Dear Dr. Naderi,
Since I was a young child (>50 y ago) I have had the sinuses/turbinates from hell. When I was a young teenager, an ENT injected steroids into my turbinates on a regular basis – which helped temporarily, but in retrospect, probably worsened things.
About 4 years ago, I had a successful septoplasty in Richmond accompanied by what I would call a mixed-result turbinectomy via cauterization. Let me explain.
Pro: For two years, I could breath without the use of any nasal spray. (BTW, the only kind that seemed to have ever really worked was the fast/short acting phenylephrine-type.)
Cons: Post-Sx, I lost my “venturis”. Risking sounding like a complete nerd, what I mean is that my air-flow vectors were (and are) nothing but a turbulent mess. My whole head vibrates when trying to blow my nose. This is completely unacceptable. Both in and out-flow are turbulent.
The surgery has now lost all effectiveness, and I cannot breath through my nose at all without nasal spray. (Also unacceptable). The prospect of going through another cauterization, which is clearly a temporary fix at best, will, no doubt, leave me with clear, but completely turbulent air flow. There MUST be a better solution! My last surgeon was completely oblivious to my air-flow complaint, stating that “I could breath through my nose, which was “good enough.” Well, it may have been good enough for him, but it’s my nose, and it’s not good enough for me.
Do you have a solution for my problem, or a suggestion of who might, if not you? I would appreciate your input.
– Dr. G
Dear Dr. G,
Rhinology is a complex science and prior to any surgery, proper evaluation is needed. The obstruction to airflow in the nose can come from various static and dynamic factors. Turbulent air flow in itself will create sensations of obstruction. For example a cocaine abuser who has lost his or her entire nasal septum will feel nasal airway obstruction despite the largest, most wide open airway possible!
Steroid injections to the turbinates carry risk of blindness and are not commonly performed anymore. Cauterization of the turbinates alone does not address the issue many times. If there is a weak attachment or section of the turbinate, this can cause rattling with airflow. More recently an article was published in the AAFPRS’ journal discussing cases where there is no obvious obstruction of the airway but patients feel obstructed along with “rattling” with breathing. They attributed this to a weak septum where most of the cartilage is gone but the lining vibrates and “flaps in the wind” creating obstruction.
My take home message is that you do have options. You do need to stop using Afrin type sprays as these CREATE problems and make the turbinates larger and the problem worse and are addictive. You need to be seen and examined and scoped using endoscopy to see what the issue is. But sometimes, you do hit a dead end and whats good enough for the surgeon may have to unfortunately be good enough for you as well. But I dont think you are at that point yet.