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.

Can using Flonase for a month cure my deviated septum?

Question: Can using Flonase for a month cure my deviated septum? Or is there another medicine for a deviated septum

Answer:

Unfortunately, there is no medicine for a deviated septum, though some medications can relieve some of the symptoms.

The nasal septum is a wall that separates the nasal passages into 2 chambers. The septum is never completely straight, but if it is twisted enough it can block the airflow through the nose by going from side to side as we go back through the airway. The nasal septum is cartilage up front and bone as we go further back in the nasal airway.

Flonase (fluticasone) is one of many available nasal steroids. These medications present a small amount of steroids in a spray form the lining of the nose. Unlike some other over the counter medications like Afrin (oxymetazoline), they take a few days to work and do not get the user “hooked” by creating a rebound worsening after use. Nasal steroid sprays bring down swelling locally, but will not change the underlying structure.

We do often try Flonase and other nasal steroids in patients with a deviated septum. Often, the twisted septum will cause irritation to the nasal lining and therefore some swelling in the lining, further blocking the breathing passages. The sprays may be successful in bringing down the swelling enough to improve the airway- without actually affecting the structure of the septum.

Straightening the septum should only be done if it is causing problems, such as nasal obstruction, recurrent sinus infections or nose bleeds. The surgery is generally quite successful.

Straightening the nasal septum (septoplasty) is a surgical procedure- done in the operating room as an outpatient. It is done totally inside the nose- and does NOT change the appearance of the nose. We at the NY Sinus Center do not use any packing (gauze in the nose) after sinus center. Many use the complaints of their deviated septum to also have rhinoplasty done- that does change the appearance and is a cosmetic surgery- while rhinoplasty is generally not necessary for straightening the septum-straightening the septum is often necessary to get the best result if we do rhinoplastic surgery.

I hope this clears things up.

Robert Pincus MD

C0-Director NY Sinus Center

Associate Professor NYMC

Q & A

My mother has a hole in her septum. What can we do?

Question: My mom lives in Ocala, FL. My mom’s problem is a hole up in her sinus that seperates the left and right nostril (perforated septum). She has had a ‘button’ put in but it had to be removed about a week later, due to the hole , in her nose, being too big. She then had a filter put in but it became infected and ,also, had to be removed and her nose cleaned by suction. Every day she is blowing her nose with alot of mucus being discharged. I am very concerned because nothing seems to work and the doctor, she is seeing, doesn’t seem to know whatelse to do.

Answer: The septum is the room divider, dividing the nose into two passages. While it is never completely straight, a deviated (twisted) septum can block air flow in the nose. Sometimes in surgery, or often after trauma or certain medications (cocaine quite commonly), a hole (perforation) develops from one side of the nose to the other. When small, this may cause no symptoms, or perhaps a whistling sound with breathing. Large holes disrupt the smooth flow of air through the nose and create drying, crusting and bleeding which often cause the hole to get larger over time. Small holes may be fixed surgically, but surgery is much less successful with large ones.

Generally, a septal button will fix a perforated septum when the holes are too large to close (plastic prosthetic septum). It allows for a normal, smooth flow of air, and the button is generally not felt by the patient. If the hole is too big for the usual sizes that are available, your Ear Nose and Throat Doctor or Rhinologist (Sinus Specialist) may be able to measure and have a special order one made to fit. Sometimes, surgery may be only partially successful, that is by making the hole smaller and then more amenable to a septal prosthesis.

At times, there is no way to really get this closed. Should that be the case, the use of nasal saline sprays, topical moisturizing with nasal ointments, and seeing your ENT doctor for cleaning of the area should make things better.

We, of course, would be happy to see your mom here at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology

Co-Director NY Sinus Center

Q & A

Will allergy shots help my sinus infections?

Question: I have allergies and about twice a year and I get a really bad head colds which take away my smell/taste and eventually lead to sinus infections. I will be starting allergy shots soon and do you think they will help?

Answer:

Thanks for your question. Sinus infections are caused by persistent blockage to the sinus drainage passages. Anything that causes a persistent swelling in the lining of the nose can predispose us to a sinus infection. This can be from an anatomic abnormality, (such as a deviated septum) a prolonged viral infection, (perhaps after the flu or other prolonged cold), environmental irritants (cold weather, chemicals, dust), reflux of gastric acid as high as the nose, and of course allergies. There can be more than one of these problems in each person.

