Balloon Sinuplasty

Sinusitis is one of the most common chronic conditions in the U.S., with 37 million American adults suffering annually. Most find relief from over-the-counter or prescription medications, but some require surgery for long-term relief. Traditional endoscopic sinus surgery isn’t always effective, and it can cause scar tissue and other complications. A newer, less-invasive procedure known as balloon sinuplasty may be an ideal alternative.

How Does Balloon Sinuplasty Differ?

Patients undergoing conventional sinus surgery must contend with the cutting and excision of nasal bone and tissue. This can be painful and may lead to scarring. Even worse, the procedure isn’t always effective; some patients’ symptoms persist despite the surgery, and they require multiple operations.

Balloon sinuplasty is a safe and effective alternative for certain patients whose chronic sinusitis symptoms result in nasal obstruction.

The benefits of balloon sinuplasty are plentiful. This FDA-approved procedure leaves the sinus cavities intact; there is no surgical cutting or removal of bone and tissue. This translates to fewer side effects (there is less pain, bleeding, bruising and swelling), a lower risk of infection and a shorter recovery period.

Balloon Sinuplasty: The Procedure

Balloon sinuplasty is usually performed on an outpatient basis. The patient is given general or local anesthesia, and a thin wire catheter with a balloon attached is inserted through the nostril. Once it reaches the blocked sinus cavity, the balloon is inflated in order to enlarge the sinus opening and widen the walls of the cavity. The balloon is then deflated and a saline solution is used to flush out debris. The majority of patients report open sinuses following the procedure as well as an improvement in the ability to breathe normally.

Not all patients are candidates for balloon sinuplasty. To qualify, their symptoms should be due to nasal obstructions and easily accessible. Those who require additional surgery or suffer from severe cases will probably require a more traditional approach.

Nasal Obstruction

Nasal obstructions are blockages of the nasal cavity that impede airflow in and out of the nose. Either one or both nostrils may be affected. Most nasal obstructions are temporary, caused by colds, allergies, sinus infections, or medications, while others require medical intervention.

Types of Nasal Obstruction

There are several different types of nasal obstruction. These include:

  • Nasal polyps. These are small, noncancerous growths that form on the lining of the sinuses or the nasal passages. They require no treatment unless they are large enough to obstruct breathing or cause infections.
  • Deviated nasal septum. The nasal septum is the wall-like structure that divides the left and right nostrils. A deviated septum refers to one that is crooked.
  • Inferior turbinate hypertrophy. The nasal cavity contains bony structures called turbinates. These are susceptible to irritation from allergies and dust, which cause swelling and breathing difficulties.
  • Choanal atresia. This is a congenital defect in which excess tissue in the nasal airway causes a partial or full blockage, resulting in difficulty breathing.
  • Foreign objects in the nose. This is especially common in children, who may shove things up their nostrils without considering the consequences.
  • Oversized adenoids. If adenoids are enflamed or infected, this issue should resolve either on its own or with the use of antibiotics. If adenoids are chronically infected or oversized, surgical removal maybe necessary.
  • Swelling of the nasal lining. This is often caused by the cold and flu.

Treating Nasal Obstructions

Your doctor will carefully examine your nose using a lighted scope and may use a CT scan or MRI in order to diagnose your nasal obstruction.

The first step in treating nasal obstructions is getting the symptoms under control. Medications or nasal steroid sprays are often helpful in reducing inflammation and providing immediate, short-term relief. An effective long-term solution may require surgery, particularly if the issue involves a deviated septum, turbinates or nasal polyps.

Nasal Polyps

Symptoms of nasal polyps include runny nose, congestion, postnasal drip, loss of smell and taste, facial pain and pressure, headache, pain in the upper teeth, itchy eyes and snoring. If symptoms last longer than ten days and are not associated with a cold or allergies, make an appointment with your doctor. If left untreated, nasal polyps can cause complications such as obstructive sleep apnea, asthma attacks, meningitis, aneurysms and blood clots.

To treat polyps, your ENT specialist will attempt to shrink them down to a manageable size through the use of medications to relieve inflammation or the underlying condition responsible. Common drugs include nasal, oral or injectable corticosteroids, antihistamines and antibiotics. When medical treatment doesn’t work, surgery may be an option. Polyps are removed during an outpatient procedure called a polypectomy or via a more in-depth endoscopic sinus surgery.

Deviated Septum

The perfect nasal septum divides the left and right nostrils evenly, but this is pretty rare; it’s estimated that about 80 percent of the population has a septum that is off center to some extent. Usually the deviation is slight and goes unnoticed; only the worst cases produce symptoms that affect breathing. Symptoms include nasal congestion (often limited to one side of the nose), frequent nosebleeds and sinus infections, facial pain and pressure, headaches, postnasal drip and noisy breathing or snoring. Surgery is the only way to correct a deviated septum.

