900 SE Oak St Ste 201

Hillsboro, OR 97123

Phone: (503) 648-8971

Fax: (503) 640-6461

Nose

Nose

Pediatrics

While many nasal conditions may seem like they only affect adults, children can also suffer from them. Sinus infections are one condition that is common in the pediatric population. Since children have small sinuses, they can become easily blocked. The symptoms of a sinus infection in children are yellow/green nasal drainage, cough, swelling around the eyes and irritability or fatigue. Since these symptoms mimic those of a cold, it is best to wait a week to 10 days to see what happens. If the symptoms do not go away, you should then bring your child to the doctor.Once at the appointment, your child’s doctor will review their medical history and perform a physical exam. The doctor will use an otoscope (a lighted instrument) to look into your child’s nose. If necessary, a CT scan may be needed to get a better picture of your child’s sinuses, since sinuses develop as you age. Imaging tests let your doctor see if there are any structural issues that could be leading to the sinus infection.

Antibiotics are the most common treatment for sinusitis. While over-the-counter decongestants and antihistamines are usually recommended for the treatment of sinus infections in adults, they are not advisable for children less than two years old. If your child begins developing multiple episodes of sinusitis, surgical treatment may be recommended.

Hay Fever

Allergic rhinitis, known as hay fever, is what we typically associate with seasonal allergies. While some do have seasonal allergic rhinitis, which means they have symptoms in the spring, summer or early fall, others have perennial allergic rhinitis and suffer from symptoms year-round. Seasonal allergic rhinitis is usually caused by an allergy to airborne mold spores or pollens from grass, trees or weeds. Perennial allergic rhinitis is caused by an allergy to dust mites, pet hair, cockroaches or mold.Those with hay fever typically have a runny nose, itchy eyes, stuffy nose, sneezing and a feeling of fatigue. Cigarette smoke, strong odors and cleaning solutions can make symptoms worse.

In order to diagnose hay fever, your doctor will review your medical history. They are specifically looking for a pattern of when you experience these symptoms. A skin test may be ordered to get a better idea of what you are allergic to. A skin test involves placing a small amount of what you may be allergic to (called an allergen extract) on or below the skin. After 15 minutes, any red or itchy bumps are measured to determine the severity of your allergy.

Once your doctor has determined what you are allergic to, they will work with you to figure out how to avoid your triggers. Keeping your windows closed during high pollen count days, using dust mite-proof covers for your bedding and washing your hands immediately after playing with a pet are all simple ways to prevent exposure to allergens. If your symptoms cannot be well controlled by simply avoiding what you are allergic to, medications such as intranasal corticosteroids and antihistamines may be used. Decongestants can be used for short-term relief. It is important to not use these for longer than recommended as they can actually make symptoms worse.

Those who do not find relief from medication may consider allergy shots or sublingual tablets. After an extended period of time, with the help of this treatment you should no longer experience any allergy symptoms.

Loss of Smell

Anosmia is more commonly known as simply a loss of smell. The severity can range from partial to complete and from temporary to permanent.

Anosmia is usually caused by an irritation in the lining of your nose or an obstruction in your nasal passage. Many things can cause the lining of your nose to become irritated: a common cold, a sinus infection, hay fever or the flu. A nasal polyp, tumor or a deformity inside the nose can all cause an obstruction.

While much less common, damage to the part of the brain that is responsible for your sense of smell can also cause anosmia. This damage can be caused by normal aging, a traumatic brain injury and a number of disorders and syndromes that affect the brain.

Typically, your sense of smell will return on its own after a few days. If this does not happen, you should contact your doctor, as it may be a symptom of a more serious condition. An antibiotic may be needed to treat a bacterial infection irritating your nasal passages and surgery may be needed to remove the nasal obstruction.

Nose Bleeds

While alarming, nosebleeds are usually not a sign of anything serious. There are two types of nosebleeds, anterior and posterior. Anterior nosebleeds are the most common and are caused by bleeding in the front part of the nose. The bleeding from a posterior nosebleed comes from an artery in the back portion of the nose.The most common cause for a nosebleed is trauma. This can be trauma to the outside of the nose such as a blow to the head or trauma to the inside of the nose such as irritation from a cold. Conditions such as hemophilia (inability to clot), abnormal blood vessels or high blood pressure can lead to an increase in nosebleeds. Nosebleeds occur most often in the winter months in cold, dry climates.

Bleeding from only one nostril is the most common symptom of a nosebleed. Usually a nosebleed from both nostrils is due to a heavy flow from one nostril, the blood has just backed up and overflown into the other. If blood drips down the back of the throat into the stomach you may spit up or vomit blood. Excessive blood loss can cause a feeling of dizziness, light-headedness and fainting.

