ENT Treatments

Septoplasty and Turbinate Reduction

A deviated septum is one of the most common reasons to have non-cosmetic nasal surgery. Your septum can be crooked and may result in a smaller nasal passage on one side or the other, or even both. In a normal nose, the mucosal lining swells and retract many times a day. With a deviated septum, one may have difficulty breathing from either side of the nose. It is usually from the already small passageway being blocked further from the swollen mucosal lining. Sometimes, blockage can occur when there is additional cartilage, bone or mucosal tissue.

This difficulty in breathing through the nose could be corrected through a Septoplasty. Many people breathe loudly and others think their noses are stuffed, but in fact they suffer from a deviated septum and when their tissues naturally swell, the side with the deviation is even more restricted.

A Septoplasty is the surgical procedure to straighten a deviated or crooked septum to improve breathing, function, and minimize possible sinus infections, creating greater comfort for the patient. A Septoplasty is almost always performed with no visible incision and in most cases is combined with reduction in the size of the turbinates. Turbinates are air-fins inside our nose that humidify and filter the air that we breathe, but when they are swollen or enlarged can add to the difficulty in breathing through the nose. Turbinate Reduction also is done inside the nose without a visible incision. Septoplasty and Turbinate Reduction procedure normally takes about 1 hour.

If you have concerns regarding nasal breathing or repetitive sinus infections, please contact our ENT Doctors. Your ENT doctor can properly examine and diagnose you for the possible need of a Septoplasty or other surgery, perhaps in the form of sinus correction.

Please refer to After Nasal/Sinus Surgery for post-operative instructions.


Vivaer® Nasal Airway Remodeling

Millions of people suffer from nasal airway obstruction, which limits airflow through the nose. Until now, your only options were medications or breathing strips that offer temporary relief, and surgeries that are invasive, painful, and often have a long recovery period. Vivaer Airway Remodeling is a new, non-invasive treatment that can be performed in our office to help you breathe more easily.

Nasal Obstruction Problems

This lower volume of air may lead to:
• Chronic nasal congestion, or stuffiness
• Persistent nasal blockage or obstruction
• Difficulty breathing through nose
• Difficulty sleeping, snoring, and fatigue
• Inability to get enough air during activities

Nasal Obstruction Causes

Narrowing of the nasal valve may be caused by an enlargement of any of the three primary structures, decreasing the overall nasal airway area.

Nasal Airway Obstruction

The Septum, Lateral Wall, and Turbinates form a triangular area known as the Nasal Valve. If any of these tissues enlarge, nasal airway size is reduced, causing lower airflow.
• The Septum is the narrow ridge of bone and tissue between the two nostrils.
• The Turbinates are fingers of tissue that direct and warm air as it enters the nasal cavity.
• The Lateral Wall is the side tissue that forms the outer wall of the nose.

Nasal Obstruction Treatment

Nasal Airway obstruction has traditionally been treated by Ongoing Home Remedies or Traditional Nasal Surgery. Today there is a third option: VIVAER® Non-Invasive Nasal Airway Remodeling.

Ongoing Home Remedies

Nightly breathing strips, nasal dilators, and sprays that never quite fix the problem are some of the ongoing home remedies you might have tried. And tried. And tried. Home Remedies are never a permanent solution.

Traditional Nasal Surgery

Traditional Surgery, involving pain, recovery time, and less-than-spectacular results has been the only course of treatment for advanced nasal problems. While it may be effective in many cases, it does not always address the problems of nasal blockage caused by narrow nasal valves.

VIVAER® Nasal Airway Remodeling

The VIVAER treatment, performed in your doctor’s office, is a non-invasive procedure with no cutting. Your nasal valve area is gently and permanently reshaped using low-temperature radiofrequency energy. Immediately after treatment, you’ll begin to experience a noticeable improvement in nasal breathing.


Nasal Endoscopy

Endoscopy is a minimally invasive, diagnostic medical procedure. It is used to examine the interior surfaces of an organ or tissue and allows visualization of body cavities not possible by standard examination. The nasal endoscope is a medical device consisting of a thin, rigid tube with fiberoptic cables for bringing in light. The endoscope is then connected to a light source and the doctor can see the image either through the eye piece on the scope, or on the computer screen.

