Seasonal allergies are common and affect many people. The medical term for seasonal allergies is allergic rhinitis, which means inflammation of the nose due to allergies. This condition can cause trouble breathing through the nose/nasal obstruction, nasal congestion, runny nose, drainage in the throat/postnasal drip, sneezing and nasal itching. In patients with allergic rhinitis, the underlying problem is allergy. Certain things in the environment are causing your immune system to respond vigorously. Treatments for allergic rhinitis are aimed at reducing the allergic response in the nose. This is usually done with nasal steroid sprays, oral antihistamines such as Allegra or Claritin, or allergy shots (immunotherapy). Sometimes these treatments are not enough to alleviate the symptoms. In these cases, a surgical procedure may be the only way to control your symptoms.

The septum is the midline structure that separates the nose into right and left sides. A deviated septum means that the septum is crooked and is obstructing either the right, the left, or sometimes both sides of the nasal cavity.

The inferior turbinates are little bones that stick out into the nose from the side. They can often become hypertrophic (enlarged). This can occur for a variety of reasons with the most common being allergies. Often, treatments for allergies such as nasal sprays and allergy shots will help prevent your turbinates from becoming too large and causing nasal obstruction.

However, sometimes nasal sprays and allergy shots do not provide enough relief or sometimes you can’t wait years for the allergy shots to take effect. If your allergies aren’t under great control, and you are suffering from nasal obstruction, you may be a candidate for an inferior turbinate reduction.

Sinusitis is inflammation of the sinuses. There are two basic types of sinusitis: acute sinusitis and chronic sinusitis. Acute sinusitis is a sinus infection that lasts less than four weeks. Chronic sinusitis is a sinus infection or sinus inflammation that lasts more than 12 weeks. Both have similar symptoms.

Symptoms of sinusitis include trouble breathing through the nose, nasal congestion, runny nose, postnasal drip or drainage in the throat, facial pain or pressure and trouble smelling. Based on symptoms alone, it is hard to know what the exact cause is without a comprehensive nasal evaluation including nasal endoscopy - a procedure that uses a camera to look at the inside of your nose where your sinuses drain to assess your nasal and sinus cavities to determine the underlying cause of your problems.

Acute sinusitis does not always need to be treated with antibiotics. Often, saline irrigations (similar to a Neti-pot) and some nasal sprays can provide enough relief until the infection clears. If further treatment is needed, it is common to use antibiotics and/or steroids to treat an acute infection if has lasted too long or if you began to improve but then abruptly worsened. If necessary, a culture can be taken directly from your sinuses. To make sure this is accurate, I do this during nasal endoscopy, so that I can culture the drainage as it comes out of your sinuses to make sure the results are not contaminated and to ensure that the results are accurate. Antibiotics specifically directed toward the bacteria collected can then be prescribed. A CT scan is not usually required unless a complication of acute sinusitis is suspected. If a complication of sinusitis is suspected, you may need more urgent treatment including a CT scan, IV antibiotics, and possibly endoscopic sinus surgery.

If your sinus infections keep coming back, you may have recurrent acute sinusitis. A CT scan may be helpful in order to determine whether certain factors in your sinus anatomy are predisposing you to these infections. If so, you might be a candidate for balloon sinuplasty or sinus surgery. The goal in this case is to reduce the frequency or the severity of your infections.

Chronic sinusitis can be a debilitating condition. We know that chronic sinusitis severely impacts quality of life and can result in many clinic visits and lost work days. So, having your chronic sinusitis treated can improve your quality of life.

There are a variety of types of chronic sinusitis. Chronic sinusitis can broadly be separated into two categories: chronic sinusitis without polyps and chronic sinusitis with polyps. Some types of chronic sinusitis are infectious, such as odontogenic sinusitis (sinus infections resulting from an infected tooth); however, the majority of chronic sinusitis cases are inflammatory in nature. This means that many patients with chronic sinusitis don’t actually have an infection. Instead, they have excess inflammation in the sinuses that is the result of an exaggerated response of the immune system to irritants within the sinuses.

Fungal sinusitis warrants its own mention. There are many types of fungal sinusitis. One of the more common types is a fungal ball. A fungal ball is a relatively common occurrence. The sinuses are a great place for fungi to grow. The sinuses are warm and humid, just the environment fungi are looking for. If a fungal spore sets up shop in your sinus cavity, it can proliferate into a fungal ball. Fortunately, these can usually be removed easily. Another common type of fungal sinusitis is allergic fungal sinusitis. In this condition, your immune system is overreacting to normal fungi in the environment due to allergy. This conditions results in significant inflammation and polyp development - see below for more information on nasal polyps. For more information, see my blog post on fungal sinusitis.

The good news is that chronic sinusitis can often be treated medically. Medical treatment always includes saline irrigations and nasal steroid sprays. The medical treatment of chronic sinusitis often includes either a long course of antibiotics and/or a steroid taper. Many patients have their symptoms resolve with this therapy.

Unfortunately, some patients continue to have symptoms of chronic sinusitis. If that is the case, a CT scan may be needed to evaluate the extent of sinus disease seen after medical treatment. In these cases, balloon sinuplasty or endoscopic sinus surgery is often recommended. Only certain patients truly are candidates for balloon sinuplasty, and many rhinologists think it is utilized more frequently than it should be. Most patients will benefit from endoscopic sinus surgery. If you think you might suffer from chronic sinus disease, come in for an evaluation so we can get started on improving your quality of life!

Nosebleeds are a nuisance no matter when they happen. Fortunately, most nosebleeds are minor. Typically, nosebleeds occur when the nose becomes dry and the lining of the nose cracks. With appropriate pressure, most nosebleeds will stop quickly. Appropriate moisturizing techniques can help prevent nosebleeds for many people. If you don’t respond to the moisture, you may benefit from an in-office cauterization to address any problem areas that are present in your nose. More serious causes of nosebleeds do exist, but thankfully - they are rare. Nevertheless, it is important that you are fully evaluated with nasal endoscopy to rule out any serious causes prior to undergoing any treatment.

While it is not common, there are nosebleeds that are so severe that they need to be addressed in the operating room. Even less commonly, you can have a significant nosebleed from the sphenopalatine artery, the artery that serves as the main blood supply to the nose. This is more likely if you have had any previous surgery in the nose or sinuses. In these cases, you might benefit from a surgical procedure called a sphenopalatine artery ligation.

Eustachian tube dysfunction can be a bothersome problem for many patients. The eustachian tube is the tube that connects the ear to the back of the nose. Eustachian tube dysfunction occurs when the eustachian tube doesn’t open and close properly. This prevents the ear from regulating its pressure properly. Symptoms of pressure changes, crackling in the ear, muffled hearing, ear fullness, and even hearing loss can occur.

A CSF leak is a serious condition. This occurs when fluid around the brain leaks out through the nose. A sign of a CSF leak is clear, watery drainage leaking from the nose, usually just from one side. The drainage tends to taste salty or metallic. It may get worse when straining or bending forward. In most cases the cause is unknown, but it can occur after a traumatic event to the head or neck.

Epiphora is excessive tearing that results in tears flowing onto the face. This can result for a variety of reasons. The problem can have to do with overproduction of tears by the lacrimal gland or inadequate drainage of tears through the lacrimal (tear drainage) system and into the nose. Depending on the cause of epiphora, the treatment options can vary.

If your problem is due to insufficient drainage of tears through the lacrimal system and into the nose, then your lacrimal (tear drainage) system might be obstructed. This is typically evaluated by an ophthalmologist. In the event that a part of your lacrimal system is obstructed or blocked, you might benefit from a dacryocystorhinostomy.