Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Will Surgery for a Deviated Septum Help?

Question:

I wanted to know if surgery for a deviated septum would solve my nasal and sinus passages. I have difficulty breathing due to mucus blockage. It has gotten so bad it effects the pitch/tone of my voice.

Answer:

Thank you for your question.

The septum is a wall that extends from the front of the nose to the back and divides the nose into two passageways. It is never completely straight, but sometimes will be twisted from side to side so that it blocks the nasal passages. If is causing enough of a problem in breathing, your ENT doctor or sinus specialist may recommend straightening the “deviated” septum. A deviated septum may cause you to sound clogged and may predispose you to sinus infections. (sinusitis)

This is a surgical procedure, done through the inside of the nose. The surgeon will make a small incision in the lining covering the septum and lift the lining off the cartilage and bone that make up the septum. Some bone or cartilage may need to be removed, and the rest is placed back in the midline- so as to improve the airway. There is NO change in the way you look after septal surgery and you should not get black and blue- That occurs when one gets a rhinoplasty (cosmetic surgery to change the appearance of the nose) at the same time.

I can’t tell for sure that the septum is your problem without an exam. There are many other causes of nasal obstruction, such as allergies, polyps or even temporarily as you know with a bad cold. Additionally, one can have the straightest septum in the world, but yet have the nose blocked from any of those problems. If you don’t have any of the other problems and septum is blocking, it is quite likely that straightening it should improve your breathing and the change in your voice that comes from not breathing well through your nose.

I hope this clears things up.

Robert Pincus MD, FACS

Co-Director NY Sinus Center

Associate Professor Otolaryngology

Q & A

My 15 year old has 6-8 colds a year. Could she have sinusitis?

Question: My teenage daughter (15) has been challenged with recurrent colds since she was at least 3 years old. At this time she still gets 6-8 colds a year, very heavy, sometimes turning into a sinus infection. Enlarged adenoids were removed in 2012 with no improvement. No OTC meds (pain or cold) have any impact, even prescription strength pain meds offer no relief. Excessive absences from school – feels too ill to go. Very heavy mucous production. CT scan in 2011 shows focus of mucosal thickening in the right maxillary sinus. Undulation of the nasal septum. No one has suggested chronic sinusitis. Are there cases of chronic sinusitis in teenagers? Our school is looking for a medical condition for the cause of her recurrent colds and seemingly continuos sinus infection. I’m looking to improve my daughter’s health.

Answer: Thank you for your question. One would not expect a healthy 15 year old to still get 6-8 colds a year. Chronic sinusitis in teenagers is rare. While upper respiratory tract infections are quite common in children, they tend to get less frequent as they enter the teen years. If she has continous sinus infections, I would suggest looking into other factors that could be causing these .

Among the possibilities (not all mutually exclusive) are: sinus infections or a chronic low grade infection with exacerbations, allergies, or least likely a partial weakness in her immune system.

Sinusitis can certainly cause her recurrent infections. Her CT scan sounds like it showed a sinus infection. The most common cause of recurrent sinus infections in children is chronic infections in the adenoids- and this seems like it was addressed. Sometimes, though, adenoids can regrow and get re-infected. I would ask your pediatrician to have her get an ENT evaluation.

She could also have allergies- either causing what seems like recurrent colds- or as a factor causing recurrent sinusitis.

Less likely is a selective immune deficiency. Some children may have a weakness in their ability to fight off colds because they have a diminished antibody response to certain viruses. This is not in any way related to AIDs- but can cause a child to have an increased number of these URIs.

If you are in the NY area- we would be happy to see your daughter here at the NY Sinus Center…

I hope this helps clears things up

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

Whom should I see first, my primary care doctor or ENT

Question: I have a lump a at the back of my head – base of skull 2 inches behind my right ear. History of sinus/ allergy issues. Should I start my primary care doctor or an ENT?

Answer: While we would always be happy to see you here at the NY Sinus Center for any problem related to the ear nose throat or head and neck,(even if you’ve not been referred) it generally makes sense to see your primary care doctor first, if possible, for most issues. He or she can take care of most problems directly- or refer you to the appropriate specialty physician should that be necessary. For instance, a lump behind your ear like that may be related to a problem with your ear, but can also be from a skin problem with your scalp, an auto-immune problem, such as sarcoidosis, or even arthritis of the neck. While your ENT doctor can make this determination as well, your family physician should help guide you through what can be a difficult maze of health care options and help co-ordinate your care.

I hope this helps clear things up.

Robert Pincus MD

Co-director NY Sinus Center

Q & A

Loss of Smell- Something New?