Because the endoscope is slender (only 2.7-4.0 mm in width), it may be passed through the nostril to examine the nasal passages, structures and sinus cavities. While the traditional nasal examination with a speculum and a flashlight (called anterior rhinoscopy) allows a limited “key-hole” view of the front part of the nose, nasal endoscopy, with its superior light and magnification, provides a superior detailed look at the deeper internal nasal anatomy, central airway and posterior aspects of the nose and sinuses. In addition, maximal visualization of the nasal and sinus cavities is provided by the various types of nasal endoscopes. The zero degree nasal endoscope allows a straight view from the tip of the instrument into the nose. The “angled” (30/45/70 degree) endoscopes, in which the view is at an angle from the tip of the endoscope, provide an “around the corner” view, deep into the sinus cavities. These superior visualization capabilities enabled by nasal endoscopy, have turned this procedure into the “work horse” in the diagnosis and management of nasal and sinus conditions.

Office Nasal Endoscopy

Office nasal endoscopy allows a detailed examination of the nasal and sinus cavities in the outpatient clinics. This examination is typically performed by Otolaryngologists (Ear Nose Throat doctors). It is currently the preferred initial method of evaluating medical problems such as nasal stuffiness and obstruction, sinusitis, nasal polyps, nasal tumors, and epistaxis (nose bleeds). During the endoscopy, the patient is seated and the physician searches for: areas of swelling in the mucosal membranes, presence of purulent secretions (pus) draining from the sinus openings, enlargement of the nasal turbinates (internal nasal structures that humidify the nose), crookedness of the nasal septum (the wall that separates the two sides of your nose), presence of polyps, sites of nasal bleeding, and the presence of tumors within the nasal and sinus cavities. If pus is observed, it may be sampled and cultured with a small swab to determine what organism is causing the infection.

Typically, nasal endoscopy is performed with a zero degree endoscope using the “three pass” technique, visualizing three main areas in the nasal and sinus cavities. In the first pass the nasal floor and the back of the nose (nasopharynx) are viewed. The endoscope is then brought out and turned upwards and sideways in order to view the drainage areas of the nasal sinuses (middle and superior meati and the spheno-ethmoidal recess). In the third pass the endoscope is used to view the roof of the nose and the area of the olfactory cleft (smell region).

In order to make this procedure easier and minimize patient discomfort, just before nasal endoscopy the nose will be sprayed with: 1) a nasal decongestant, to gently reduce the swelling in the nasal membranes to permit an easy passage of the endoscope, and 2) a local anesthetic, which temporarily numbs the nose and helps to decrease the chances of sneezing from sensitivity. The procedure is rarely painful, but some patients may experience discomfort if the nasal cavity is unusually narrow or the nasal lining is very swollen.

Overall, nasal endoscopy is a safe and low risk procedure. Nonetheless, potential complications such as mucosal trauma and bleeding may occur, particularly in susceptible patients with increased risk of bleeding, such as those receiving aspirin or other anticoagulant medications (i.e. Plavix, Coumadin, etc.). In addition, adverse reactions to the topical decongestants or anesthetic provided prior to the procedure may occur. Thus before administering these topical medications, patients’ allergies should be verified. 


Tonsillectomy and Adenoidectomy

Tonsillectomies and adenoidectomies are common and safe procedures. As a matter of fact, tonsillectomy is the second most common pediatric surgical procedure. It is also necessary at times for this procedure to be performed on adults. A tonsillectomy and adenoidectomy can help prevent frequent sore throats and ear infections. These procedures are not always performed at the same time. Only one may be needed, sometimes both.

The tonsils are glands located in the back of the mouth on both sides of your throat. As part of the immune system, tonsils help fight infections. The adenoids are located behind the soft palate, the back, muscular section of the roof of your mouth. Adenoids also help fight infections. Behind the uvula, there is a passageway that connects the nose to the mouth. And in this passageway, the eustachian tubes connect the middle ear to the back of the nose. These tubes prevent large differences in pressure inside the ear. When your adenoids swell, they become inflamed and can cause blockage of the eustachian tubes. Blockage can cause your middle ear to become filled with pus, causing additional infection and swelling. This can even lead to hearing loss.

