DRHOOK- Nose jobs: Sinus problems nothing to sneeze at

the handsome doctor John Hong

Maggie Moo, our beloved hound, sniffs everything. Her nose is like a bank of knowledge. We can drive somewhere, and without even looking out the window, she can smell where she is. If we drive to the vet, her nose tips her off, and she starts to shake with dread. When we drive to the grandparents, she sniffs a few times and starts to smile. 

 What would happen if Maggie Moo had nasal obstructions?

 Structural problems can occur in the nose to cause congestion, repeated sinus infections, allergy symptoms, and loss of smell and taste. The architecture of the nasal passages and sinuses looks like a labyrinth; and, frankly, snot and bacteria can easily get lost in there and cause havoc.

 Air-filled cavities, called sinuses, can become infected. (Ever have sinusitis?) Each sinus cavity drains into the nasal passages via an ostium (bony opening). So anything from congestion to obstruction can dam up the sinus cavity, so to speak. 

 The nasal passages have turbinates and other structures that slow down the air we breathe to humidify and filter it. This is all fine and dandy as long as nothing gets in the way to cause a traffic jam in the nose. 

A broken nose can deviate the septum and/or damage the structures that support the nose. Many people are born with a deviated septum, and it can bottleneck areas to prevent proper sinus drainage or allow good airflow.

 Thank God I don't have kids, because you always hear about a child with facial pain, headache, and nose symptoms– all because he stuck something like a Monopoly house up his schnoz. (I would be like, "Why not a hotel? Think big, kid!)

Other things can become lodged in the sinuses such as sawdust or even food. My friend was pregnant with terrible morning sickness. A grain of rice was stuck in her sinus cavity for a week. "Rice-a-Roni, a San Francisco treat– Honk!"

 Nasal polyps are growths just like those in a colon, and they jut out like benign tumors. They usually look grey or white and glisten with mucous, inflammatory stuff. (Sounds like a Christmas ornament, huh?) Nasal polyps are associated in Aspirin-Exacerbated Respiratory Disease: chronic sinusitis, asthma, and aspirin sensitivity. For kids, the polyps are often associated with cystic fibrosis. Other patients with nasal polyps have allergic fungal sinusitis or allergic rhinitis (aka nasal allergies).

 Nasal polyps obviously obstruct airflow through the nasal passages and make a sufferer feel congested all the time, create thick discharge, and compromise the sense of smell. If the polyp blocks a sinus passage from draining, facial pain and headache can occur. Some people with maxillary sinusitis will have upper molar tooth pain.

 Paige Powers, a terrific ear-nose-throat specialist (entdoc.com), says, "Most polyps won't go away without surgery." Surgery to remove these nasty boogers– er, polyps– can relieve the symptoms, but, unfortunately, they can recur. Dr. Powers says, "It's a chronic disease but doesn't have to be a chronic problem." 

Management with nasal steroids, nasal saline sprays, allergies shots (if applicable), antihistamines, and medicines like Singulair is usually warranted. People allergic to aspirin might need to see an allergist for aspirin desensitization if aspirin is needed to prevent heart attack or stroke.

 Miss Moo Moo, the hound who takes care of our patients, does sneeze when she's sniffing the ground or when she lies on her back. (Actually, the patients tell us they come to see her, not us!) I hope she never needs nose surgery, but as is always true in life, one never nose what's around the corner. 


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.