Question: I am a 75-year-old female, and I am losing my sense of smell. I have had sinus and allergy problems all my life, and I always have a tissue with me. In the past 4—5 years I have lost about 95% of my ability to smell. Taste is fine. Since I live alone, losing the sense of smell can be a real hazard. I miss this sense very much. I tried zinc. Nothing happened. Is there anything new that might bring back my ability to smell?? Thank you so much.

Answer:

Finally, there may be something new…

The loss of the sense of smell can be a devastating problem. Smell is important not just for the enjoyment of food and activities of life, but for safety – avoiding fire and spoiled foods. A person’s sense of smell becomes limited because of nasal congestion- in that case, air does not reach the smell fibers, or due to damage to the fibers themselves. Damage can occur after trauma, an upper respiratory infection, or for reasons unknown. We all do lose some sense of smell as we age.

The loss of the sense of smell should, however, get evaluated. One needs to be sure that there is no growth obstructing the smell fibers or damaging them directly. The nasal cavity should be evaluated to make sure there is no unusual congestion (polyps, chronic infection). Most otolaryngologists (ear nose and throat doctors) can do the appropriate evaluations and recommend therapy if indicated.

When these causes are ruled out, the treatment for the loss of smell is limited. We have recommended alpha lipoic acid- a vitamin that may help with nerve regrowth- but its there is no proof of its effectiveness as of yet.

A recent study, however, just published in November of 2012, is quite promising. Revealed in this study, the use of a low dose theophylline nasal spray (an old asthma drug- usually taken by mouth) helped almost all of a small group of patients improve their sense of smell, without reported side effects.

While this clearly needs to be further evaluated, the possible ill effects seem quite small- and the prospects for improvement are encouraging. We plan on doing a study shortly at the NY Sinus Center to see if we can confirm these results. Please call us for an appointment if you would be interested.

Robert Pincus MD

Co-director NY Sinus Center

Q & A

Revision Sinus Surgery – Is It Necessary?

Choosing to have sinus surgery can be a difficult decision. Despite all of the advances in medical technology, there will still be some pain and swelling. Plus, getting surgery is just plain scary…we understand that. What can be even more disheartening, however, is having sinus surgery and still suffering repeated bouts of sinusitis. The good news is, in most cases, revision surgery isn’t necessary.

As mentioned in a previous blog post (link), the post-surgery recurrent congestion or pain could be due to:

Allergies
Nasal polyps
Acid reflux
Headaches
Immuno-deficiencies

Treating these underlying conditions may clear the congestion and the pain, without the need for revision sinus surgery.

In some cases, however, an additional revision sinus surgery may be necessary. The goal of sinus surgery is generally to enlarge the natural ostium, or opening, of the sinus. If a surgeon misses the natural opening by so much as a millimeter, he or she will make an opening in the wrong place in the sinus. In these cases, the patient may have problems with the mucus recirculating—going out of one opening, and coming right back in the other opening.

In these situations, additional surgery may be required. Fortunately, this revision surgery should be much simpler than the original surgery, as it entails solely shaving down the tiny bridge of tissue that separates the openings. This is typically extremely straightforward, and can sometimes be done as an office procedure.

Revision surgery is one of our specialties. If you have any questions about it, please contact us today. You can breathe easier, and we can help.

Q & A

My Nose Has Been Congested For 6 Months

Question:
I have been congested (stuffy nose) for over 6 months now. At first I thought I was getting a cold but when my cold meds weren’t working, I figured it was just allergies. After trying Claritin, nasal sprays, and the neti pot, I was realized nothing was working. My doctor also suggested that it was allergies, but I know that it is something more than that. I have chronic congestion, and it is keeping me awake at night, and its taking a toll on my life! I’ve tried online research but am not having any luck. Can you plase suggest some chronic congestion relief?

Answer:
Thanks for your note- It seems unlikely that your symptoms are from allergies, alone. Usually with allergies, a patient will have at least temporary relief of congestion with antihistamines. We certainly are proponents of using a neti pot- but if your congestion is persisting for 6 months, you should have a more thorough evaluation than your primary care physician can offer. Your chronic congestion may well be a sign of a low grade sinus infection, nasal polyps or other treatable problem. Sometimes, medications taken for other problems can cause nasal congestion as a side effect.

I would suggest that you have a thorough ENT evaluation which includes a complete history, but also looking at your nasal airway with a lighted telescope. This is an office procedure which will allow a doctor to find the cause of your problem and a treatment specifically for chronic congestion relief.

Robert Pincus MD
Co-director NY Sinus Center

allergies Archives - The New York Otolaryngology Group

Will Surgery for a Deviated Septum Help?

My 15 year old has 6-8 colds a year. Could she have sinusitis?

Whom should I see first, my primary care doctor or ENT

Loss of Smell- Something New?

Revision Sinus Surgery – Is It Necessary?

My Nose Has Been Congested For 6 Months