Nose & Sinus

Sinusitis

Sinusitis is a common condition in which the cavities around the sinuses become inflamed and swollen. Acute sinusitis is usually caused by an infection, but also by allergies, chemical irritation, or smoke (and also unknown causes). For sinusitis caused by any bacterial, fungal, or viral infections, give us a call to find out how Dr. Kay can improve your quality of life.

On the other hand, chronic sinusitis can also be caused by an infection, but is usually caused by growths in the sinuses such as nasal polyps, or by a deviated septum. If your sinusitis is lasting longer than 12 weeks, or if you suffer from more than 2-3 infections per year, and your prescribed medications are not helping much, chances are there is a more complex issue to deal with. The long-lasting symptoms associated with chronic sinusitis may include thick yellow or greenish discharge from the nose or down the back of your throat, nasal obstruction or congestion that causes difficulty breathing, tenderness or swelling in the facial area around the eyes, or reduced sense of smell and/or taste.

Nasal & Sinus Endoscopy

In the case of chronic sinusitis, Dr. Kay can easily make a diagnosis by taking a CT scan of the sinuses or by a nasal endoscopy. A nasal endoscopy is a procedure that uses a high quality endoscope (a type of camera that can easily examine your nasal passages) to obtain a magnified view of the nasal and sinus passages.

A nasal endoscopy is generally a quick and easy procedure that gives us a great view of the inside of your nasal passage and sinus cavities. First, we numb the inside of the nose so you cannot feel a thing. Then, we take a look inside with a tiny camera that makes it easy to spot potential issues and make an accurate diagnosis. This procedure is done inside our office, and is a great first step in treating sinus disease.

Sinus Surgery

The goal of surgery is to carefully remove the thin, delicate bone and mucous membranes that block the drainage pathways of the sinuses. The term "endoscopic" refers to the use of small fiberoptic telescopes that allow all of the surgery to be performed through the nostrils, without the need for any skin incisions. Endoscopic sinus surgery is generally performed on an outpatient basis, and our patients suffer only a very mild discomfort with a relatively short recovery time.

When treating chronic sinusitis with surgery, Dr. Kay uses the Medtronic Fusion System to help her give you the best treatment available. The Fusion ENT Navigation System is the first and only image-guided navigational system for ENT surgeries, providing the maximum amount of information about your unique anatomy for a safer and more thorough procedure. By using the Medtronic system, our patients will receive a more precise surgery with a better outcome.

Nasal Obstruction

Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes, and are caused by chronic inflammation due to athsma, recurring infection, allergies, drug sensitivity, or certain immune disorders. Small nasal polyps may not cause symptoms, but larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell, or frequent infections.

Turbinate Reduction

There are three turbinates (inferior, middle, and superior) on each side of the nose. Their job is to clean and humidify the air we breathe as it moves through the nose and into the lungs. Turbinate hypertrophy is a condition we treat that is caused by an enlargement of the turbinates. When the turbinates become too large, they obstruct our ability to breathe normally.

Surgery for turbinate reduction is often performed in conjunction with septoplasty or rhinoplasty. This procedure shrinks the size of the turbinate glands using heat, and does not require cutting into the skin. Most patients experience mild or no discomfort, and are back to normal almost immediately. With smaller turbinates, you will breathe better, with much less mucous production and congestion.

What is a nasal septum?

A nasal septum is a small wall inside the nose that divides the right and left sides of the nasal cavity. The nasal septum is composted of cartilage in the front and bone in the back. Ideally, the nasal septum should be straight to allow the same amount of airflow through both nostrils. If the septum is deviated, crooked, or bent, one side becomes more narrow which resulting in nasal obstruction on just that side. It is also possible that the septum could impact both sides, if it first buckles over to one side and then into the other--like an "S".

While a deviated septum can happen towards the front of the nose, it is more often that the deviation happens further back in the nose, and not easy to see or diagnose. Because the obstruction can happen anywhere along the three inch (3") septum, we often perform a nasal endoscopy to see exactly what's causing a patient's breathing issues.

I have a deviated septum. What's next?

The only way a deviated septum can be fixed is through surgery, and is not recommended until after adolescence, when the nose stops growing. There are no medications or physical therapy methods that can be performed, since this is an anatomic structural problem. Without surgery, it may be possible to improve airflow and breathing by using nasal steroid sprays or allergy medications to decrease any swelling inside the nose.

Here's how the surgery goes:

  1. A small incision is made inside the nose, and the mucosal lining is carefully lifted away from the septum on one side.
  2. The septum is incised immediately in front of the deviation, and the nasal mucosal lining is lifted away from the septum on the opposite side.
  3. The deviated septum is now physically removed. One removes the deviated septum completely, instead of forcing it into a midline position. This is because the septum is just like a young tree sapling. It has "memory" and bending or forcing it into a certain position will last only temporarily before it springs back to how it was before.
  4. The nasal mucosal lining is re-approximated in the midline.

Recovery from septoplasty is about 3-4 days long. Most patients are surprised by how little pain there is after surgery. There is no bruising or swelling of the face or external nose, unless the patient requires or requests a rhinoplasty (reshaping of the outside of the nose) as well. The biggest complaint after surgery is typically congestion and drainage that may last as long as 2-3 weeks. Because this is mainly caused by swelling and trauma inside the nasal cavity, it will slowly resolve itself over time as the nose heals. (Fortunately, not everyone experiences these post-operative symptoms.)

Unless the operation is performed with a rhinoplasty, there will be no change to the outside appearance of the nose. And after surgery, almost all patients will have excellent improvements in their quality of life, sleep, and breathing for the rest of their lives.