What are Nasal Polyps?
Nobody wants to hear they have polyps in their nose. This is not your garden variety nasal issues. Most of the time caused by allergy, polyps are a chronic condition that is not often cured with surgery. Usually an allergist is going to provide the best long-term control. But there are times when surgery is needed, even repeatedly in the most extreme cases.
Polyps grow in response to nasal inflammation. They are relatively discrete mounds of incredibly swollen nasal mucosa (lining). Most of the time it is something in the air that stimulates them to grow. At times, it is a sinus infection that provides the impetuous for their existence. No matter the cause, polyps are disruptive to nasal airflow and tend to cause secondary sinus infections.
Epidemiology and differential diagnosis of nasal polyps.
Chaaban MR, Walsh EM, Woodworth BA - Am J Rhinol Allergy (2013 Nov-Dec)
Surgery is needed for polyps if medical management can’t keep them at bay and an allergist can’t help you control the environmental reaction that started them in the first place. It is by no means the first choice of treatment unless they are, sometimes quite literally, hanging out of your nose.
Adult-onset woakes' syndrome: report of a rare case.
Schoenenberger U, Tasman AJ - Case Rep Otolaryngol (2015)
The problem with surgery is it is not a permanent fix most of the time. Think about mowing the grass – it just keeps coming back.
When someone has a significant enough polyp issue to require an ENT to take them to the OR, the surgery should be a part of the process. Combining surgery with aggressive medical management pre- and post-op is often the best way to keep you and your nose healthy.
Mark T. Brown, MD, FACS
When is Sinus Surgery Appropriate?
The official name of this sort of procedure is Functional Endoscopic Sinus Surgery (or FESS to those of us in the biz.) If you have tried everything from sinus yoga to big time antibiotics and steroids and you are still sick, it may be time to consider a more invasive but remarkably effective approach.
The “Functional” part of this surgery indicates that we are helping your sinuses aerated and drain properly, the way they are supposed to. Normally the sinuses are connected through small but efficient openings into the nose. If, for whatever reason (cold, allergy, distorted anatomy), those are not able to allow air in and mucous out you are set up for infection. Mucous pools, bacteria have a playground in which to grow, the infection induces swelling, and the drainage is further blocked. We give all sorts of medications to try to reverse this process. If those meds fail surgery physically unblocks the drainage. Properly draining sinuses are happy sinuses. They function normally again and your chronic infection goes away. For most people, this is a permanent fix too. It is rare that we need to go back in to reopen operated sinuses.
Case Report: retained gutta-percha as a cause for persistent maxillary sinusitis and pain.
Hodnett BL, Ferguson B - F1000Res (2014)
The best news is what patients tell us. The vast majority of patients undergoing FESS have a real improvement in the quality of their lives. And they see their doctors a lot less often.
Mark T. Brown, MD, FACS
What is a Parotid Tumor Anyway?
So you have a lump on your jaw near the ear. Everybody freaks out when they have a lump somewhere, so your concern is justified. Rest assured that your ENT will figure out what is going on and help you take care of this.
The parotid gland is one of the salivary, or spit, glands that help lubricate your mouth and begin the process of digesting the food you are chewing. It is one of 6 major glands that provide saliva on demand when you eat – or when you are thinking about going to your favorite Italian place and your mouth starts to water.
Just like with any organ in the body, parotid tumors may grow. Usually (>90% of the time) these are benign. But they can be malignant so concern is appropriate. And the most common tumor, called a pleomorphic adenoma, has a 10-15% chance of becoming malignant if not removed.
If you have one of these seek the advice of a professional. Better to get it taken care of than to worry about it.
Dr. Mark Brown's Sleep Challenge
I am going to challenge you to prove to yourself that sleep really is important to good health and well-being. I ask for 1 week of your life, Sunday through Friday. Follow these 10 recommendations and if you are not better rested, more productive, in a better mood, and feeling better in general by the weekend I want to hear about it. Really. Send me an email or letter to let me know what didn’t work. If you follow my suggestions I am confident you will understand the power of sleep.
- Prepare for bed every night thoughtfully. Make sure that you have time to wind down for bed every night this week. No last minute disruptions. When it is time to sleep, start getting ready and go!
- Follow the Eight Hour Rule. Every night, go to bed AT LEAST 8 hours before your alarm clock is set to go off. Don’t worry this week about what you are missing on TV. Record it and watch on the weekend if you must!
- Be cozy in your bed. Make sure that your mattress is comfortable, the sheets are clean, the pillows are fluffed, and your PJs are pressed.
- Your bed is sacred ground. This is your oasis from the stresses of the day. Sleep and sex and the only 2 activities allowed. Make a conscious effort to leave the day behind before you get ready to sleep.
- Keep the room as cool or as warm as you like it. Find the temperature that is conducive to your sleep and set it. Let your bed partner adjust to your temperature this week if they need to.
- Nap wisely. No naps late in the day. If you catch a little shut-eye, do it before 3 PM and make it short (less than 30 minutes).
- Eat smart. Have the last meal of your day at least two hours before bedtime. Going to bed with a stomach full of food is a recipe for indigestion and Insomnia.
- Exercise at the right time: early in the day. Exercising within an hour of bedtime can be stimulating, not relaxing.
- Caffeinate early (if you must). Caffeine is a stimulant. Avoid having it after 3 PM.
- Drink early (if you so choose). While alcohol makes you sleepy, it also interferes with healthy, regular sleep cycles. No alcohol after dinner. Water is your friend before bed.
Follow these 10 steps every night Sunday through Friday. By Saturday morning, you will be better rested. Honest. And as a result, you will perform better at home and at work and be in a better mood.
When you prioritize sleep, you will be happier, healthier and more productive. It just happens. If you do this Challenge and DO NOT feel better, there is likely more to your sleep problem than not taking care of yourself. Talk to your primary care doctor to make sure that there are no health problems looming that impact sleep.
Mark T. Brown, MD, FACS
Reprinted by permission from Mark T. Brown, MD from Smarter Sleep, Clear Answers, Science Based Solutions, Healthier Sleep. Old Wives Tales Publishing, 2015.
What is Radiofrequency Turbinate Reduction?
New developments in medical technology have made it possible to comfortably open your nasal airway under local anesthesia in your ENT’s office. Really. This approach saves time, money, and keeps you on your feet. It is even covered by insurance.
The procedure goes like this. When you are comfortably seated in the exam chair, local anesthetic is sprayed into your nose. When that has kicked in the same topical medication is soaked onto cotton and placed in there for a while to further numb your nose. Finally, more local anesthetic is injected into the turbinates directly.
After you are completely numbed, a slim probe is introduced into the nose using a small endoscope.
It is applied at 5 or 6 spots along the turbinate and radiofrequency energy is transmitted through the lining (mucosa) into the swollen tissues that cause your obstruction. That injury shrinks the turbinate so, when you are healed up, there is more space for breathing.
After the procedure, you walk to your car and drive home. Simple, effective, and quick.
Mark T. Brown, MD, FACS
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