NSIBR |Featured, Procedures | October 3, 2020
The blocked nose is one of the most troublesome symptoms patients experience on a long term basis. They can present with years or even decades of blocked, stuffy nose, leading often to issues with daily life, exercise, and sleeping. One of the great advances in the medical field has been the ability to treat these stubborn, often frustrating issues, with non invasive or minimally invasive procedures. Of course, improving the obstructed and/or congested nose depends upon the etiology of the symptoms. Diagnosis will be dealt with separately. When we evaluate someone for nasal obstruction/congestion we thoroughly analyze the nasal septum, the relationship of the outside of the nose to the nasal septum (the nasal valves), the structures inside the nose that become large with allergies (the nasal turbinates), the nasal sinuses, and other structures inside the nose which may lead to anatomic blockage. Once we have diagnosed the issue, then we come up with the most minimally intrusive way of treatment. Here are 7 ways minimally or noninvasive ways of dealing with the obstructed or congested nose.
Perhaps the most significant advance in medical management of nasal obstruction and congestion in the past four decades has been getting its cost under control. Nasal sprays, which are either anti-inflammatory or antihistamine sprays, are designed to improve reversible swelling in the nasal turbinates and nasal mucosa. This swelling is often related to underlying allergies. At one time these sprays universally required a prescription and cost well over one hundred dollars for a single bottle. Three of the anti-inflammatory sprays, Flonase, Rhinocort, and Nasacort are now over the counter and can usually be bought for around twenty dollars for a month’s supply. In many patients, one of these sprays along with an over the counter antihistamine provides sufficient relief. Antihistamine sprays still require a prescription, but can be useful in patients who cannot use anti-inflammatory sprays because of the steroid in them.
Understanding allergies and specifically knowing those elements in the environment that an individual’s body is reactive to is valuable in improving nasal and sinus symptoms. Using the information obtained by testing for specific allergies provides the basis for effective environmental control as well as for specific allergy treatment. Environmental control often includes measures to minimize dust exposure, remediate any exposure to mold, pet allergy awareness, and caution in the case of tree, grass, or ragweed allergy. Supplementing environmental control is the use of immunotherapy, a treatment where the offending allergens are given to the patient in very dilute doses, increasing over time to build up the body’s own defense mechanisms against them. Traditional allergy shots are still used, but many patients elect to receive their immunotherapy either in the form of drops they give to themselves under their tongue at home, or even toothpaste containing these allergens in increasing concentrations to accomplish the same goal. Immunotherapy given either in the traditional manner or in one of the newer alternative means has been shown to gradually reduce associated symptoms.
Reducing the size of the inferior turbinates will often replicate the effect of using daily anti-inflammatory nasal sprays such as Flonase, Nasacort, or Rhinocort. This is a procedure done under local anesthesia in the office and involves placing a small suction with a tiny oscillating blade on the inside the of the turbinate and removing excess tissue from the inside. The procedure takes several minutes on each side and heals in a few days to a week. Some of the turbinate bone may also be shaved down if needed. The effects are long lasting as long as the allergies stay under control. Most patients resume normal activity the next day.
Balloon Sinuplasty over the past decade has become one of the most frequently performed procedures in the specialty. It is a relatively quick in office procedure that involves precise placement of a small balloon in the blocked outflow track of one or more sinuses. The balloon is inflated, deflated, and then removed. This procedure is done either under local anesthesia or intravenous sedation. By relieving blocked sinuses, nasal obstruction, congestion, headaches, and facial pressure related to sinus blockage may all be improved. Most patients resume normal activity the next day.
Correcting a deviated septum with a noninvasive procedure is a new concept popularized over this past year. An airway balloon is used to correct the deviations of the septum. The truly remarkable thing about this procedure is that septal deformities which previously required a hospital or outpatient setting to correct, can now be done in a totally noninvasive fashion with the balloon. The sinonasal physician can determine if balloon septoplasty is appropriate for a particular septal deformity. This procedure is done under local or IV sedation in the office and is extremely well tolerated by the patient. Most patients resume normal activity the next day.
The concept of microneedle radiofrequency ablation has been popularized in the cosmetic surgery field for the past decade. Procedures that utilize this technology take advantage of the fact that the energy is transmitted through the skin to the underlying tissue without damaging the skin. This allows for a tightening of the dermis and a rejuvenated appearance to the skin. In the area of the nasal valve, similar technology is administered by a small probe that is placed inside the nose just inside the nostril which tightens and ‘resculpts’ the narrowed valve. This can mimic the effect of using a breathe rite strip or of manually pulling the side of the nostril towards the outside of the eye. The physician will test the nose with a ‘modified Cottle’ exam, where a small curette is placed inside the nostril and the outer wall is supported during inspiration. If this provides significant relief, it indicates a weakness or insufficiency of the sidewall of the nose. The ‘Vivaer’ procedure is performed under local anesthesia in the office and is extremely well tolerated. Patients resume normal activity immediately.
Another excellent treatment for nasal valve insufficiency is the Spirox Latera, a dissolvable stent which is inserted in the lateral nasal wall and acts as an implantable nasal support to strengthen the nasal valve during inspiration. Patients who benefit from Breathe Rite nasal strips will often benefit from this procedure. Deciding between the Spirox Latera, the Vivaer nasal sculpting procedure, and more traditional surgical approaches to the nasal valve depend upon the degree of nasal valve collapse and the overall goals of the patients.
In most cases, one of the minimally or non invasive options are appropriate. The above minimally invasive and non invasive procedures can be performed as stand alone procedures or in combination with each other. Nasal obstruction and congestion are most often multifactorial and it is not uncommon for multiple procedures addressing different etiologic factors are performed during the same sitting. Even when done in combination, these procedures are performed in the office setting and normal activity is typically resumed the following day.
The Nose and Sinus Institute of Boca Raton has been caring for patients in Florida and surrounding regions for over three decades. Drs Nachlas and Hancock specialize in medical, allergic, and surgical care of the nose, sinuses and face. Both surgeons are double board certified – otolaryngology as well as facial plastic surgery. Many state of the art procedures for the minimally invasive treatment of these areas were pioneered at the NSIBR, including minimally invasive sinus surgery, in office computer assisted balloon sinuplasty (first in the United States, performed in 2014 at NSIBR), balloon septoplasty and noninvasive sculpting of the nose for breathing relief. Patients undergoing any or all of these procedures at the Institute can elect to have these performed under local anesthesia or under light anesthesia. For more information, please contact Sandy Friedman, our Director of Patient Relations, at 561-939-0909.
