Conditions

Nose & Sinus Conditions Treated

The nose and sinuses have many important functions, including warming and humidifying air for proper breathing, clearing the air of particles that would otherwise harm the lungs or worsen airway symptoms, monitoring the air for pathogens to aid in the subsequent immune response, and an olfactory system responsible for the sense of smell. Nasal anatomy also helps shape the sound of your voice as sound resonates through these areas while speaking and singing. Diseases of the nose and sinuses lead to bothersome nasal congestion or obstruction, excessive mucus, pressure or pain in the sinuses, and secondary symptoms such as sore throats, ear pressure or pain, poor sleep leading to daytime fatigue and reduced productivity, and much more. As a fellowship-trained rhinologist, Dr. Shawn Allen provides the best available treatments for sinus and nasal problems ranging from simple office procedures to complex revision sinus surgery typically performed in academic centers.

Snoring

It is estimated that snoring affects 40% of women and 57% of men in the United States and is caused by vibration or fluttering of relaxed tissues such as the tongue and palate within the throat while sleeping. When consistent, snoring suggests problems with the airway that should be evaluated further. Many patients who snore also suffer from sleep apnea, which carries more significant health implications.

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Chronic Cough

A cough is considered chronic when it lasts eight weeks or more, which may indicate underlying conditions such as postnasal drip or acid reflux as possible triggers. Thorough evaluation by an ENT surgeon is warranted to ensure any triggers or underlying conditions are properly identified and treated.

Sleep Apnea

Sleep apnea involves pauses in breathing during sleep that are either obstructive (more common, obstructions in the airway temporarily prevent breathing despite effort) or central (less common, temporary lack of effort to breathe). Common symptoms include snoring, gasping for air during sleep, frequently waking up, daytime fatigue, and more. Sleep apnea takes a significant toll on health, including negatively impacting weight gain, high blood pressure, heart arrhythmias, and diabetes control, in addition to elevating the risk of severe complications such as heart attack, stroke, and sudden death during sleep.

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Chronic Allergic and Non-allergic Rhinitis

Chronic rhinitis, an ongoing inflammation of the mucous membranes, is a common condition that causes nasal congestion, sneezing, and other unpleasant symptoms. There are two types, allergic and non-allergic. Dr. Allen can provide an accurate diagnosis that will allow him to recommend an effective treatment plan.

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CPAP Intolerance

Continuous positive airway pressure (CPAP) is the current gold standard treatment for obstructive sleep apnea. Unfortunately, many patients fail to tolerate this therapy and either stop treating their illness (suffering many health consequences) or seek help from a qualified ENT surgeon with expertise in the surgical management of sleep apnea. Dr. Allen has years of experience and additional training in correcting nasal breathing, which improves CPAP tolerance tremendously. He is also trained in other surgeries with the potential to replace the need for CPAP altogether, including Inspire implantation, UPPP, hyoid suspension surgery, and more.

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Sinus Pressure Headaches

Headaches may be triggered by problems within the nose and sinuses. However, there are many different types of headaches with differing treatments, and accurate identification of the underlying cause is essential to the successful treatment of headache disorders. Surgery should be reserved only for significant pathology identified with imaging studies aimed at correcting other symptoms such as nasal obstruction and chronic sinusitis. That stated many patients with underlying nasal problems find that their headaches improve significantly when their nasal conditions are appropriately treated. Dr. Allen has extensive experience helping patients find the appropriate and effective solutions they need for their symptoms, including headaches arising from nasal conditions.

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Sinusitis

Sinusitis is inflammation (and/or infection) of one or more of the paranasal sinuses. Symptoms may include nasal congestion, runny nose, facial pain or pressure, and many others (take our sinus quiz to see if your symptoms suggest a sinus problem). Recurring sinusitis that clears between episodes is likely triggered by viral illnesses in patients with narrow sinus openings, and this generally responds well to antibiotics followed by more conservative sinus procedures when the frequency of infections warrants intervention. Chronic sinusitis never fully clears and leaves patients with symptoms that only respond temporarily to medications. Chronic sinusitis failing medications is often best managed with appropriate surgery followed by ongoing medical treatments aimed at controlling allergies and inflammation within the nose and sinuses. Sinusitis varies tremendously in the severity of symptoms, impact on health, and ease of treatment. As a fellowship-trained sinus expert, Dr. Allen has years of experience managing all forms of sinus disease with success.

