The doctors at Ear, Nose & Throat Associates of Nassau County are skilled in managing nasal cavity disorders as well as any external concerns. Allergies, Sense of Smell issues as well as Nasal Respiration Conditions may be treated at our various locations.
When nasal surgery is indicated because of deformity, injury, accident, or functional deficit, talk to our surgeons first. They are Diplomates of the American Board of Otolaryngology, highly skilled and experienced.
Do you have sinus problems; colds that won't go away; sinus infections that make you feel tired. Are you taking antibiotics all the time? Get to the cause of the problem instead of dealing with the symptoms.
Be sure to Contact Us when you have any issue concerning Nasal or Sinus Problems
Deviation of nasal Septum
Sinusitis
Acute
Chronic
Allergic
Fungal
Nasal Polyps
Sinus Surgery
Turbinate Surgery
Smell and taste disorders
Nasal Obstruction
A common complaint of many individuals with sinus problems is a "blocked nose." This feeling of blockage can result from sinus infections. In addition, there are a number of things that anatomically block the nose and can lead to sinus problems. Blockage may occur when the lining of the nose swells, or when there is a deformity of the cartilaginous or bony structures that make up the framework of the nose. This article will explore the common conditions that cause nasal blockage and how they can be treated.
Why can’t I breath well from my nose?
You’ve come to the right place! In order to understand why you’re not breathing well, you first need to understand the anatomy of your nose and nasal passage.
At ENT Associates of Nassau County, we’ve found that it is best to classify nasal obstruction into two categories:
Anatomical obstruction
Inflammatory obstruction
Anatomical Obstruction
There are three main structures that often cause anatomical obstruction: the nasal septum, the inferior turbinates, and the lateral nasal wall. Together, these three structures form what is called the “Internal Nasal Valve.” An abnormality in some or all of these structures will make breathing difficult.
Other causes of anatomical obstruction include nasal polyps, nasal masses, or enlarged adenoids.
Inflammatory obstruction
Inflammatory obstruction is typically caused by allergy or sinusitis. When there is an allergen present, small cells in your body, called mast cells, release molecules that cause your nasal linings to swell. Many patients with allergy or other inflammatory causes of obstruction respond well to various nasal sprays and will not require a procedure. If you’ve tried various nasal sprays, or no longer want to use sprays, we have a solution too!
Clarifix
The Clarifix procedure is a simple procedure performed in our office; It’s pain free, and only takes a few minutes. It is FDA approved for allergic rhinitis, vasomotor rhinitis, and nasal obstruction. After gently numbing the nose, the clarifix device is used to freeze the nerve that’s responsible for your symptoms! This causes the nerve to degenerate and provides long-lasting relief for a vast majority of our patients.
What can I expect during an office visit for nasal obstruction?
Every patient encounter will start with a detailed history. We will ask you various questions to better understand your unique case. Next, we will do a comprehensive physical examination of the nasal cavity with a tiny camera. This is called a “nasal endoscopy” and it allows us to visualize all of the structures in your nose so we can identify the abnormality or abnormalities that are causing your symptoms. In some patients, after the history and physical exam, we will determine that a CT scan of the sinus is indicated. As you can see, our approach allows us to design a treatment plan tailored JUST FOR YOU!
What is the Nasal Septum?
The nasal septum is a vital structure in your nose. It serves several functions including separating the nose into a right and left cavity. A straight and intact septum allows air to flow freely through both sides of the nose. In patients with a deviated septum, the nasal cavity can become blocked. Some patients have holes in their septums which can cause abnormal airflow through the nose resulting in significant dryness. The septum also acts along with the inferior turbinates and the lateral nasal wall to form the internal nasal valve (see diagram below).
How is a deviated septum treated?
At ENT Associates of Nassau County, we determine what specific treatment each patient requires based on their symptoms and our physical exam. Some patients have a deviated septum and breath well! Those patients require no treatment! For patients who are suffering from nasal obstruction, we may first offer nasal sprays to reduce swelling around the septum. If the deviation is significant or sprays don’t help, a septoplasty may be required.
SEE THE SEPTOPLASTY TAB, UNDER IN-OFFICE PROCEDURES FOR MORE INFORMATION
What is Nasal Valve Collapse?
At ENT Associates of Nassau County, when we talk about nasal valve collapse, what we are really describing is collapse of the soft portion of the nasal sidewall. The side of the nose consists of three structural elements. The upper portion is bone, below that is the upper lateral cartilage, then the lower lateral cartilage. If the cartilages don't have structural integrity, they can get sucked in by the vacuum effect created when you inhale.
Why is Nasal Valve Collapse important?
