to get you through it.
2. For drainage lasting a week, especially if worsening, the cause is likely bacterial and antibiotics are helpful.
3. For headache and facial pain without drainage, consider something not related to the sinuses, such as tension headache, migraine, and facial muscle tension. The right treatment starts by knowing the right diagnosis.
4. For symptoms lasting over 3 months, you may have "chronic sinusitis" and you should consult a specialist. Things get complicated here and getting help is the way to go. You shouldn't have to go at it alone!
Author: Thomas S. Higgins, MD, MSPH
Dad. Husband. Physician. Sinus Nerd.
The treatment of nose and sinus conditions has advanced markedly over the past few decades. Our understanding of the mechanisms involved in the body's inflammatory cascade has allowed development of new therapies. Advancements in functional endoscopic sinus surgery, image guidance, and balloon sinus ostial dilation have made surgical intervention much safer with far easier recovery than in the past when open procedures were standard and complications were more common. Here, I will summarize what I see as the innovations in nose and sinus treatment for 2019.
1. Advancements in Nasal Polyposis Treatment
In the past, the treatment of nasal polyps was straightforward. The doctor would just look in the nose with a headlight and grab as many polyps as could be seen or until the patient could breathe again, then tamponade the bleeding. Researchers now recognize that different kinds of nasal polyps exist, and they are often associated with severe inflammation. A combination of surgery and medical therapies are often necessary. From topical therapies to medications specifically targeting the receptors of inflammation, many therapeutic options are now being studied and broadening the treatment algorithm.
2. Minimally-Invasive Procedures for Nasal Valve Stenosis
The nasal valve is a narrow part at the entrance of the nasal passageways. It can contribute to nasal obstruction when the nostril is either narrow (often a slit-like opening) or collapsing when sniffing. Nasal valve stenosis, as it is called, is the reason some athletes wear nasal strips as they temporarily stent open the nose. Surgical management using closed or open nasal valve repair or rhinoplasty techniques can be effective, but they often are associated with delicate soft tissue dissection, general anesthesia, and prolonged recovery with bruising. New techniques have been developed to address nasal valve stenosis in the office and quicker recovery.
3. Expanded Image Guidance Technology
Image guidance is like a GPS system surgeons can use to determine exact location (to a millimeter or so) in which their instruments are in the sinus cavities. This system helps surgeons thoroughly investigate the surgical site and avoid severe complications from injury of surrounding structures. Because the advances in computer science, image guidance systems are now getting important updates, including higher accuracy, mapping of the sinus pathways, warnings for encroachment on vital structures, and virtual endoscopy.
4. Cryotherapy for Chronic Rhinitis
Have you ever noticed all the grandpas and grandmas who have tissue paper with them to wipe the constant drip from their noses? This drip is a form of vasomotor rhinitis (a nerve-generated runny nose). A nasal spray may help, but it is not always effective and some may not like its drying effects. There is a surgical approach to cut the nerve responsible for this condition; however, the surgery can be challenging and cause severe dry eye. New technology permits freezing the nerve to deactivate it in the office. Research has shown effectiveness, although it is still too early to know exactly how long the symptom resolution lasts.
5. 4K HD Video Medical Monitors
This one shows how far healthcare lags behind the general market in digital technology. Homes all across the world have 4K Ultra HD televisions now. And we are excited about 4K Ultra HD monitors? Doctors are going to be bragging about having 4K monitors and going home to their 8K HD television sets! Anyway, these monitors do greatly enhance our visualization, so they are still a medical innovation worth mentioning.
These innovations are helping doctors treat nose and sinus conditions better than ever before. As our understanding of the complexity of these conditions expands, researchers continue to discover more effective and safer treatment options. It is an exciting time to be involved in the care and research of rhinologic problems.
Every 10 years, American and International Rhinology Societies collaborate to host a large meeting of experts from around the world, called RhinoWorld, the premier congress for rhinologists. This year's meeting will be held in Chicago, IL. Dr. Thomas Higgins was invited to be faculty and provide his expertise in the management of chronic sinus conditions. The website for RhinoWorld Chicago 2019 states, "The faculty are broad and deep, representing major centers in the United States and internationally." Dr. Higgins is honored and excited to take part in this grand meeting.
See the meeting website at www.rhinoworld2019.com. See the list of invited faculty, including Dr. Thomas Higgins.
Dr. Thomas Higgins wishes everyone happy holidays! Click below for a special message.
8/22/2018 0 Comments
Wave 3 News of Louisville, KY stopped by the Springs office to talk to Dr. Thomas Higgins about a novel device, called Propel, used for chronic sinusitis after functional endoscopic sinus surgery. Watch the interview here.
Learn more about chronic sinusitis.
Learn more about functional endoscopic sinus surgery.
Dr. Thomas S. Higgins, Jr.
Nasal surgery provides many benefits in the treatment of obstructive sleep apnea (OSA), says the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS). Nasal surgery is considered any surgery of the nasal passages to improve nasal breathing, such as septoplasty and inferior turbinate reduction. According to the AAOHNS Position Statement from September 8, 2017, here are four evidence-based benefits of nasal surgery in OSA.
1. Nasal surgery improves the use of Continuous Positive Airway Pressure (CPAP), the mainstay treatment for OSA. Many people do not tolerate CPAP, often throwing the mask off in the middle of the night. A CPAP mask on the nightstand doesn't help at all!
2. Nasal surgery may improve the use of oral appliances. Oral appliances are used to pull the jaw and/or tongue forward at night to open the airway. A couple of studies have shown that many of the people who are unable to tolerate such appliances are those with higher nasal resistance, so reducing nasal resistance could improve compliance.
3. Nasal surgery improves quality of life in people with OSA. Two quality-of-life scales, the Epworth Sleepiness Scale and the SF-36, improve significantly after nasal surgery, with decreases in excessive sleepiness along with improved general health and mental health scores.
4. Nasal surgery can reduce the severity of OSA in some people. A few studies, including a randomized control trial, showed improvement in OSA severity, after nasal surgery alone. These results certainly do not indicate that nasal surgery is the cure for OSA, but they do show direct beneficial effects of nasal surgery on OSA.
The evidence currently shows that nasal surgery provides benefit to OSA sufferers. Can it take away OSA? Usually not, but it can help make the treatment easier. Thanks for reading this article. Don't forget to check out other related topics, including septoplasty, inferior turbinate reduction, and functional endoscopic sinus surgery.
Ref: http://www.entnet.org/content/nasal-surgery-and-osas# (accessed 5/20/2018)
To see Dr. Thomas Higgins, a fellowship-trained Rhinologist (Sinus Specialist) with offices in Louisville, Kentucky and southern Indiana, click below or call.
A novel FDA-approved therapy was introduced to the market in March 2018 called Sinuva, a long-acting steroid-eluting implant that can be placed in the sinus cavities during an office visit. Recurrent nasal polyps can form in previously opened sinus cavities. Oral steroids can help shrink them, but these medications can have short-term and long-term side effects. The steroid in Sinuva has minimal absorption into the body and gradual provides steroid to the surface of the polyps to shrink them and keep them away for up to 3-6 months. For more information: CLICK HERE.
By Thomas S. Higgins, Jr., MD, MSPH
1. Antibiotics reduce inflammation.
2. Antibiotics reduce pain.
3. Antibiotics induce the placebo effect.
But antibiotics are not good to use for non-bacterial infections!
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