Treatment for recurrent infections includes finding the cause or causes of the blockage and treating or removing them. If you have allergies, frequently we will try to remove the allergen, if possible- (get rid of a feather pillow if you have feather allergies, lessen dust in the home if you have dust allergies)- medical treatment such as antihistamines (orally or nasal sprays), nasal steroid sprays (such as Flonase or Nasonex) and saline rinses to remove the allergen from your nose faster.

Should your allergic and sinus problems persist- and you have significant allergies- we would then recommend desensitization. (allergy shots). They can definitely help reduce nasal allergies and nasal congestion and therefore sinus infections in many individuals.

I hope this clears things up.

Robert Pincus MD- Associate Professor Otolaryngology

Co-Director NY Sinus Center

NY Otolaryngology Group

Q & A

What could be the cause/reason for on/off nosebleeds from one nostril frequently?

Question: What could be the cause/reason for on/off frequent nosebleeds from one nostril?

Answer:

First of all, thank you for your question. Frequent nosebleeds (epistaxis in medical terms) is quite a common problem. We see this most often during the winter when the heat is on. If we heat room air from 30 to 65 degrees, the humidity drops down to levels one sees in the desert. The mucous membrane lining of the nose then can dry out and crack, causing a nose bleed. It there is a prominent blood vessel on one side- or if the septum- (center wall of the nose) is deviated (twisted)- then there can be a prominent point on the wall that the air hits and dries out faster. Both of these will cause nose bleeds to be more common on one side.

If you are taking aspirin (even baby aspirin) or a blood thinner- then the bleeding can often become more problematic- as these medications delay the forming of a clot- or scab.

When the lining of the nose is more swollen (from a cold, allergies or a sinus infection- among other causes)- then there is greater blood flow to the nasal lining, and that also makes people more susceptible to nose bleeds.

Lastly, and thankfully least commonly, there can be a growth- benign or malignant tumor- in the nose that causes bleeding.

Try to keep the nasal passages moist in the winter- use topical saline sprays, ointments to the tip of the nose, humidifier if you can keep clean,-

If you have a nose bleed- put some cotton in the nose- with Afrin(oxymetazoline 0.05%) if you have- and find a clock. Then pinch the bottom of your nose for 5 minutes (about the time it takes to form a clot in most people)- but longer if you are taking a blood thinner.

If the bleeding persists, you need to seek medical care, and if you continue to have bleeding from one side of the nose, even if it stops. It is important to have your nasal cavities evaluated to make sure there is no worrisome cause and to see if there is a blood vessel that needs to be cauterized.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

I have trouble breathing through my nose and have a deviated septum. Can that be corrected?

Question: After always having trouble breathing through my nose (with my mouth closed) when sleeping on my right side, I asked my PCP to check, and he informed me that I have a deviated septum which could explain it. Since I can’t ever remember being able to breathe easily through my nose with my mouth closed while sleeping (and not snoring), I’m writing you to see what may be the issue and if I might be a candidate for some sort of deviated septum correction.

Answer: Thanks for your question.

The most likely cause of your breathing problem is a “deviated” septum. The septum is a wall that separates the nasal airway into two separate passages and is never completely straight. Unfortunately, either from birth or from trauma, this wall may be twisted and block either one or both sides of the nose. First, I would suggest an ENT examination to make sure that is the cause of your symptoms. Other problems, such as nasal polyps (benign nasal growths) can block one side or the other- or both, as well.

If a deviated septum is the cause, this can be readily fixed with a minor surgical procedure. Straightening the septum, by the way, does NOT change the appearance of the nose, nor should you get black and blue from this. Frequently, people have coupled cosmetic surgery (rhinoplasty) at the same time, which does both.

I hope this clears things up. We’d be happy to see you here at the Sinus Center and help figure out how to best improve your breathing.

Robert Pincus MD
Co-director NY Sinus Center
212-889-8575

deviated septum Archives - The New York Otolaryngology Group

Can using Flonase for a month cure my deviated septum?

My mother has a hole in her septum. What can we do?

Will allergy shots help my sinus infections?

What could be the cause/reason for on/off nosebleeds from one nostril frequently?

I have trouble breathing through my nose and have a deviated septum. Can that be corrected?