Unfortunately, valve collapse is very often overlooked as a cause of nasal obstruction. If the nasal valve isn’t stable, a surgery to fix the septum or reduce the turbinates may not give you the improvement you desire. At the Sinus Centers of Long Island, we make sure to thoroughly examine the nasal valve and we repair it if needed.
How do you fix Nasal Valve Collapse?
The repair required will depend on each patient’s unique situation and anatomy. Is the upper cartilage collapsing? Is the lower cartilage collapsing? Or both? Frequently, we will employ the LATERA procedure to address valve collapse. This is a simple procedure that only takes a few minutes to perform (see link with video below). Patients with more severe collapse may require more detailed reconstruction by one of our Facial Plastic Surgery colleagues.
The nasal turbinates are bony structures along the side of the nose, covered by a moist lining called mucosa. The purpose of the turbinates are to humidify air as it enters the nose, supply you with the sensation of air flow, and act as anatomical landmarks during sinus surgery.
What is turbinate hypertrophy?
If the turbinates become too large, they can obstruct the flow of air through the nose. The turbinates commonly become inflamed from allergy and/or sinusitis. In these cases, the mucosal lining becomes very thick and contributes to nasal blockage. In some patients, the bony component is enlarged and causes the obstruction.
How is turbinate hypertrophy treated?
The treatment required depends on the cause and extent of the enlargement. Some patients have enlarged turbinates but breath just fine. In these situations, treatment is not indicated. If mucosal inflammation is the cause, treating underlying allergy or sinusitis often significantly helps. If a patient does not improve with medication, or has significant bony enlargement, they may require an in-office procedure to permanently reduce the size of the turbinates.
What is a turbinate reduction?
A turbinate reduction is a procedure commonly performed at ENT Associates of Nassau County to permanently reduce the size of the turbinates and get you breathing much better! Most commonly, this is done quickly and pain free in our office. If we are performing it in conjunction with a complex sinus surgery, or complex septoplasty, it may be performed in the operating room. The area is gently numbed, a small incision is made on the front part of the turbinate, and a tiny rotating machine called a microdebrider is used to remove excess mucosa and/or bone. The procedure takes less than 10 minutes and is pain free. Since there are no external cuts, your nose will look the same!
What should I expect after a turbinate reduction?
Anytime we make an incision, there is a risk of bleeding. This risk is extremely low and we don't expect you to have significant bleeding or discomfort in the days following the procedure. Nasal congestion in the days following the procedure is common and expected. As your turbinates heal, they swell. Thankfully, the swelling is temporary and once healing is complete, your turbinates will be significantly smaller and your breathing will be significantly improved!
With chronic sinusitis, the cavities around nasal passages (sinuses) become inflamed and swollen. This interferes with drainage and causes mucus to build up. This common condition is also called chronic rhinosinusitis.
If you have chronic sinusitis, it may be difficult to breathe through your nose. The area around your eyes and face may feel swollen, and you may have throbbing facial pain or a headache.
Chronic sinusitis may be caused by an infection but can also be caused by growths in the sinuses (nasal polyps) or a deviated nasal septum. While most people have a short-lived bout of sinusitis at some point (known as acute sinusitis), chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back.
What are Sinuses?
Sinuses are air-filled chambers within the facial skeleton that are lined with a thin layer of tissue called mucosa. The mucosa forms mucus, which traps pollutants, molds, allergens, and germs to keep us healthy. The sinuses also function as a resonance structure for our voices, to decrease the weight of our heads, and act to protect vital facial and cranial structures in the event of blunt trauma.
• Nasal Drainage (from the front of nose or into the back of the throat)
• Nasal obstruction or difficulty breathing from the nose
• Facial pain
• Facial pressure or fullness
• Headaches
• Bad breath
• Upper tooth pain
• Fatigue
What Causes Sinusitis?
The sinuses and airway are lined with thin tissue called respiratory mucosa. The purpose of the mucosa is to create mucus that acts as a protective barrier against pollutants, dust, allergens, and germs. Sometimes, when the sinus openings become blocked, the mucosa becomes inflamed and infected leading to the typical sinus symptoms of facial pain, facial pressure, nasal congestion, decreased sense of smell, headaches, nasal drainage and chronic fatigue. Interestingly, since the sinus and lower airway share the same lining, many patients with asthma or other lung conditions improve once their sinuses are appropriately treated.
Can I Avoid Sinus Infections?