Tonsillectomy is generally performed because of repeat occurrences of tonsillitis. Tonsillitis is an infection in the throat that starts with your tonsils. These types of sore throats are usually severe and fever can occur. It hurts to swallow!

It’s important to be examined when you have tonsillitis because it’s can be dangerous if there have been seven or more occurrences within one year. And when the illness is not responsive to antibiotic treatment, please see us immediately!

Additionally, if your tonsils get large enough to touch each other you probably have a serious case of tonsillectomy. Also, if there is an abscess surrounding your tonsils, you will see puss filled sacs. This is another cause for attention.

Treatment of tonsillitis and ear infections generally requires antibiotics. If left untreated, tonsillitis could damage organs in your body. A tonsillectomy is an in which the tonsils are removed. Adenoidectomy is the removal of the adenoids. The combined operation is called a T&A. Generally these surgical procedures are performed if antibiotics are unresponsive. If antibiotics do not work to eliminate tonsillitis or ear infection, a tonsillectomy and possible adenoidectomy may be performed. These surgical procedures will help you reduce the number of throat and ear infections.

T&A is performed under general anesthesia. When surgery is complete, the patient is admitted into recovery. Upon awakening, you will be given pain medication. Within a little while, you will be able to go home. Surgery is usually well tolerated although a sore throat is common for the first 5-10 days after surgery. Watch for bleeding. You will initially find it easiest to swallow liquids and cold desert-like foods.

Please refer to After Tonsillectomy/Adenoidectomy for post-operative instructions.


Laryngoscopy

Laryngoscopy is an exam that lets our ENT Doctors see the back of your throat and your voice box (larynx) using a tool called a Laryngoscope. A Laryngoscopy will be performed for the following reasons:

  • to find the cause of voice problems, such as breathy, hoarse, weak or no voice
  • to find the cause of pain in your throat or ear
  • to find the cause for problems such as difficulty in swallowing, a lump in the throat feeling, or bloody mucus
  • to check injuries to the throat
  • to check for breathing difficulties such as narrowing of the throat or blockages in the airway

There are two different types of laryngoscopy – Indirect and Direct.

Indirect Laryngoscopy

This procedure is done in the office using a fiber-optic scope through your nose or mouth. First you will have numbing spray to your nose and/or mouth to provide more comfort to you. You will be asked to sit up straight, stick out your tongue and possibly make some eee or ahhh sounds. This type of laryngoscopy is diagnostic and usually no biopsies are done with this procedure.

Direct Laryngoscopy

Direct laryngoscopy lets us see more directly at your throat and voice box in the operating room while you are asleep under general anesthesia. These are rigid scopes, which are often used in surgery to remove foreign objects, perform biopsies, remove polyps or perform laser treatments. It may also be used to help find cancer of the voice box. 

How To Prepare

For the in-office procedure using a flexible scope, please do not to eat or drink anything before the procedure. Although numbing medication is used, some patients with a strong gag reflex may have trouble and we want to prevent vomiting. If you wear dentures, you will just need to remove them before the examination.

If a rigid scope is necessary, it will be performed under general anesthesia. Our ENT Doctors will want to know if you:

  • Are allergic to any medicines, including anesthetics
  • Are taking any medications or herbal drugs
  • Have bleeding problems or take any blood-thinning medicine
  • Have a history of heart problems
  • Are pregnant or might be pregnant
  • Have had surgery or radiation treatments to your mouth or throat

Prepare as you would for a surgery. Be sure NOT to eat or drink for 8 hours before the procedure. Remove all jewelry, dentures, glasses, and use the restroom. Also plan to have someone drive you home following the procedure.

The Procedure

Once you are asleep, our ENT Doctors will place the scope in your mouth and down your throat to perform your treatment. After the procedure, you will be in recovery until you are fully awake and able to swallow.