While your doctor can look into your nostril with a light (anterior rhinoscopy) a small telescope is needed to visualize the entire nasal cavity. This is one of the fastest and easiest ways to identify polyps, posterior septal deviations, and infections. A topical numbing and decongesting solution is typically sprayed inside the nose. This allows the 1 minute in-office procedure to be as comfortable as possible.
The nasal septum divides the nose into a right and left side. In many people this is crooked either due to irregular development of nasal trauma. The deflection can block up one or both sides. Septoplasty is an outpatient procedure to improve nasal breathing for those whose septal deviation is a significant contributor to their nasal obstruction. This may be performed with rhinoplasty to optimize nasal breathing.
Any changing of the outside portion of the nose is considered rhinoplasty. This may be done for functional reasons, cosmetic reasons or both. The area immediately inside the nostril is the area of highest resistance to nasal breathing for most people. A deviated septum may contribute to blockage in this area. However the cartilages of the nose are supposed to support the skin and soft tissues of the nose to hold it open when breathing deeply. When this fails, it is known as “nasal valve collapse”. Breathe-rite® strips are designed to be one type of solution to this problem. This only works for people with a particular type of nasal valve collapse and only when the strip is in place. Cartilage grafts used surgically as internal supports can permanently improve breathing in the same way.
In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal, healthy sinuses is to open up the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal. Functional endoscopic sinus surgery (FESS) involves the insertion of the endoscope (a very thin camera) into the nose for a direct, visual examination of the openings into the sinuses. With state-of-the art micro-telescopes and instruments, abnormal and obstructing tissues are then removed. The surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort. Another advantage of the endoscopic sinus surgery is that is that it is less extensive than traditional sinus surgery. With FESS there is often less removal of normal tissues. In most cases sinus surgery can be performed on an outpatient basis. Usually no packing is needed.
The sinuses are physically close to the brain, the eye and major arteries, which are of particular concern. The use of image guided endoscopic technology may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image guidance is a near three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals.
Nasal polyps are managed similar to many chronic diseases. When they grow they can obstruct nasal breathing, worsen sleep and lead to blockage and drainage of the sinuses causing infections. Although topical and occasionally oral steroid medications are the mainstay of medical treatment, surgical removal is used to “debulk” most of the polyps to improve symptoms and improve the effectiveness of topical medications. Often this is done in conjunction with endoscopic sinus surgery to improve sinus drainage.