Secrets of a Beverly Hills Cosmetic Surgeon

Most people think they have sinus problems. Most are wrong. But, they do have a problem – in the nose.

Oh, the lowly sinuses. Television and radio ads blare out the need to have decongestant pills, nose sprays, nose drops, directed at stopping “sinus problems.” Long ago, one company had an ad campaign that proclaimed that its medications would be like “sending your sinuses to Arizona.” You would hope the sinuses would be sent to Arizona in the winter and not the summer. But, in fact, people living in the cold parts of the country generally have sinus problems in the winter, hence the appeal of toasty-warm Arizona during the winter.

Most people that complain of pressure on the front of their face, a clogged nose and postnasal drip do not have a verified sinus infection, but are having problems because they have internal nasal airway obstruction. They probably have a deviated septum. They may also have in addition enlarged turbinates. The problem is the nasal passages, not the sinuses.

Classically, a true sinus infection is a very serious medical condition and it would not be a mystery to the patient or their doctor. There would be high temperature, nausea, vomiting, facial swelling and pain. There would be such pressure between the eyes or above the teeth in the cheek bones that strong pain medication would be required. Just touching those tissues would cause an instant further discomfort on the part of the patient. There would be pus pouring out of the nose and into the throat. You would be one sick cookie.

Diagnostic tests can either confirm or deny the presence of a true sinus infection. An x-ray or CT scan of the sinuses are the standard examinations doctors order.

The classical picture of a significant sinus infection that I have painted is different than what most people complain of. Hence, in fact most people do not have true sinus infections.

The salvation for the patient who typically has nasal congestion, postnasal drip, nighttime blockage, snoring and possibly sleep apnea, lies within the nose.

Correction of the deviated septum and reduction of the turbinates improves the airway. Each nasal passage is converted from a one-lane road to a two-lane super highway with respect to carrying air through the nose and down to the lungs.

Remember that the sinuses are air-filled ante-rooms or chambers that communicate with the nasal passages. In order to have a significant sinus problem, whether caused initially by the above-mentioned wrong architecture, nasal allergy or a cold virus, the symptoms begin in the nose, as if the nasal passages were hallways leading to the sinus bedrooms.

Finally, remember you smokers, you already have one strike against good nasal breathing by continually bathing your internal nose with those blasts of hot, dry and irritating smoke. The smoker’s nose is ripe for further problems from allergy or a cold virus. And, as the nose suffers, so ultimately will those poor, much maligned sinuses. Kick the habit.

- Robert Kotler, MD, FACS

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