Breathing/Sinus
It is important to understand the functions behind your breathing and sinuses. This section will teach you about the anatomy of your nose and shed light on why you may be experiencing breathing or sinus problems.
Articles
Deviated Septum
Sinusitis and Sinus Surgery
Broken Nose (Nasal Fracture)
Nasal Polyposis (Nose Polyps)
Nasal Valve Collapse Treatment
Deviated Septum
by Garrett H. Bennett, M.D.
What is a nasal septum and what are turbinates?
The nasal septum is the wall of cartilage and bone that divides the middle of your nose. The turbinates are the large structures on either side of the nasal septum. The septum and turbinates warm, humidify and filter the air we breathe to protect the lungs from dust and pollen.
What is a deviated nasal septum and what are enlarged turbinates?
A deviated septum occurs when the bone or cartilage that makes up the septum is crooked. Enlarged turbinates (turbinate hypertrophy) are caused by irritation of the turbinates or allergies. These conditions can make breathing difficult, cause snoring, sleep apnea, or sinus infections. You can treat nasal swelling with over the counter and prescription nasal sprays or oral medication.
Was I born with a deviated septum?
Childbirth may cause small fractures in the nasal septum that can become larger as we grow. Any trauma to the nose can cause deviation to the nasal bones and nasal septum. As we age, the shape of the septum may change as cartilage stretches and grows. You may also inherit a deviated septum or twisted nose from your parents.
When do you need corrective surgery for a deviated septum?
Straightening the deviated nasal septum is called a septoplasty. Reducing the turbinates is called a turbinoplasty. These procedures may be necessary when medication and other treatments have failed. The purpose of the procedures is to allow easier breathing, decrease snoring, or to improve sinus function. Dr. Bennett performs the procedure without external incisions, going through the nostrils to straighten the twisted cartilage and bone. The procedures take about an hour at an ambulatory surgery center. General anesthesia is usually required. Patients can go home about an hour after surgery. There is generally a noticeable improvement in breathing one week after the procedure. Breathing will continue to improve over the next 12 months.
Is it necessary to pack the nose after surgery?
Packing the nose involves placing gauze in the nasal cavities after surgery. Dr. Bennett finds that packing the nose is very rarely required. Surgical techniques have greatly advanced in the last 15 years. Today, doctors have a better understanding of how the nose heals . Packing placement and removal can cause trauma to the nasal septum and turbinates and may cause scarring. Packing will not prevent bleeding and may prevent topical decongestants from working.
Sinusitis and Sinus Surgery
by Garrett H. Bennett, M.D.
What are the sinuses?
Sinuses are spaces in the skull that are lined with tissue (mucosa). Small passages (osteomeatal complexes) connect the sinuses with the inside of the nose. The sinuses are shown below:
What is sinusitis?
When allergies, a deviated septum, or common cold prevent the sinuses from draining normally, a sinus infection (sinusitis) can occur. Because the draining spaces inside the nose are millimeters or less in size, even a small amount of swelling can cause sinusitis. A head cold that lasts more than a few days may be undiagnosed sinusitis.
What are the signs and symptoms of sinusitis?
Thick drainage from the nose- Infected mucus is abnormally thick, green or yellow in color, and sometimes has a foul odor. Infected mucus can drain from the nose or be coughed up.
Headache or sinus pain- Pressure from blockage of the small sinus cavities can cause severe facial pain, headaches, toothaches, or nasal congestion.
Repeated sinus infections- Tissue thickening inside the sinuses can narrow the passages. The bacteria inside the nose may become resistant to antibiotics.
Fatigue- Constantly fighting an infection drains the body’s energy and can interfere with the ability to get a good night’s sleep.
How is sinusitis treated?
Successful treatment of an acute sinus infection is often possible using antibiotics directed toward the most likely causes of infection. Failure of antibiotics may require further testing, including a CT scan of the sinuses. Additional improvement can come from a combination of anti-allergy medication, decongestants, nasal sprays, and saline rinses. Environmental controls, such as removing your carpet or using an air purifier, can also decrease symptoms.
When is sinus surgery necessary?
When medical treatment has failed, sinus surgery can dramatically improve your quality of life and sense of well-being. Functional endoscopic sinus surgery (FESS) removes blockages, allow ing each sinus to ventilate and drain through its natural opening.
How is the recovery from sinus surgery?
With Dr. Bennett’s advanced surgical techniques, placement of packing in the nasal cavities (and the associated) discomfort is rarely necessary. This improves the overall experience and contributes to a more rapid recovery. Patients typically return to normal activity in 7-10 days.