Sinus Infections

A sinus infection, also called sinusitis, is inflammation and swelling of the tissues that line the sinuses. This interferes with normal mucus drainage, leading to breathing difficulties, pain and pressure. When the condition persists for 12 weeks or longer, it is considered chronic.

Causes & Symptoms

Sinusitis is the number one reported chronic condition in the United States, affecting an estimated 37 million Americans. It’s most often caused by an infection brought on by a cold or allergies, but may also be the result of nasal polyps, a deviated septum, trauma to the face, hay fever, complications from immune system disorders or tumors.

Individuals suffering from sinusitis experience a variety of cold-like symptoms such as nasal congestion and discharge, postnasal drip, sore throat, facial pressure and swelling, loss of smell and taste, headache, fever, fatigue and bad breath. Complications can include asthma attacks, meningitis, vision problems, aneurysms and stroke.

Diagnosis & Treatment

In addition to a physical examination and a review of your medical history, your doctor will inspect your nasal passages for polyps, abnormalities, inflammation and a buildup of fluid. Additional tests utilizing nasal endoscopy, CT scans, MRIs and allergy tests can be used to help confirm the diagnosis.

Treatments will vary depending upon the severity of your sinus infection and whether it’s an acute or chronic condition. Saline nasal sprays and corticosteroids are useful for rinsing your nasal passages and relieving inflammation. Decongestants are a good short-term solution, but extended use can actually worsen the condition. Antibiotics are usually prescribed for bacterial infections.

Antihistamines, nasal steroid sprays, saline washes and oral steroids all provide long-term relief. More permanent solutions such as immunotherapy (allergy shots or drops) or surgery can bring relief to those suffering from chronic sinusitis.

Chronic Rhinitis

Rhinitis is similar to hay fever, but is caused by something other than an allergen. Dubbed non-allergic rhinitis to differentiate the two, it produces cold-like symptoms that can leave you feeling miserable and worn-down. Rhinitis is common and can be brought on by a variety of factors. Viruses, bacteria and other irritants can all cause symptoms. Non-allergic rhinitis isn’t just bothersome; if untreated, it can cause nasal polyps, chronic sinusitis and ear infections.

Your doctor will diagnose non-allergic rhinitis based on your symptoms and medical history. Mild cases of rhinitis may respond to simple home remedies; irrigation of the nasal passages with a Neti pot, using a humidifier to moisten the air and drinking lots of liquids can all help. In addition, your doctor may recommend over-the-counter or prescription drugs including antihistamines, decongestants and saline or corticosteroid nasal sprays. Surgery is necessary for nasal polyps, a deviated septum or any other physical abnormalities.

Nose Bleeds

Though common and sometimes frightening, nosebleeds are rarely anything more than a nuisance. They are usually the result of minor irritations in the nasal passages and are most common in children younger than 10 or adults older than 50.

Nosebleed Causes & Categories

When the membranes lining the inside of the nose dry out and become irritated, the blood vessels break, causing a nosebleed. These are more common in the winter months, when the air is cold and dry. Other factors that may contribute to nosebleeds include colds, allergies, sinus infections, nose picking, blowing the nose too hard, frequent sneezing, overuse of nasal sprays, foreign objects in the nose and trauma to the nose.

If nosebleeds are chronic or occur frequently, they may be the result of high blood pressure, vascular diseases or a tumor.

Nosebleeds are categorized depending on where they originate in the nose. Anterior, beginning in the front of the nose, are by far the most common type, with bleeding often confined to a single nostril. Posterior nosebleeds begin high and deep within the nose and cause blood to flow down the back of the mouth and throat. They are rare but serious and require immediate medical attention.

Treating & Preventing Nosebleeds

The first step in treating a nosebleed is to remain calm. Though there may appear to be a lot of blood, it is likely not nearly as bad as it seems. Sit up and lean forward slightly, and pinch your nostrils together using your thumb and index finger. Hold this position for 5 to 10 minutes or until the bleeding has stopped. Refrain from blowing your nose and sneezing afterwards. If bleeding continues for longer than 20 minutes or has occurred because of trauma to the head or face, see a doctor right away.

If you are prone to nosebleeds, use a humidifier to moisten the air. Saline nasal sprays and petroleum jelly are useful in preventing your nasal passages from drying out. Try not to blow your nose too hard and never insert objects into your nostrils.

