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It has been quoted that more than 20% of all visits to all physicians in this country have to do with something in the ear, nose and throat areas.  Living in this part of the country, that is certainly true.  The most common patient topics usually involve  an OTOLARYNGOLOGIST (Ear, Nose and Throat specialist) which has to do with nasal and sinus disorders.  This is especially true of the Atlanta area which, though a great place to live, is unfortunately becoming more problematic from the air quality with the immense traffic problem, the elevation of the area at nearly 1000 ft. above sea level, and the 8+ month growing season for the bumper crop of grasses, trees and other allergens we have in the area.

Most common complaints are that of runny noses (rhinorrhea), whether it be clear drainage (most commonly allergy in origin or viral, usually accompanied by sneezing and itchy watery eyes) or colored / cloudy drainage (most commonly bacterial infections accompanied by fever, pain and sore throat as well).  The treatment of nasal disorders can be with the use of medications, allergy shots or surgery, and are usually in that order.

Medications for most nasal problems deal with the treatment and control of allergy symptoms which are varied and can include the common non-drying, non-sedating antihistamines (Clarinex, Allegra, Zyrtec), the leukotriene inhibitor Singulair, or the common decongestants with similar names but with the hyphen-D at the end. Usually side effects are minimal and the treatment is usually seasonal.

Usually in combination with the antihistamines, a prescription of topical nasal steroids may be used as well, such as Nasonex, Nasocort AQ, Rhinocort AQ, Flonase, etc, which do not work like the antihistamines but simply take down the swelling of the nasal membranes (much like steroid creams take down the swelling of the skin with rashes or poison ivy).  An antihistamine spray called Astelin is also commonly prescribed which also works on the membranes of the nose and all of these can help the patient get off of the over the counter (OTC) nasal sprays which can actually burn the membranes with excess usage for longer than 3 or 4 days.

Other medicines like nasal creams and ointments may be prescribed in certain circumstances as a protective barrier and moisturizing agent for persons who may be exposed to very dry or contaminated environments like classrooms, airplane travel, etc.

Bacterial infections of the sinuses are usually treated with antibiotics, usually after a culture is done from the nasal membrane when the accompanying symptoms suggest this as the cause.  If there is a bacterial infection, the body will try to wash the infection out by making more mucus so during this phase antihistamines are usually not prescribed until the infection has gotten under control (as the drainage turns more clear from the yellow or green tint).

Allergy treatment may be considered if the symptoms are more repetitive when certain exposures or times of the year are noted.  Often, a course of steroids  (Medrol Dosepak, Deltasone, Prednisone, etc.) or a steroid injection is used to get more rapid relief than the topical steroid sprays, and consideration of referral to an Allergist for skin testing and allergy desensitization may be considered as well if the problem continues to recur frequently (and the patient gets good relief from the steroid which would be an indication of how much improvement can be expected from allergy desensitization).  Blood testing can also be used as a general indication of whether allergy testing would be beneficial.  It should be understood, that allergy desensitization usually is a long term process and may take several years or longer of continuous desensitization to get the desired effect.

If the sinus and nasal symptoms are not well controlled with medications or allergy treatment, the final treatment option may be consideration of surgery.  This can be determined by an office nasal or endoscopic examination (placement of a small flexible camera inside the anesthetized nose and viewing the inside of the nose and sinus openings off of a TV monitor), as well as by CT scans of the sinuses.  If there is blockage to the breathing passages, this can be easily determined by these techniques, and it may be due to commonly seen problems like broken or twisted bones inside of the nose (deviated nasal septum) from traumas that a patient may have sustained to the nose in childhood and not really recall, with a perfectly normal looking external nose.  The obstruction may also be from enlarged turbinates related to allergy, the areas inside of the nose that shrink up with the use of nose sprays.  There could also be growths like polyps (little bags of fluid) inside the nose as well, also seen commonly related to allergy.  Excess mucus production is commonly seen with all of these forms of production because the sinuses are a filtration mechanism which make "a gallon" of mucus every day. If there is only "a half gallon" of air that passes through your nose, then there is a half gallon of mucus that will either run out of the nose, down the back of the nose (post nasal drip), or sits in the sinuses like a wet basement (or a swamp) and becomes a breeding ground for bacterial, fungal and viral infections.  If this is the case, then surgery can be performed by straightening out the blockage by removing whatever may be blocking the breathing (or blocking air from getting into the sinuses to dry up the mucus and establish air flow through the "filter," the sinuses).
 
This is accomplished by a technique known as Endoscopic Sinus Surgery and is done usually under a general anesthetic as an outpatient.  The operating is off of a TV screen with small surgical cameras and scopes placed through the nostrils. Patients are also given the opportunity to have a videotape made of their surgery if they have interest, since most find it fascinating to watch their surgery at a later date.

Nasal and sinus surgery is much more advanced than the earlier days of packing the nose and can almost always be performed as outpatient with no scars or bruising  (with the patient's ability to breathe through their noses immediately through small tubes in the nose which are kept in place usually 3-4 days).  Discomfort is usually minimal and can be compared to the discomfort that a person usually has with a sinus infection (and can be controlled well with pain medicines if needed). Strenuous activity is limited for approximately 10 days.