There are various factors that may predispose you to sinus infections. Typically, these factors lead to fluid accumulation in the sinuses that becomes acutely or chronically infected with germs. Sometimes, narrow sinus openings, allergies, or a deviated nasal septum can prevent the sinuses from aerating normally; this can lead to chronic sinus pressure and nasal blockage in the absence of significant fluid accumulation. If you’re prone to developing sinus infections, here are some steps you can take to help prevent them:
• Wash your hands
• Quit smoking and avoid second hand
• Use an air humidifier (make sure you clean the filter frequently)
• Maintain your AC filters at home to prevent accumulation of dust, mold, and allergens
• Avoid known allergens
How are Sinus Infections Classified?
At ENT Associates of Nassau County, we classify sinusitis into 3 categories.
1. Acute Rhinosinusitis (ARS) – commonly caused by viruses and bacteria, acute sinusitis are sinus infections lasting only days to a few weeks, at most. If symptoms persist for 7-10 days, or improve then worsen (double worsening sign), we will typically offer antibiotics +/- steroid medication along with nasal sprays/irrigations. The vast majority of acute sinus infections will resolve on their own and will not require antibiotics. It is normal to get up to three acute sinus infections per year.
2. Recurrent Acute Rhinosinusitis (RARS) – Patients will have 4 or more acute sinus infections per year, with asymptomatic periods between infections. There are several factors, both structural and environmental, that may predispose a patient frequent sinus infections. Structural factors include narrowed or blocked sinus openings resulting from abnormal sinus development and/or significant nasal septal deviations/turbinate hypertrophy. Environmental factors may include seasonal or year-long allergies which result in swelling and further narrowing of the sinus openings. Typically, we will recommend a CT scan of the sinuses to visualize the patient’s unique sinus anatomy as well as comprehensive allergy testing. Many of our patients with RARS like to avoid multiple courses of antibiotics per year and thus, are fantastic candidates for some combination of in-office balloon sinus dilation, in-office functional endoscopic sinus surgery (FESS), and allergy shots. The purpose of these treatments is to help open the sinuses to relieve the patient’s symptoms and significantly reduce the frequency and severity of future infections.
3. Chronic Rhinosinusitis (CRS) – Our patients with CRS have persistent sinus symptoms lasting over 3 months. Many of our patients have been suffering for many years and have significant nasal inflammation and fluid in their sinuses. Many have already been on several courses of antibiotics, steroids, and nasal sprays before their initial consultation with us. Some patients with CRS also have nasal polyps which are caused by excessive nasal inflammation and can lead to further blockage of the sinus openings. A badly deviated septum or severe allergies can also lead to chronic sinus obstruction and CRS. CRS patients require a CT of the sinus to visualize their unique anatomy and to determine which sinuses are involved. Patients with CRS typically do not improve with “maximum” medical management (antibiotics, steroids, nasal sprays) and thus, many will require either balloon sinus dilation or FESS (sometimes in the operating room).
What Happens If I Don’t Treat A Sinus Infection?
Most acute sinus infections are caused by viruses and will resolve on their own without antibiotics. We typically recommend waiting from 7 to 10 days before seeing a doctor as viral infections will resolve in that timeframe. If your symptoms last beyond that period, or start to improve then get worse (double worsening sign), the infection is likely bacterial. In these situations, antibiotics will help, and they can prevent the infection from spreading.
How is Sinusitis Diagnosed?
Proper diagnosis is essential for proper treatment and results in optimal outcomes. As you learned above, there are multiple potential factors that may be working together to contribute to your sinus complaints. If we focus on treating symptoms alone, there is high risk of recurrence after treatment. For this reason, there are several diagnostic tests that may be employed to establish the underlying cause of your sinus complaints.
They include:
• A comprehensive history and physical examination
• Nasal endoscopy
• CT Scan
• Allergy Testing
The results of these tests will allow us to formulate a unique treatment strategy for each patient. A “one-size fits all” method fails to account for subtle differences among patients in regards to their specific goals, concerns, and desires. Tailoring a customized approach to each patient has allowed us to successfully treat thousands of sinus patients.
How is Sinusitis Treated?
At ENT Associates of Nassau County, treatment is classified into two general categories: medical and non-medical.
1. Medical Management
- Nasal saline sprays/irrigations
- Steroid irrigations
- Antibiotics
- Oral steroids
- Intranasal steroids
Medical management works well to treat the majority of patients with sinusitis. However, since we are specialists, we often see patients with more complicated and severe sinusitis. Many of our patients with chronic sinusitis and recurrent acute sinusitis have already exhausted the above treatments many times over, without significant improvement. These patients will often benefit from non-medical management.