Broken Nose (Nasal Fracture)
by Garrett H. Bennett, MD
What is a nasal fracture?
The nasal bones are a pair of bones that extend about a third of the way from the forehead to the tip of the nose. Because they are very thin and in the center of the face, they are highly susceptible to injury. Nasal fractures account for 40 percent of all bone fractures. The most common causes of breaks among younger people they are fights and sports injuries, whereas falls are the most common cause in the older population. Trauma to the nose can change the shape and functionality of the bone and cartilage that make up the nose.
How do I know if I have a broken nose?
Breaking the nose is usually very painful. The nose will swell, and breathing can become difficult. The outside of the nose may be depressed, twisted, or C-shaped. The nasal bones may be mobile, and you may be able to feel or hear them moving. The eyes may be black and blue and the nose will frequently bleed profusely.
Do I need to see a doctor?
Yes. It is important to see a doctor as soon as possible after the injury occurs. The doctor will look for signs of a septal hematoma, or blood collected against the cartilage of the middle nose that can cause infection and destruction of the cartilage. It is best to see an Ear, Nose and Throat doctor, as they will be able to diagnose and treat the problem at the same time. Diagnosis is usually made by physical examination and an X-ray is rarely necessary.
How long do I have to fix my nose?
The broken bones will be mobile for up to two weeks and can sometimes be moved back into a natural position during that time. This can be done in the office or in an ambulatory surgery center. If the injury remains untreated for more than two weeks, the patient must wait at least two months – allowing the bones to completely heal – before seeking reparative treatment. The patient must then undergo a more extensive treatment to repair the nose.
What are the complications of a broken nose?
The main complications of a broken nose include permanent difficulty breathing and physical deformity of the nose. A fractured or deviated septum may be the cause of this breathing difficulty. The shape of the nose tip may change if the tip of the septum is bent. A hole in the septum (septal perforation) can cause the nose to collapse (saddle nose deformity). The cerebrospinal fluid (CSF) that cushions the brain may leak. The patient may lose their sense of smell. Infections of the nose or sinuses may occur. Other bones of the face may also be fractured, so you should check carefully for any addition head or neck injuries. Seek emergency medical attention if you suspect you may have a septal hematoma, CSF leakage, or an uncontrollable nosebleed (epistaxis).
What can I do at home?
Applying ice across the nose and keeping your head elevated will reduce swelling. Consistent pressure to the nose for 10-15 minutes without letting go will control most nosebleeds. Afrin drops inside the nose may also help the bleeding stop. Tylenol (acetaminophen) is the only over the counter pain medication that should be used. Other pain medicines like Motrin/Advil (ibuprofen), aspirin, and Aleve (naproxen) can promote or worsen bleeding.
Will insurance pay to fix my broken nose?
Insurance will almost always cover the cost of broken nose and deviated septum repair, as these are considered functional issues. Insurance will never cover cosmetic surgery, although your nose may look better after it is repaired with functional surgery. We will check your benefits for you and let you know what they are.
Nasal Polyposis (Nose polyps)
by Garrett H. Bennett, MD
What causes nasal polyps?
Nasal polyposis (Nose polyps) occurs when tissue within the nose swells and grows outward, creating mucus-filled sacs. No conclusive cause for nasal polyposis has been established, but they are thought to be caused by allergy or sinus irritation, and can be associated with asthma in adults and cystic fibrosis in children. More recently, an allergy to fungal spores in the air has been identified as a major risk factor for nasal polyps.
What are the symptoms of nasal polyps?
-Nose is always blocked (nasal congestion)
-Constant runny nose or postnasal drip
-Decreased or loss of sense of smell (anosmia)
-Headache or forehead and cheek pain
-A bad head cold that does not go away
How are nasal polyps diagnosed?
A doctor can often detect polyps simply by looking in the front of the nose with a headlight. For a more complete examination, the doctor can use a narrow lighted tube with a magnifying lens (nasal endoscope) to look deeper inside the nasal cavity. A CAT scan of the sinuses will show areas that cannot be seen by looking into the nose and can show the extent to which the polyps have spread in the sinuses.
The doctor can use skin or blood allergy testing to determine if allergies are causing some of the inflammation.
What are the potential complications of nasal polyposis?
Patients may have recurrent sinus infections from obstructive nasal polyps. Large polyps can eventually compress the eyes or push on the brain. Nasal obstruction can cause sleep apnea, a condition that stops your breathing during sleep and can cause serious heart and lung damage.
What medical treatments are available?