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Nasal Polyps

Nasal polyps are benign tissue growths that can cause frequent congestion, sinus infections, snoring problems, and loss of smell. Dr. Allen offers a range of treatment options for nasal polyps.

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Allergic Fungal Sinusitis (AFS)

Allergic fungal sinusitis is a type of sinus infection that is caused by fungus rather than bacteria. While healthy patients may have milder symptoms difficult to differentiate from other common sinus problems, patients who are immunocompromised are at risk for serious complications and require urgent treatment. Sinus experts like Dr. Shawn Allen can quickly determine the nature of a fungal sinusitis problem and provide targeted treatments likely to succeed long-term.

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Sinus Mucoceles

Mucoceles are obstructed sinuses or portions of sinuses that progressively expand beyond their initial size by eroding or remodeling the bone surrounding the mucus within. They may result from chronic sinusitis with complete sinus obstruction, trauma and scarring of the sinus outflow tract, allergic fungal sinusitis when the mucus is too thick to drain, and in some cases have no apparent underlying cause. In severe cases, mucoceles expand into adjacent structures such as the orbit or cranial cavity and risk significant dysfunction such as double vision, blindness, meningitis, and more. Mucoceles do not resolve with medications and require surgical drainage to prevent eventual complications.

Nasal Congestion or Obstruction

Nasal congestion or obstruction is a sensation of abnormal or inadequate airflow within the nose on one or both sides. Causes vary and include structural problems (deviated septum, turbinate hypertrophy, concha bullosa, nasal valve collapse, etc.), inflammatory causes (severe swelling, polyps, crusting and mucus buildup, etc.), and changes related to blood flow (turbinate swelling when lying down, natural nasal cycle that alternates sides, etc.). In general, nasal obstruction is easily corrected with a combination of topical steroid therapy, surgical correction of problems that will not resolve with medications, or both.

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Deviated Septum

When the nasal septum is not straight, the airflow through one or both sides of the nose can become compromised due to obstruction or abnormal turbulence. While deviated septums are common (estimated 70-80%), most cases are mild and have minimal impact on nasal breathing. Moderate to severe septal deviation, however, can significantly impact breathing and is easily corrected with simple outpatient surgery.

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Enlarged Turbinates

The inferior turbinates (seen when looking up someone’s nostrils) may hypertrophy, or enlarge, in response to chronic inflammation (allergies), recurring viral illnesses, smoking and other airborne irritants, chronic sinusitis, and more. Once larger than normal, they begin to restrict airflow most or all of the time. Initial therapy with topical nasal steroid sprays (such as Flonase) reduces swelling and helps prevent ongoing enlargement of the turbinates. However, the growth of these tissues cannot be reversed, and once significantly enlarged the turbinates require procedures to reduce their size in order to improve nasal airflow. This is particularly true in the setting of nasal decongestant abuse, where chronic changes in the blood flow lead to permanent enlargement of the turbinates, and is the reason decongestant use should be limited to a few days. When properly performed, turbinate reduction surgery is highly effective in providing lasting improvement in nasal breathing for patients with enlarged turbinates.

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Epistaxis (Nosebleeds)

The formal name for nosebleeds is epistaxis. While the majority of nosebleeds can be treated at home, severe or chronic nosebleeds require the attention of a specialist such as Dr. Allen.

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Anosmia (Smell Loss)

Anosmia/Hyposmia (complete or partial loss of smell) results from obstructions in the nose or damage to the nerves that provide smell sensation in the upper portions of the nose. Obstructions may temporarily impact smell function, and most commonly include nasal polyps, nasal swelling from rhinitis or viral upper respiratory illnesses, and the other causes of nasal obstruction mentioned above. Nerve damage results in long-lasting, often permanent smell dysfunction, and is most often caused by a viral illness that invades these nerves resulting in an immune response and subsequent loss of nerve function. Other causes of damage to the nerves that provide smell sensation include head trauma, inflammation or scarring related to nasal surgery, smoking, and progressive neurological disorders such as dementia. Obstructions can often be relieved with steroid therapy and surgical correction of structural problems in the nose. Olfactory retraining therapy and other treatments that are currently under investigation offer some hope for smell recovery in patients with nerve dysfunction.