Loss of Smell

Loss of smell, known medically as anosmia, is an inability to perceive odors. It can be partial or complete and, while rarely the symptom of a serious condition, can still cause misery for those suffering from its effects. It is usually temporary, the result of a cold or upper respiratory infection, but in some cases – especially for the elderly – may be permanent and signal a serious condition.
Anosmia occurs when the sinuses become swollen and inflamed. The most common causes include colds, flu, allergies, sinusitis and nonallergic rhinitis. Nasal obstructions, such as polyps, tumors and other deformities, can block the flow of air through the nose and lead to a loss of smell. There are many other possible causes including Alzheimer’s disease, brain tumor, aneurysm, diabetes, cocaine use, chemical exposure, malnutrition, hormonal imbalances, medications, Parkinson’s disease, rhinoplasty and radiation therapy, among others.

Treating anosmia depends on what is causing it. If a cold or allergies are to blame, treatment is unnecessary; your sense of smell should return in a few days as symptoms improve. If a polyp or other growth is blocking your nasal passages, surgery may be necessary. For bacterial infections, antibiotics are prescribed. Other conditions may require more specialized medical treatment. Occasionally, the sense of smell returns automatically, without any type of treatment.

Loss of smell can’t always be treated effectively, especially if it is the result of age. In these cases, it’s important to take extra precautions to ensure your safety. Make sure the batteries in your smoke detectors are all functioning properly and change them often. Take care when eating leftovers; your sense of smell directly affects your ability to taste, and consuming spoiled food can cause serious health problems.

Hay Fever

Hay fever is the common term for allergic rhinitis, a condition in which the nasal passages become swollen and inflamed, producing cold-like symptoms. Unlike a cold, however, hay fever is caused by an allergic response to a substance such as pollen, mold or animal dander.

Signs of Hay Fever

An allergic reaction to a substance causes an immediate reaction from the body’s immune system. Symptoms include runny nose and congestion, itchy or watery eyes, sneezing, cough, sinus pressure and pain, itchy nose and allergic swelling.

Differentiating hay fever from a cold can be tricky, given that the symptoms are so similar. Typically, hay fever causes a runny nose with a thin, watery discharge; fever is absent. With a cold, your runny nose will be accompanied by a thicker, yellow discharge, and you may experience body aches and fever. Your doctor can order tests to verify that hay fever is the cause of your symptoms.

Hay fever is often seasonal in nature, especially when triggered by pollen. Trees, grasses and weeds all release pollen as they bloom in the spring and summer. Other allergens, like dust mites and animal dander, produce symptoms year-round. The extent of your symptoms depends on which substance you are allergic to and how frequently it occurs.

Treating Hay Fever

If left untreated, hay may lead to sinus and ear infections, poor sleep and asthma. Avoiding the allergens that trigger your body’s immune system response is the best way to prevent hay fever. It can be tough to avoid all traces of these substances, of course, making medical treatment necessary for many people.

Drugs – including antihistamines, decongestants and nasal or oral corticosteroids – are often helpful. Over-the-counter medications work fine in many cases, but if you aren’t finding relief from those, your doctor may prescribe stronger medications. Allergy shots and drops (immunotherapy) offer long-term relief when other options fail; these work by allowing your body to build up a tolerance to the offending substance by introducing gradually increasing exposure over time.

Pediatric Nose Services

Allergy and sinus conditions are common in children, whose sinuses continue to develop well into the teen years. Allergy and sinus symptoms are similar, making a proper diagnosis a bit challenging. Symptoms of allergy and sinus conditions include runny nose, sneezing, stuffiness, coughing, sore throat, wheezing, headaches, snoring and itchy eyes and nose.
When allergies are to blame, the immune system responds to a perceived threat by flooding the bloodstream with chemicals called histamines, which attack the offending substance but cause inflammation and swelling of the airways in the process. Common allergy triggers include pollen, mold, animal dander, dust mites, chemicals, medications and certain foods.

Pediatric sinusitis is usually the result of cold viruses and may be aggravated by allergies. It can be either acute or chronic (lasting longer than 12 weeks and/or recurring frequently). Distinguishing whether your child’s symptoms are the result of allergies or a sinus condition is the key to successful treatment.

In addition to a physical examination, your child’s doctor will carefully inspect the ears, nose and throat for signs of infection. Skin and blood tests will likely be administered to determine whether an allergen trigger is responsible.

When your child is diagnosed with allergies and avoiding the allergen trigger isn’t possible, treatment consists of a variety of medications. These include antihistamines, decongestants, nasal corticosteroid sprays, eye drops and prescription drugs. Severe cases that don’t respond to medical treatment may require immunotherapy, usually delivered through weekly shots or drops. This enables the body to build up a tolerance to the allergen over time, bringing long-term symptom relief.

Sinusitis can be treated with home remedies (e.g. warm compresses, drinking lots of liquids, using a humidifier to moisten dry air, etc.) and medications to relieve symptoms. Chronic cases may require surgery.