2. Non-Medical Management
- Balloon sinus dilation
- Functional Endoscopic Sinus Surgery
Balloon sinus dilation is an advanced technology employed at ENT Associates of Nassau County. The procedure is nearly always done in our office under local anesthesia (similar to a dental procedure). A tiny balloon is placed into the sinus opening under visual guidance with a small camera. Once the balloon is in the small sinus opening, the balloon is dilated, then removed. The result is permanent remodeling and widening of the sinus opening.
Functional Endoscopic Sinus Surgery (FESS) involves removing sinus tissue to open the sinus cavities. This is also done with tiny instruments through the nose with no external cutting. Typically, patients with more severe sinusitis as determined by the CT scan require FESS. Traditionally, FESS was only offered under general anesthesia in the operating room. However, at the Sinus Centers of Long Island, our surgeons have extensive experience in office based FESS and hybrid Balloon Dilation/FESS procedures. Many of our patients can be cared for in the office with local anesthesia.
Nasal polyps are caused by excessive inflammation in your nose. They can be caused by chronic sinusitis, severe allergy, underlying nasal masses and other medical conditions. In a vast majority of patients, they are caused by chronic rhinosinusitis.
Are Nasal Polyps Dangerous?
The short answer is, no. Nasal polyps are due to inflammation. However, if they get large enough, they can block the nasal passage causing difficulty with breathing. Similarly, polyps can block the small sinus openings, preventing them from draining. When this occurs, fluid becomes stagnant in the sinus and germs can rapidly develop, further exacerbating the inflammatory process in a vicious cycle.
How are Polyps Treated?
At ENT Associates of Nassau County, we never use a “one-size fits all” approach. Each situation is unique. Treatment will depend on the severity of your symptoms and the extent of your polyps. Some of our patients require no treatment - especially if they don't have any symptoms. Others may require only nasal sprays. Others, with more severe cases, may require an office procedure to remove the polyps and open the sinus cavities.
Can polyps grow back?
Yes. Sometimes. That’s why it is important to have a doctor who specializes in the treatment of nasal polyps. Some patients will be more prone to regrowth than others. Patients who have underlying chronic sinusitis are at increased risk for regrowth. For select patients, there are new technologies and treatments we frequently employ to reduce the likelihood of regrowth. We will determine if you are a candidate for any of these treatments. See the videos below for more information.
Balloon sinus dilation is a procedure commonly performed in our office for the treatment of chronic and recurrent acute sinusitis. It involves placing small balloons into the affected sinus opening, dilating the balloon, and removing it. The result is permanent remodeling and widening of your sinus openings.
Why should I choose ENT Associates of Nassau County for my sinus procedure?
Our number one focus is your care. We work tirelessly to stay up-to-date and invested in the most cutting-edge techniques and technologies. Our surgeons have been trained at some of the most prestigious institutions in the country and nearly solely focus on sinus and nasal surgery. Additionally, we have extensive experience in office-based sinus and nasal procedures. Many centers perform balloon sinus dilation, but at ENT Associates of Nassau County, we also perform hybrid procedures as well and comprehensive sinus surgery in the office. If you would like to avoid the operating room and general anesthesia, you’ve come to the right place. If you prefer to go to the operating room, we can do that too!
Am I a candidate for Balloon Sinus Dilation?
We will have to do a thorough review of your history and CT scan. If you haven't had a CT scan, we can easily get one ordered for you. Typically, patients who have failed medical management and have chronic or recurrent acute sinusitis are candidates for this procedure.
Recurrent Acute Sinusitis - 3-4 or more sinus infections/year lasting at least 7-10 days with asymptomatic periods in between.
Chronic sinusitis - 12+ weeks of sinus symptoms. These may include: facial pain, facial pressure, nasal congestion, nasal drainage, altered smell, upper tooth pain, headaches, fatigue.
Are the Surgeons at ENT Associates of Nassau County experienced in Balloon Sinus Dilation?
We perform some of the highest volumes of balloon sinus dilation in the Region and have extensive experience and training in all forms of sinus and nasal surgery, from comprehensive traditional functional endoscopic sinus surgery in the operating room, to minimally invasive balloon sinus dilation.
I am scheduled for Balloon Sinus Dilation, What should I expect?
The day of your procedure, you will take the prescribed medication at home to help with minor anxiety that some patients experience. Since the medication can make you feel a bit drowsy, you will need to have someone drive you to and from your procedure.
Once you are in the office, you will be greeted by one of our well trained medical assistants and will be escorted into the procedure room. In a relaxed environment, with dim lights and spa music, your surgeon will gently numb your nose and sinuses with a combination of gel and cotton pledgets. Once the nasal cavity is completely numb, there will be an additional numbing injection which most patients will not feel at all. The entire process to numb the nose takes approximately 10 minutes.