More often than not, a nosebleed can be easily controlled at home. Sit up straight, lean your head forward and pinch the nostrils together with your thumb and index finger for 10 minutes. Try not to swallow any blood as it will cause you to vomit. Once the bleeding has stopped, try not to blow your nose for the next 24 hours and avoid dry air.

If this home remedy does not stop the bleeding, you will have to visit the doctor. If the bleeding is coming from a blood vessel at the front of the nose, your doctor can easily seal up the opening with silver nitrate in a process called cauterizing. If the blood vessel is further back, nasal packing may be needed. This involves packing the nasal cavity with gauze, which puts pressure on vessel and will stop the bleeding. The packing is left in place for 24 to 72 hours.

If the bleeding is coming from the back of the nose (a posterior nosebleed) a special type of packing is needed. The patient usually requires hospitalization, a sedative and pain medication. The packing is left in place for 48 to 72 hours. If the bleeding still does not stop, surgery may be needed.

Sinus Infections/Sinusitis

Sinusitis, commonly called a sinus infection, is the inflammation or swelling of the tissue that lines the sinuses. Your sinuses are made up of four sets of hollow cavities inside your skull, lined with soft tissue called mucosa. These cavities are located in the cheekbones, the forehead, behind the eyes and behind the nasal cavity.If the sinuses become blocked, they can fill with fluid. If this fluid contains germs, such as bacteria, fungi or a virus, it can grow into an infection. A common cold, allergies, nasal polyps or even a deviated septum can all cause a blocked sinus.

There are four distinct types of sinusitis: acute, subacute, chronic and recurrent. Acute sinusitis is a sudden onset of a stuffy nose and facial pain that lasts for a week to 4 weeks. Subacute sinusitis has symptoms that last from 4 to 8 weeks. The symptoms of chronic sinusitis can last for longer than 8 weeks. Recurrent sinusitis is marked by several attacks over the course of one year.

The symptoms of a sinus infection closely mimic a cold: facial pressure, nasal stuffiness, nasal discharge, loss of smell and a cough. Some may also experience a fever, bad breath and fatigue.

In order to diagnose a sinus infection, your doctor will review your medical history and complete a physical exam. During this exam, the doctor will press your sinuses to test for tenderness. To get a better look in your sinuses, your doctor will perform a nasal endoscopy. A nasal endoscope, a flexible tube with a light and camera on the end, is inserted into the nasal cavity. Your doctor is able to see if there is any sign of structural damage or an obstruction, such as a nasal polyp.

Treatment for a sinus infection can range from home remedies to surgery. A warm compress, inhaling steam from a pot of boiling water and simple saline nasal spray can help alleviate symptoms. Decongestants, either prescription or over the counter, can be used in moderation; any longer than four to five days can actually increase congestion. Antibiotics may also be prescribed if your doctor thinks your sinus infection is caused by bacteria.

If these treatments are not effective at controlling your sinus infection, sinus surgery may be the next step. Traditional sinus surgery involves removing some bone or tissue to widen the sinus cavity. A turbinectomy may be performed; this procedure removes the turbinate bones within the nasal passage. This can be successful in relieving nasal obstruction. Balloon sinuplasty is a fairly new option. A balloon is inserted into the inflamed sinus and inflated, widening the sinus cavity. The balloon is then deflated and removed, leaving behind an opened sinus.

If you are suffering from any of these signs of a sinus infection, contact us at xxx-xxx-xxxx. One of our experienced doctors will be able to work with you to come up with a treatment plan that will finally relieve you of these symptoms.

Nasal Fracture

Commonly referred to as a broken nose, a nasal fracture is a break or crack in the bone in your nose. Contact with a fixed object, such as a door or wall can cause a break. Contact sports (like hockey and football) and motor vehicle accidents are common causes of a broken nose.

Pain when touched, swelling of the nose and bleeding from the nose are common symptoms of a nasal fracture. If you have a nose injury accompanied by difficulty breathing, unstoppable bleeding and a noticeable change in the shape of your nose, you should seek medical attention as it is probably broken.

To confirm a nasal fracture, your doctor will perform a physical exam. He or she will press on the sides of your nose and look inside your nostrils for signs of broken bones. Topical anesthetics may be applied before the physical exam to control the pain. An imaging test is usually unnecessary, but based on the severity of your injury a CT scan may be required if a physical exam is too painful to be performed.

The treatment for a nasal fracture depends on the severity. A minor fracture that has not changed the shape of your nose may not require medical attention at all and will heal on its own. Larger breaks will require your doctor to manually realign your nose. This procedure is performed with injected anesthesia. A nasal speculum is inserted into the nostrils and with the help of other specialty instruments your broken nose and cartilage are put back into place. An internal and external splint will be attached to help keep your nose in place while the bone heals. For severe breaks surgery may be needed.

