Nose & Sinus
Medical & Allergic Therapy
When both skin prick allergy testing and intradermal testing are combined, the result is referred to as modified quantitative testing. By combining both types of tests, doctors can arrive at a more accurate list of allergens that a patient has shown positive reactions for. To perform 40 tests on the skin and arms can take upwards of an hour, sometimes slightly longer. The small scratches or pricks are covered with specific allergens to determine if a reaction is present. With intradermal testing, the allergen is placed just under the skin using a TB needle. When positive results are present, there is no nee to test further. If the test is inconclusive or negative, the doctor may choose to use the intradermal test as a failsafe. Some allergens may not cause a surface reaction, but when exposed to underlying tissues create an allergic response. This double testing ensures that the results are accurate and the person receives exactly what they need when their allergy formulas are created. Once the formulas are created, the doctor will then determine the beginning dosage and the treatment schedule will begin.
Septoplasty (SEP-toe-plas-tee) is a surgical procedure to straighten the bone and cartilage dividing the space between your two nostrils (septum). When the septum is crooked, it’s known as a deviated septum. A deviated septum can make it harder to breathe through your nose and can increase the risk of sinus infections due to poor drainage. During septoplasty, your nasal septum is repositioned to the middle of your nose. This may require your surgeon to cut and remove parts of your nasal septum before reinserting them in the proper position. Once a septoplasty is healed, you’ll likely find it’s easier to breathe. Your surgeon can discuss what septoplasty can achieve for you. Why it’s done A crooked septum is common. But when it’s severe, a deviated septum can block one side of your nose and reduce airflow, causing difficulty breathing through one or both sides of your nose. Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage, bone or both. If you experience symptoms — such as difficulty breathing through your nose — that affect your quality of life, you may consider surgery to fix a deviated septum.
Inferior turbinates are long, sausage shaped structures which protrude from the side-wall of the internal nasal cavity on each side. These structures are composed of a ridge of bone lined with thick, well vascularized soft tissue and covered by a moist mucous membrane. These structures warm, filter and humidify the air inspired through the nose. When irreversibly enlarged from chronic inflammation or congenital enlargement, reduction in the size of inferior turbinates may be necessary. Inferior turbinate reduction or submucous resection is performed as an outpatient procedure. If you have other medical conditions such as sleep apnea, you may spend one night in the hospital after your procedure. Absorbable foam or gel dressings may be placed in the nose to minimize bleeding. On rare occasion, nasal sponge packing may be placed to control bleeding. The nose may be congested or obstructed in the first few to several days following the procedure. This is relieved with saline rinses (see Nasal Care following the Surgery below). Mild oozing of blood from the nose is expected in the first 48 hours.
Nasal care following the surgery
Rinse the nose 3 times daily with saline solution beginning the afternoon following surgery. This can beaccomplished with a Neil-Med Sinus Rinse bottle (available over the counter at most pharmacies) or a Netti-Pot. Gently apply a layer of antibiotic ointment to the nostrils twice daily for the first week. Hot steam showers as needed are very helpful in relieving nasal congestion and crusting. Sleep with the head elevated for the first 48 hours; this will minimize pain and congestion. You may use two pillows to do this or sleep in a reclining chair. Your surgeon may have you spray your nose with decongestant spray (oxymetazoline or neosynepherine) as needed for persistent nasal congestion and oozing. Soaking a cotton ball with oxymetazoline or neosynepherine spray, stuffing it into the front of the nasal cavity and pinching the nostrils together for 10 minutes is often effective in halting troublesome bleeding during the first few days.
Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve. When planning rhinoplasty, Dr. Halliday will consider your other facial features, the skin on your nose and what you would like to change.
Why it’s done
Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.
During the surgery
Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on how complex your surgery is and what your surgeon prefers. Discuss with your doctor before surgery which type of anesthesia is most appropriate for you.
Very slight changes to the structure of your nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren’t enough, and you and your surgeon might decide to do a second surgery for further changes. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can go through changes during this time.
During balloon sinuplasty, under computer guided control, the sinus channels are dilated up with a balloon. This is mostly done in an office setting, under a local anesthesia, virtually no recovery or risk because there is no cutting. This has been shown to improve your symptoms by 90% – 95% and no down time.
*Procedure done in office
Cryoablation can be done for patients with chronic symptoms of rhinorrhea and or post nasal drip, done under local anesthesia, and no down time. During cryoablation, this procedure partially controls the nerves that create heavy nasal drainage and in a vast majority of patients can reduce the amount of chronic post nasal drip, nasal drainage, and chronic rhinorrhea. There is no significant risk to have this done.
*Procedure done in office
Functional Endoscopic Sinus Surgery
The second level of sinus surgery is called Functional Endoscopic Sinus Surgery (FESS). During this procedure the sinus channels are surgically widened and sometimes involves nasal polyp removal. This is done as an out patient facility and takes between 60-90 minutes and recovery is 7-10 days, no packing is involved in the vast majority of patients. In some selected patients a steroid implant can be placed in the nose, called Propel, which can greatly reduce the chances of polyps recurring and helps with post- operative inflammation.
Imaged Guided FESS
The last level of sinus surgery is called Image Guided Fess. This is a move advanced and for more severe sinus blocked patients. The sinus surgery is guided by an image guided computer-based system, is extremely efficient, and allows for an added level of safety when working near the eyes and skull base. Dr. Halliday has years of experience with all of these sinus surgeries, and is readily available for consultations to determine which procedure would be best for you.