Dizziness & Vertigo

The inner ear has a mechanism called the vestibular system that controls balance. Inside the system are semicircular canals with ducts, tiny hairs cells (stereocilia) and a thick gel structure called the cupula. When you turn your head, stand up or sit down, the gel moves against the stereocilia and receptors tell the brain that your body has changed orientation.
When the inner ear becomes infected, grows a tumor or encounters trauma, these structures may malfunction. When this happens, you can experience dizziness, vertigo and other balance issues. For some people, balance and inner ear disorders are hereditary and lifelong.

Symptoms of vertigo go beyond simply dizziness; they include feeling disoriented, nauseous and weak as well as cause erratic eye movements. Vertigo is sometimes associated with an illusion of movement – feeling like you are swaying or falling even if you are perfectly still. Since vertigo is connected with inner ear problems, someone experiencing vertigo may also have hearing loss and/or ringing in the ears.

The most common tests for inner-ear related vertigo or balance issues include electronystagmogram (ENG) or videonystagmogram (VNG) procedures, wherein warm or cool air is softly blown into the ear canal and then eye movements are measured. The purpose of this is to test the strength of the inner ear as well as eye movement coordination. Our physician experts are best equipped to make any necessary referrals appropriate for the individualized testing and treatment needs of our patients.

Treatment for dizziness takes many forms depending on the cause. Your physician will try to target the underlying condition in order to reduce or eliminate the symptoms. Options include medications (antihistamines, sedatives, antibiotics, steroids), physical or occupational therapy, surgery, repositioning exercises, vestibular retraining programs and lifestyle modifications such as dietary changes and elimination of alcohol and nicotine.

BAHA

A bone-anchored hearing aid (BAHA) is a surgically implanted hearing aid that works by transmitting soundwaves directly through the skull rather than through air waves passing through the ears. People with normal hearing can hear sounds coming through both air waves and through bone; those with outer or middle ear damages, however, are often unable to process sound waves through air. This is where BAHA comes in.

BAHA consists of three parts: a titanium fixture, an abutment and an external sound processor. The titanium fixture is surgically implanted into the bone behind the ear so that only the abutment is visible. The sound processor, which “catches” the vibrations of sound waves, transfers the waves through the abutment and fixture into the bone and then to the inner ear. It allows the user to still hear sounds naturally, similar to how one hears their own voice.

The audiologist will fit and program the BAHA device’s external components to your unique hearing situation. The programming system is called mapping; maps are programs that are customized for the user’s implant. Frequent customized mapping provides the best hearing experience for the user. The audiologist performs mapping by using beeps to adjust the device’s processors.

BAHA is best suited for those with conductive hearing loss, unilateral hearing loss, single-sided deafness and mixed hearing losses due to damages to the middle or outer ear. This is because the BAHA system bypasses these features and transfers sound directly from outside the head to the inner ear.

It is possible to test the BAHA system to see if it will work for you. Your doctor can connect the BAHA sound processor to your head via headband, which will provide a similar hearing experience as the implant.

Perforated Ear Drums

An eardrum perforation is defined as a hole or rupture in the eardrum. Known medically as a tympanic membrane rupture, this tear in the membrane separating your outer ear from your inner ear can lead to a middle ear infection and possible hearing loss, though in many cases it will heal on its own without medical treatment.

What Causes an Eardrum Perforation?

The eardrum converts sound waves into nerve impulses that are sent to the brain as well as protects the middle ear from bacteria, moisture and foreign objects. A perforation can disrupt both important functions, allowing bacteria to enter the ear and cause an ear infection (otitis media), and may also contribute to a loss of hearing.

Eardrum perforations are most often caused by infection, injury or Eustachian tube disorders. Middle ear infections cause a buildup of pressure that may result in a ruptured eardrum. Injury or trauma to the ear or head can cause a perforation, as can a skull fracture or sudden loud noise. Inserting objects like bobby pins or Q-tips in the ear to clean wax can inadvertently cause a rupture as well. Chronic Eustachian tube problems can weaken the eardrum, making it more prone to perforation.

Symptoms & Treatment

Some people are completely unaware of a ruptured eardrum; there may be a complete lack of symptoms, or only a feeling of general discomfort. Other times, people will experience a sudden sharp pain in the ear or a sudden decrease in pain if it has already been present; a discharge of fluid that may be bloody, clear, or pus-like; a buzzing or ringing in the ear; partial or complete hearing loss in the affected ear; ear infection; facial weakness or dizziness.

A doctor will examine the ears with an otoscope to visually identify a hole or tear in the eardrum. Because the majority of perforated eardrums heal on their own in a few months, no treatment may be needed other than antibiotics to prevent or treat infection. Nonprescription pain medication and a warm compress can help. Large perforations may require surgery. While the rupture is healing, you’ll need to keep the ear dry, avoiding water as much as possible.