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Watery Eyes (Epiphora)

The lacrimal (tear) system drains through the eyelids and into the nasal cavity, and the lacrimal sac and duct might be impacted by many conditions that result in excessive tearing or epiphora. When medical treatments fail to resolve epiphora, dacryocystorhinostomy (DCR) can provide a surgical opening from the lacrimal sac into the nasal cavity and alleviate excessive tearing.

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Eustachian Tube Dysfunction

Eustachian tube dysfunction occurs when the Eustachian tube that connects the middle ear to the back of the nose is narrowed or obstructed leading to muffled hearing, ear pressure or discomfort, and the feeling of fullness in one or both ears. In adults without previous ear problems, it is most often caused by postnasal drainage due to allergies or chronic sinusitis. In those with lifelong ear problems, it is more likely a symptom of unfortunate anatomy (narrow eustachian tubes).

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Postnasal Drip

A number of conditions can lead to postnasal drip, including infection, anatomical factors, and allergies. Dr. Allen customizes treatment for postnasal drip to address the root cause of the issue, providing patients with effective and long-lasting relief.

Cerebrospinal Fluid (CSF) Leaks

A CSF leak can occur when the membranes surrounding the brain or spinal cord are torn or punctured, allowing spinal fluid to leak into surrounding tissues. Small defects in the bone separating the nose and middle ears from the brain may allow for this CSF to leak from the nose or accumulate within the ears as an effusion. This is generally notable when leaning forward and observing a continual drip, which may only occur intermittently. Causes include elevated pressure (benign intracranial hypertension), head trauma, surgical trauma, erosions secondary to lesions or growths that involve the skull, and more. As this defect is a risk for meningitis and other severe complications, anyone with a suspected CSF leak should seek evaluation without delay.

Orbital Proptosis (Bulging Eye)

Often the result of the autoimmune condition Grave’s disease, orbital proptosis is a condition that causes one or both eyes to protrude more than normal from the orbits as tissues within the orbits progressively enlarge. When this occurs slowly over time, as in Grave’s disease, the vision is rarely compromised. Other bothersome symptoms such as eyelid retraction and dry eyes may necessitate surgical correction, however. Sudden eye bulging generally results from bleeding or infection within the orbit and requires emergent surgery to prevent vision loss and other serious complications.

Sinus And Skull Base Tumors

Sinus and skull base tumors are growths that form within the sinuses or along the base of the skull. Examples include inverted papilloma, osteoma, neuroma, and other benign lesions, as well as malignancies such as squamous cell carcinoma, lymphoma, and mucosal melanoma. Sinus and skull base tumors are rare and tend to present with obstruction on one or both sides of the nose, intermittent nose bleeding, pressure, or pain similar to sinusitis, and rarely with signs of neurological dysfunction such as blurry vision, smell loss, or numbness in the face. Identification generally involves imaging (CT and/or MRI) and subsequent biopsy depending upon the suspected diagnosis. In many cases, sinus and skull base tumors can be removed endoscopically (through the nostrils) to avoid external incisions. Other treatments such as chemotherapy and radiation are often required to give patients with malignancies optimal outcomes.

Pituitary Tumors

The pituitary gland resides within the sella, a bony compartment located within the back wall of the sphenoid sinuses. Growths and hemorrhages within the gland may cause vision loss, headaches, and hormone imbalances that disrupt important bodily functions. Most pituitary lesions are benign, but cause progressive dysfunction as they enlarge. Endoscopic surgery allows ENT surgeons and Neurosurgeons to collaborate and provide optimal outcomes by achieving more complete removal of pituitary lesions and keeping the functional portions of the gland and nearby critical structures safe from injury during surgery.