Nasal Polyps

Nasal polyps are soft, noncancerous growths in the lining of your nasal passage or sinuses. They can affect those of all ages but are most common in young and middle-aged adults. The polyps can range in size from small, unnoticeable growths to large polyps that can completely block your airflow.Inflammation within the lining of the nose and sinuses is thought to cause polyp formation. Asthma, allergies and sinus infections are usually responsible for the inflammation.

Small polyps can go unnoticed and produce no side effects. As the polyps get larger they can cause a runny nose, a feeling of stuffiness, a postnasal drip, loss of your sense of smell, headache and snoring. Large growths or a combination of multiple smaller ones can block the nasal passage. If these symptoms last longer than 10 days you should contact your doctor.

In order to diagnose a nasal polyp, your doctor will review your medical history and complete a physical exam. If the polyps are not immediately visible, a nasal endoscopy will be performed. A flexible tube with a lighted camera on the end (endoscope) will be inserted into your nasal cavity. This will give your doctor a detailed view of what is going on. If the polyps are too deep within the nasal cavity for the endoscope to reach, imaging may be needed. Not only can a CT scan or an MRI help your doctor see even deeper into your nasal canal, these tests can help to determine if something else is obstructing the passage, such as a cancerous growth.

The first line of defense towards nasal polyps is medication. A nasal corticosteroid spray can help to reduce inflammation; this should work to shrink or completely eliminate the polyps. If the spray does not work, the next step would be an oral corticosteroid. Oral steroids can have serious side effects so these drugs should be used for only a short period of time. If the drugs do not reduce the size of the polyps, surgery may be required. Surgery can usually be performed endoscopically as an outpatient procedure. An endoscope is inserted through the nostril and the polyp and any other obstruction is removed.

Deviated Septum

Your nostrils are separated by a thin wall known as a nasal septum. If this wall moves, one nasal passage becomes larger than the other; this is known as a deviated septum. A deviated septum is usually present at birth or is caused by an injury to the nose. Many conditions can cause an issue in fetal development that results in a deviated septum at birth. Likewise, any number of injuries to the nose can cause the nasal septum to deviate. More often than not, a nose injury is sustained during a sporting event or a car accident. While not causes of a deviated septum, normal aging and swelling of the nasal tissues from a cold or allergies can make a deviated septum worse.

Most deviated septums produce no symptoms; in fact, many individuals do not even know they have one. Nosebleeds, facial pain, noisy breathing while sleeping and trouble breathing may occur. Chronic mouth breathing, due to difficulty breathing through the nose, can lead to dry mouth.

If you are experiencing any of these symptoms, you should contact your doctor. At the appointment, your doctor will go through your medical history and perform a physical exam. A lighted instrument called a nasal speculum will be used to examine your nostrils.

Typically, the first line of treatment is a nasal decongestant, an antihistamine or a nasal steroid spray. All of these medications are focused on reducing the inflammation within the nasal passage, but do not fix the problem of the deviated septum.

If your symptoms do not improve with medication, surgery to fix the deviated septum may be needed. A septoplasty reposition is the surgical procedure used to straighten your septum. Some may also require their nose to be reshaped in a procedure called a rhinoplasty. Typically, these two surgeries can be performed at the same time.

Allergies

Allergies occur when your body mistakes a normally harmless substance (called an allergen) for a threat and attacks it. Your body will release a specific antibody called Immunoglobulin E (IgE) which causes the release of inflammatory chemicals such as histamine. Histamine causes the symptoms commonly associated with an allergic reaction, such as sneezing, runny nose, hives and watery eyes.In order to treat your allergy symptoms, your doctor will first need to figure out what you are allergic to. This is usually done through a skin test, a blood test or a challenge test.

A skin test involves placing a small amount of what you may be allergic to (called an allergen extract) on or below the skin. There are three types of skin tests: a skin prick test, an intradermal test and a skin patch test.

A skin prick test requires a drop of the allergen extract to be placed on the skin, and a needle is used to either scratch or prick the skin through the drop. This allows the extract to enter the skin. After 15 minutes, any red, raised and itchy areas that have developed are measured. This is usually an indication that you are allergic to the allergen.

An intradermal test is more sensitive so it is performed after the skin prick test has come back negative but an allergy is still suspected. The allergen extract is injected into the skin. After 15 minutes any red, raised and itchy areas are measured.

A skin patch test is used to test for contact dermatitis, a skin allergy. A small pad with the allergy extract is taped to the skin for 24 to 72 hours. Any red or itchy areas are measured afterwards. This reaction indicates an allergy.

A blood test is used to measure the amount of allergy specific IgE antibodies in your blood. Unlike skin tests where the bigger the reaction, the more allergic you are, a blood test cannot tell you the degree to which you are allergic. This test is used when the individual’s skin is too sensitive for a skin test, if they cannot stop taking medications that will affect the results of a skin test or they are too allergic and a skin test could result in a life-threatening reaction.

