Do I need sinus surgery?

I get a lot of questions asking about having surgery of the turbinates. Here are some answers. What are turbinates? The turbinates are shelves on the side of the nose. The main ones are the middle and the inferior. They normally enlarge and shrink. They especially enlarge with a cold or infection because blood is coming to the area to fight infection. They enlarge with allergy, and become pale and swollen. Sometimes they happen to be swollen on the day you see the doctor, and if you are complaining that your breathing feels blocked, it makes sense to reduce their size. Enlargement of the turbinates can, at times, be seen on an X- ray. BUT What Do Turbinates Do? The turbinates serve a major function. They warm inhaled air before it enters the lungs. They are covered by millions of cilia which defend the body against contaigons and irritants in the inhaled air. They provide an environment for the good white blood cells, and a bacteria-fighting enzyme called lysozyme, to gather and fight infection. They act as a baffle to better direct the flow of air. No matter how much your turbinates seem to cause you trouble, you don’t want to just remove them. If you did, you would have dryness, crusting and sensations of burning pain. Doctors have therefore come up with various ways to reduce the blockage of your nasal passages without removing your turbinates and their cilia. Surgery Methods One technique is to just remove a small amount, not enough to take away too much cilia. In certain cases the position of the turbinates is such...

Smog, Kilauea Volcano, and Air Pollution

Whether it is gasses from volcanoes, or fumes from traffic, air pollution is a serious problem. Tragically this health crisis keeps getting worse with more automobiles and industry. Once upon a time if you went to a deserted Pacific Island, there was no problem with polluted air. Now, the winds carry these pollutants even to the distant sunny beaches! Effects of smoke, gasses and Kilauea  Volcano: • Coughing • Decreased mucus secretion • Eye irritation • Sinus congestion • Sore and dry throat • Wheezing There are two problems with polluted air. One is the size of the particles.     Usually these are carbon or of carbon like composition. The tiny ones can be moved out of the lungs by the action of tiny oars called cilia. The larger ones are too big to be handled by the cilia and so they remain in place and cause inflammation and coughing.  When you see the black soot on your skin, you know it is time to grab an N95 filter mask. The second problem is one of chemical composition. Sulphur dioxide – SO2 – is a common product of burning coal. It combines with other products to form dozens of chemicals, one of which is sulphuric acid, a highly caustic acid. It is any wonder that your eyes burn, nose feels sore, and you cough? Where farming consists of burning left over crops to clear the land and put good chemicals into the soil, the problem is worse. Winter time can be worse than summer when the polluted air is held in place by weather conditions. In the killer London...

What is the Best Solution for Irrigation?

Which Solution Should You Use for Sinus Irrigation? What is the best solution for irrigation? If you search the literature on nasal irrigation you will find hundreds of articles on using various solutions discussed. The differences are based on the science of pressures caused by osmotic pressure. Osmotic pressure exists when you have two “containers” separated by a membrane, called a permeable membrane, such as the nasal tissue. If container A is isotonic, and B is the natural human tissue, which is isotonic, then there is no osmotic pressure, since they are both equal. If container A is hypertonic – extra salt – then container A would exert a pressure to draw water out of the other side. That pressure, in science, continues until both containers have equal osmotic pressure. For nasal irrigation there is: a. Isotonic saline. This is a saline solution which can be used for many purposes in the human body. It is called isotonic because when it is given, for example, intravenously it doesn’t cause any harm. b. Hypertonic saline. Here the amount of salt is increased so that the osmotic pressure is much higher than in the body fluids. In theory the extra osmotic pressure would draw off extra fluid. This is toxic if given intravenously c. Ringer’s solution. This is a special formula that is made to match the body fluid composition. Ringer’s is made up of the elements that are ideally in the body fluids. In the Emergency room, they give Ringer’s solution intravenously to injured patients. Various studies show that this composition is superior for nasal cilia enhancement. (See References at...

