Nasal Disease:
Patients referred for sinus complaints often present with one or a combination of complaints. These include; Facial pain, Headaches, Nasal congestion or symptoms resulting from increased nasal secretions.
Facial Pain:
Pain over the cheeks can develop for a number of reasons. When this is associated with symptoms such as nasal discharge, post nasal drip, cough, it is likely related to sinus disease.
If these symptoms are not present, then other causes of that pain need to be considered. There are several options, such as, grinding, muscle tension disorder, Dental or temporomandibular joint disease.
Nasal Congestion:
This is a symptom and describes difficulty breathing through the nose. It can be unilateral (one nostril) or bilateral (both nostrils). It is often worse when lying down as the soft tissues in the nose tend to swell when we lay down at night.
Nasal congestion can be caused by structural, infectious, allergic or a combination of these three pathologies. Surgery is helpful to treat septal deviations, nasal polyposis and chronic sinus disease. Allergies are treated primarily through medical therapy such as nasal sprays and allergy pills. In severe cases nasal airway obstruction can lead to loss of the ability to smell or taste your food.
Nasal Secretions:
Patients may develop clear or discolored nasal discharge from the front of the nose, called rhinorhea. This can be problematic socially, and in some cases result in skin irritation and redness around the nostrils. When this drains down the back of the nose, the secretions may cause a cough, throat clearing, hoarse voice, and in some cases stomach pain when the secretions are quite prominent.
Consultation:
During your consultation your main nasal complaint will be discussed with associated symptoms. If you have a CAT scan done of your sinuses or head, it will be reviewed, and you should bring this with you for your appointment. The main questions will pertain to the symptoms outlined above. How often you have had antibiotics for sinus infections, any nasal sprays you have used, and for how long is very important information to bring with you for the visit. A history of dental disease and grinding, clenching your teeth, or use of a tooth guard and chewing gum is important to mention as well. Previous nasal surgery for a septal deviation or sinus infections may be indicated on the office medical form.
You may need further tests ordered once the history and exam are completed. This often includes a CAT scan if one has not already been done. In some cases a trial of further medical therapy may be indicated or referral to an allergist. Your examination will likely include fiber optic examination of the nasal cavity and upper airway to look for abnormalities in the nasal cavity, such as a septal deviation, nasal masses, or polyps and discharge from the sinus cavities. In some cases video endoscopy is used to allow the exam to be recorded digitally and reviewed with you during the appointment. You will also have a general examination of the head and neck, ears, and oral cavity during your visit. A general questionnaire will also be completed to determine you overall health and candidacy for surgery, should this be indicated. This can be printed off in advance from this site to bring with you to your appointment.
Surgery
If you are a candidate for Sinus surgery, Septoplasty or a combination of these, this will be discussed with the alternatives and risks of surgery. Sinus surgery is generally not done without appropriate pre operative CAT scans available before the surgical date. It is important to know that for patients who may benefit from sinus surgery, that it is considered successful in about 90% of cases. There is a risk of bleeding during or after sinus surgery, infection, and a remote risk of injury to the eyes or a CSF leak depending on what areas of the sinuses that are involved in the surgery. Under forms, there is a Functional Endoscopic Sinus surgery (FESS) information page which reviews the standard post operative course and care instructions. There is also a separate information form for Septoplasty and Turbinate reduction which may be helpful to review.