Nasal or oral steroids can reduce inflammation and may shrink nasal polyps. Oral or nasal antihistamines can decrease symptoms of allergies. Sinus infections should be treated aggressively with antibiotics. For fungal sinusitis, an antifungal medication may be effective.
If your nasal polyps prove resistant to medications, then they can be removed in an ambulatory sinus surgery procedure (polypectomy). If you are experiencing sinus inflammation, endoscopic sinus surgery can ventilate and provide drainage to the sinuses. You will generally go home about an hour after surgery. You may feel congested following surgery, but your breathing may also be better immediately.
Can I prevent nasal polyps from coming back?
The patient must maintain constant vigilance after nasal polyp removal. Unfortunately, nasal polyps will return in approximately 2 out of every 3 people who experience them. Saline rinses may decrease irritation in some patients, although others may feel that they cause more irritation. Air purification is always a good idea, as the air inside the home can have 5 to 10 times as many impurities as outside air. Avoiding dust, pollution, and irritating chemicals can decrease nasal swelling. Humidifiers can keep the inside lining of the nose moist in the winter or in dry environments. Medical treatment of allergies and asthma will also decrease inflammation inside the nose. Hand washing and covering your nose when you sneeze are some of the best ways to prevent the spread of viral and bacterial infections that may aggravate the polyposis.
Nasal Valve Collapse and Treatment
by Garrett H. Bennett, MD
Introduction
Collapse of the nasal valves – internal and external – is a commonly overlooked cause of breathing obstruction. Common causes include previous trauma to the nose or cosmetic rhinoplasty. Lifting the soft tissue of the cheek on the affected side of the nose or using BreatheRite nasal strips may relieve some symptoms, but surgery is the best option for permanent treatment of nasal valve collapse. Many ENT surgeons are not comfortable with these surgical techniques. It may be necessary to find a surgeon with Facial Plastic Surgery Board certification, as he/she will have the additional training required to perform this corrective surgery.
Internal Valve Collapse
Before and after: Correction of bilateral internal valve collapse due to a previous cosmetic rhinoplasty. Note the ‘inverted-V’ shape of the nasal bones on the left (actual patient).
The intersection of the nasal septum and upper lateral cartilage forms an angle that is usually eight to 15 degrees. Less than this can cause collapse of the internal valve, where much of the sensation of breathing comes from. Internal collapse may also cause narrowing of the middle third of the nose. Visually, the nose may have an ‘inverted-V’ where cartilage has pulled away from the nasal bones. This can be corrected by placing of strips of cartilage at the area of collapse to splint out the valve, or reattaching the cartilage to the nasal septum.
External Valve Collapse
Before and after: correction of right external valve collapse (actual patient).
If the side of the nose collapses inward during inspiration (breathing in), you may have a collapsed external valved. The sidewalls of the nose may look pinched where the cartilage is weak or has collapsed inward. This can also make the nose tip appear larger when it in fact has a normal size. Placing a cartilage graft into the weakest area of the nose can prevent collapse in that area. A deviated nasal septum or enlarged inferior turbinates may further contribute to external valve collapse.
Causes of Valve Collapse
Aging weakens the nasal sidewalls and causes the tip of the nose to sag. These changes can obstruct airflow inside the nose. Weak cartilage or cartilage turned inward can also predispose patients to nasal valve obstruction. The primary cause of nasal valve obstruction requiring surgery is previous nasal surgery. Taking down a large bump or decreasing a large tip can weaken support in the rest of the nose. Dividing the cartilage from the septum can cause scarring in the internal valve area that is very difficult to correct. Cosmetically, the nose may look great, but your breathing is still problematic. This can be avoided by choosing a surgeon trained to avoid and correct this deformity.
Cottle Maneuver: If your breathing improves when holding the cheek outward (as pictured above), you may have a collapsed valve(s).
A “Cottle maneuver” is an invaluable tool for diagnosing nasal valve collapse. The nose’s internal and external valves are elevated outward and the improvement in breathing is scored on a 10 point scale. The doctor should perform an intranasal exam should be performed before and after the nose is decongested. He/she can also perform a nasal endoscopic exam to evaluate structures deeper within the nose. In addition to valve collapse, a complete intranasal exam should look for indications of a deviated nasal septum, inferior turbinate swelling, sinus infection, or adenoid enlargement. A Sinus CT scan may be required for some patients.
Is this considered cosmetic surgery?
No. The ability to breathe through the nose is recognized by insurance companies as important to health and has its own insurance code. The nose shape may be more pleasing aesthetically as a result of correction of the nasal valves. Insurance will cover the functional cost of the surgery.