Nasal Obstructions

Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell, and frequent infections.
Nasal polyps can form at any age, but they’re most common in young and middle-aged adults. Medications can often shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them.

Symptoms of Nasal Polyps
Common signs and symptoms of chronic sinusitis with nasal polyps include:

  • A runny nose

  • Persistent stuffiness

  • Decreased or absent sense of smell

  • Loss of sense of taste

  • Facial pain or headache

  • Pain in your upper teeth

  • A sense of pressure over your forehead and face

  • Itching around your eyes

  • Pain in your upper teeth

Causes of Nasal Polyps
Scientists don’t yet fully understand what causes nasal polyps. It’s not clear why some people develop chronic inflammation or why ongoing inflammation triggers polyp formation in some people and not in others. The inflammation occurs in the fluid-producing lining (mucous membrane) of your nose and sinuses. There’s some evidence that people who develop polyps have a different immune system response and different chemical markers in their mucous membranes than do those who don’t develop polyps.
Treatment of Nasal Polyps
Chronic sinusitis, with or without polyps, is a challenging condition to clear up completely. The best long-term treatment plan is to manage your symptoms and to treat factors, such as allergies, that may contribute to chronic inflammation.
The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach and surgery may sometimes be needed.
The type of surgery depends on the size, number and location of your polyps and the extent of inflammation. Surgery options for nasal polyps include:

  • Polypectomy. Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider, an instrument that cuts and extracts soft tissue. This procedure, called a polypectomy, is performed on an outpatient basis.

  • Endoscopic sinus surgery. You may need surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and polyp development. The surgeon inserts an endoscope, a small tube with a magnifying lens or tiny camera, into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other obstructions that block the flow of fluids from your sinuses. Your surgeon may also enlarge the openings leading from your sinuses to your nasal passages. Endoscopic surgery is usually performed as an outpatient procedure.
    After surgery, you’ll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.

Nasal Turbinates/Nasal Concha

Turbinates are spongy bone structures on the sides of the inner nose that regulate airflow and protect the inner nasal anatomy. The general function of the turbinates is to control airflow. From the bottom to the top of the nose, there are three (sometimes four) sections of turbinate structures: the inferior, middle, and superior turbinates (the fourth, the supreme turbinate, is not present in every person).

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The inferior turbinate plays the largest part in directing airflow, but it also moistens, heats, and filters air coming into the respiratory system. The middle turbinate primarily protects the sinuses, while the superior turbinate primarily protects the olfactory bulb, which houses your smell receptors.

Enlarged Turbinates
The primary issue people experience with their turbinates is turbinate hypertrophy (enlarged turbinates). Enlarged turbinates can be caused by allergies, chronic sinus inflammation, or environmental irritants. Turbinate hypertrophy can be situational or chronic. A common type of situational turbinate hypertrophy is the nasal cycle, in which the turbinates on one side of the nose will swell for four to six hours before returning to their normal size, at which point the turbinates on the other side will begin to swell.

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Concha bullosa is a condition unique to the middle turbinates where the middle turbinate is filled with air and enlarged like a balloon. When this happens, the concha bullosa blocks the flow of air to the sinuses via a small passageway called the sinus ostium. If the sinus ostium is blocked and air does not reach the sinuses, they can accumulate fluid and become infected.

Treatment of Enlarged Turbinates
Treatment options vary depending on the cause of your enlarged turbinates. Make sure you are certain of the cause before you begin treatment. If your enlarged turbinates are a result of allergies or environmental irritants, you can allergy-proof your home (link) by following simple precautions to get rid of pollen, dust, and pet dander. The best long-term treatment for chronically enlarged turbinates – especially if caused by a deviated septum – is turbinate reduction surgery, which is often performed at the same as a septoplasty.
In this procedure, portions of the turbinate are modified, shrunk, de-bulked or excised. The easiest way to do this is by cutting off the lower part of the swollen turbinate with scissors or through electro cautery.
The simplest way to shrink nasal turbinates is with a procedure known as intramural cautery. This procedure can be done in the doctor’s office and it does not involve cutting or removing of the mucous membranes. In this procedure, a probe or needle is inserted into the nostril which vaporizes or cauterizes the blood vessels. Scar tissue that is a result of the procedure shrinks, and in doing this, tightens the soft tissue of the turbinate.
Another method of treating engorged turbinates is with a sub mucous resection. A small incision is made in the turbinate exposing the bone. A section of the bone is then removed and the mucous membranes along with nasal packing are pressed down onto the exposed bone. Sometimes a suction microdebrider is used which replaces the need for an incision. A long narrow rod with a rotation blade on the tip is applied into the nasal cavity. Here is oscillates and removes bone or soft tissue which is suctioned up into the open end of the rod.

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