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.        

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.   

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.    

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.   

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.      

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.

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.

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)

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. 

We now offer this revolutionary therapy! Contact Dr. Thomas Higgins' office at (502) 894-8441 or use our Make an Appointment Form.

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! 

The Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University has once again been ranked the #1 hospital for ENT services by US News. Dr. Thomas Higgins obtained his fellowship training in Rhinology at Johns Hopkins University and is proud to be associated with this historic institution.  

Click here for more information: http://health.usnews.com/best-hospitals/rankings/ear-nose-and-throat

August is upon us again.

August is the last month of Summer Break for the kids.

August is a hot month. August is a great month for swimming, going to the lake, and vacationing.

And August is Ragweed pollination month!

Ragweed pollen starts increasing in August and spreads through the air most actively through September. Just look at the Google search trends for "Ragweed" (below) and you will see how, consistently over the past 5 years, Ragweed has peaked in late August/early September! 

Symptoms of ragweed allergy can mimic a sinus infection, but antibiotics are not the way to treat ragweed allergy. Symptoms may include the following:

• Sneezing
• Nasal congestion
• Runny eyes / Runny nose
• Malaise (feeling sick)
• Itchy throat

Treatment includes symptomatic relief and preventative measures, including:

• Antihistamines
• Nasal steroid and/or antihistamine nasal sprays
• Saline nasal irrigations and saline sprays
• Decongestants as needed
• Allergy immunotherapy directed at ragweed pollen

So be ready for that annual oxymoron of a condition, The Summer Cold, to try to interrupt your fun. Get back on those allergy medications or seek help now to prevent feeling miserable when the ragweed pollen counts peak!  

To see Dr. Thomas S. Higgins, Jr. a fellowship-trained Rhinologist (Sinus Specialist) , click below
or call (502) 894-8441.