Empty Nose Syndrome

ENS Diagnosis Patients with Empty Nose Syndrome have a special problem. When they tell the doctor that they have trouble getting enough air. When she looks in the nose and sees that the airway is wide open, she may conclude that there is simply nothing wrong with this patient, or worse, prescribe a nasal corticosteroid which can make the symptoms worse. ENS is Life Altering Empty Nose Syndrome (ENS) is a devastating problem and can be life altering. Symptoms can include a sensation of not getting enough air, nasal pain, loss of olfactory sense, frequent sinus infections, headaches, poor sleep, fatigue, unpleasant dryness and crusting. There is frequent nasal pain. Yet, the blood oxygen measures normal. Today’s treatment includes using a Ringer’s type saline without preservatives, and special ointments to build up tissues. Hydro Pulse™ pulsating irrigation acts as a replacement to the absent nasal cilia defense. Surgical Correction: Steve Houser In 2000, at the Academy of Otolaryngology, Dr Steve Houser and I presented a program on this topic, called Mucociliary Clearance. Surgical correction for ENS has been described by doctor Houser since then, but up to now, there hasn’t been large studies that measured symptom relief. An article just published in the JAMA – Otolaryngology Journal, May 2014, reports on a group of patients diagnosed ENS who had MedPor implant surgery. They reported on symptoms of fatigue, reduced concentration, sadness, dryness and nose too open, in addition to the standard nasal airway complaints. After the implant surgery, these patients reported that their ENS symptoms were reduced. Use of MedPor implants for absent tissue is one of the subjects...

Let me count the ways for snoring relief

If you can count, you can get find snoring relief. There is a misconception that I see in the popular magazines. They write that simple snoring is a form of Obstructive Sleep Apnea.(OSA). This is a serious mis-information. You can have snoring that disturbs the entire house and still not have periods where you don’t get oxygen to your brain –OSA What I stress to my patients, is that you need to clear simple snoring because it could lead to Obstructive Sleep Apnea – OSA. How that works: It’s simple arithmetic. When each factor adds to 10, you snore o GERD stomach acid reflux o Large floppy tongue o Flabby weak throat muscles o Enlarged fatty soft palate and uvula o Nasal airway blockage o Enlarged Adenoids o Larynx/voice box blockage o Obesity A person may snore from a single factor, such as chronic sinusitis that is a ten. Or it may be a sum of GERD 4, plus enlarged soft palate 4, plus Sinusitis 4 equals 12. If we stop the GERD, than we are below ten; below ten he sleeps soundly. If you clear the GERD and the chronic sinusitis, then the enlarged palate alone may not be a ten, enough to cause a snoring problem. If you understand how snoring can develop into problems that lead to a condition where a patient actually stops getting oxygen to his brain, OSA, then you can stop the snoring early and prevent this. Enlarged Adenoids are rare in adults, common in children. If adenoids are enlarged on only one side, that needs to be investigated. Would You Like to...

Allergy? Flu? Sinusitis? How to tell the difference.

How to tell the difference and the best way to treat it… Sniffling, sneezing and wiping your eyes? You might assume you have a cold…but not so fast. These symptoms can also come from the flu or allergies…from something that’s similar to an allergy…and even from something else entirely—sinusitis! Telling these five conditions apart can be tricky—even for doctors and for people who may have developed allergies later in life. But knowing the difference is the key to getting the most effective treatment. To be well, you need to know the difference Marcie had a constant runny nose. She was referred to me for surgery. “No surgery! You have dust and cat allergy.” With medication, she was fine. COLDS Colds are caused by more than 100 different viruses. Your symptoms will depend on the specific virus you are infected with. Telltale signs: In addition to common cold symptoms, such as sneezing, a sore throat, congestion and/or a cough, you may also have a low-grade fever, mild body aches and aching, swollen sinuses. Symptoms usually last a week or two. My favorite cold remedies: Get into bed and rest. If you can, watch a funny movie. Research shows that laughing promotes healing. Also, have chicken soup and decaffeinated green tea with lemon and honey. Chicken soup and green tea have anti-inflammatory properties that help fight infection. If you need help sleeping, try 25 mg to 50 mg of diphenhydramine (Benadryl). For an immune-boosting herbal cough syrup: Mix one-half teaspoon each of cayenne pepper and freshly grated gingerroot…two tablespoons each of honey and apple cider vinegar…and four tablespoons of water. Take...