Once the nose is numb, the balloons will be placed into the sinus openings and dilated. Since the small sinus openings are made up of thin bone, you will hear some cracking and feel some pressure. On a pain scale from 1-10, with 10 being severe pain and 1 being zero pain, most patients rate their discomfort at a level 2.
Does Balloon Sinus Dilation work?
When balloon sinus dilation is indicated, it works. There are many variables that will determine whether we will recommend office balloon sinus dilation vs an office hybrid balloon/FESS procedure vs a FESS in the office or operating room. In the right patients, BSD alone results in long-term relief and improvement in 94% of the time. We are very experienced in identifying the patients who may NOT respond to a balloon and are sure to offer those patients a hybrid or FESS procedure, often also easily done in the office.
The REMODEL study, published in 2013, demonstrated Balloon Sinus Dilation is as effective as conventional sinus surgery at improving chronic sinusitis symptoms long term, but with less downtime, less postoperative pain and a faster return to normal activities.
What is the recovery like for Balloon Sinus Dilation?
Typically patients will have mild discharge from their nose for the few days following the procedure. Since there is no cutting, bleeding is not really expected. Most patients can return to their normal activities the following day. We will often place absorbable packing into the nose to aid the healing process. The packing will dissolve with saline sprays, but we will help the process along by suctioning remnant packing from the nose when you see us back in the office.
Do I need to come back for doctor visits after the balloon procedure?
We have all of our balloon patients return for three post-procedure visits, typically spaced out weekly, for the three weeks following the procedure. These visits are essential and quick. The purpose of the visit is to ensure the sinus openings remain clean and to remove any scar tissue that may have formed after the procedure. Failure to do this may result in suboptimal outcomes.
What is the REMODEL Study?
The REMODEL was the first prospective, multicenter, randomized controlled trial comparing traditional Functional Endoscopic Sinus Surgery (FESS) to Balloon Sinus Dilation (BSD) for the treatment of chronic or recurrent sinusitis. It demonstrated that Balloon Sinus Dilation is as effective as conventional sinus surgery at improving chronic sinusitis symptoms long term, but with less downtime, less postoperative pain and a faster return to normal activities.
In 2015, an update to the original REMODEL study was published based on a larger patient population and followed outcomes out to 2 years.
Results
Both BSD and FESS delivered comparable significant symptomatic improvement at each time point.
BSD resulted in significantly faster recovery, less post-operative pain, and fewer debridements compared to traditional sinus surgery (FESS).
Balloon Sinus Dilation META-ANALYSIS
Meta-analysis studies combine the date from several similar studies. This paper compared data from 6 BSD studies totaling 358 patients with 6 month to 24 month follow-up
Results
97.5% success rate of BSD
Significant, long lasting clinical improvement in symptoms
1.4 day average recovery time
Patients reported improved productivity
Outcomes consistent across Chronic Rhinosinusitis (CRS) and Recurrent Acute Rhinosinusitis (RARS).
Why are these studies important?
They confirmed that BSD is a safe and effective alternative to traditional sinus surgery, allowing us to care for you in our office with little downtime.
At ENT Associates of Nassau County, we perform all types of sinus surgery and we classify them in 3 ways:
- Balloon sinus dilation
- Functional Endoscopic Sinus Surgery (FESS)
- Hybrid Balloon sinus dilation/ FESS
Balloon sinus dilation is an advanced technology employed at ENT Associates of Nassau County. The procedure is nearly always done in our office under local anesthesia (similar to a dental procedure). A tiny balloon is placed into the sinus opening under visual guidance with a small camera. Once the balloon is in the small sinus opening, the balloon is dilated, then removed. The result is permanent remodeling and widening of the sinus opening.
Functional Endoscopic Sinus Surgery (FESS) involves removing sinus tissue to open the sinus cavities. This is also done with tiny instruments through the nose with no external cutting. Typically, patients with more severe sinusitis as determined by the CT scan require FESS. Traditionally, FESS was only offered under general anesthesia in the operating room. However, at ENT Associates of Nassau County, our surgeons have extensive experience in office based FESS and hybrid Balloon Dilation/FESS procedures. Many of our patients can be cared for in the office with local anesthesia.
The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home results in drying and changes in the nose which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons.
Roughly 1 - 2 percent of people in North America say that they have a smell disorder. Problems with smell increase as people get older, and they are more common in men than women. In one study, nearly one-quarter of men ages 60 - 69 had a smell disorder, while about 11 percent of women in that age range reported a problem. Many people who have smell disorders also notice problems with their sense of taste.