A challenge test is used to rule out an allergy. This test involves ingesting a small amount of what you are allergic to in order to see if you still have a reaction. This test is usually performed with food or medications in a medical setting to make sure if you do have a reaction, it can be treated quickly.

Typically, the symptoms of an allergic reaction vary depending on what you are allergic to and how you are exposed to the allergen. If you breathe in pollen your eyes, nose and lungs may show symptoms. Whereas, if you eat something you are allergic to, symptoms will typically develop in your mouth, stomach and intestines.

Allergy symptoms can range from mild to life threatening. The level of severity depends on your level of sensitivity. Mild symptoms, such as those from seasonal allergies, can consist of a runny nose, itchy eyes, sneezing, stuffy nose and fatigue. Moderate symptoms, such as those from a pet allergy, can consist of nasal congestion, coughing, red and watery eyes and a skin rash. Food allergies and insect stings are the most likely to produce severe or life threatening symptoms. The symptoms for this level of reaction include hives, itching, redness, swelling, dizziness, vomiting, unconsciousness and cardiac arrest.

Balloon Sinuplasty

Balloon Sinuplasty is a safe in-office procedure used to treat chronic sinusitis. Unlike more traditional surgical sinus treatments, this requires no cutting or removal of any bone or tissue. This treatment is ideal for those whose inflamed sinuses do not respond well to medication.A small and flexible deflated balloon is inserted into an inflamed sinus with the help of a guide wire. Once the balloon has been placed in the right position it is inflated, opening up the sinus. The inflated balloon is able to widen and restructure the walls of the sinus without affecting the integrity of the lining. Saline is sprayed into the opened sinus to flush out any trapped bacteria or mucus. The balloon is then deflated and removed, leaving a clean and open sinus behind.

The procedure is often able to be performed in the comfort of your doctor’s office, under local anesthesia. Since the procedure is minimally invasive it has a faster and less painful recovery time; most are able to resume their normal activates after a few days.

Chronic Rhinitis

Rhinitis is the inflammation of the mucous membrane inside the nose caused by a virus, bacteria, irritants or allergens. There are three categories rhinitis can fall into: allergic, non-allergic or mixed. While each type may have its own causes, the symptoms are all similar.A runny nose, congestion, sneezing and a post-nasal drip are all common symptoms of chronic rhinitis. A post-nasal drip is characterized by the feeling of liquid sliding down your throat, causing you to constantly clear your throat. Normally, the mucus from your nose mixes with the saliva from your throat, drips down the back of your throat and is swallowed—all without you noticing. Rhinitis causes the mucus to thicken, making it more noticeable.

Allergic rhinitis (hay fever) is caused by environmental allergies and can be seasonal or perennial. Seasonal allergic rhinitis means you only experience these symptoms during specific seasons, depending on when certain plants bloom. Those who suffer form perennial allergic rhinitis experience their symptoms year-round. These are usually caused by indoor allergens such as mold, dust and pet dander.

Non-allergic rhinitis occurs when the blood vessels in your nose expand, filling the nasal lining with blood and fluid. Unlike allergic rhinitis, which is caused by something you are allergic to, non-allergic rhinitis can be caused by a number of factors. Changes in the weather, an infection, environmental irritants and even certain types of medications can cause non-allergic rhinitis.

Mixed chronic rhinitis is a combination of both allergic and non-allergic types. Typically, the cause of the allergic rhinitis will be treated first then the non-allergic rhinitis will be addressed.

The treatment for these conditions depends entirely on the cause of the symptoms. If environmental irritants, such as cigarette smoke, or allergens are causing the symptoms, the best treatment is avoidance. If avoidance is unrealistic, protecting your home from the allergens is your next best step. This can be done by changing your air filters and using dust mite-proof pillow and mattress covers.

If these steps do not alleviate you of your symptoms, medications should be considered. Steroid nasal sprays can be used for all types of rhinitis. Oral steroids, antihistamines and decongestants may also be used. Most of these are conveniently available over-the-counter.

Nasal and Sinus Surgery

If traditional treatments do not alleviate your nasal or sinus symptoms, surgery may be the next step.Often, a foreign object such as a polyp may be hindering proper drainage from your sinus. Local anesthesia is used in this outpatient procedure, called a polypectomy. A nasal speculum is used to open the nasal cavity and a wire loop or forceps are used to remove the polyps.

If turbinates, structures of bone and tissue inside the nose, become inflamed, they can obstruct airflow through the nose. To correct this, a turbinate reduction surgery will be needed. An incision is made in the lining of the nose and the bone within the turbinate is removed. Tissue may also be removed to further reduce inflammation.

Balloon sinuplasty is a fairly new procedure that can be used to treat chronic sinusitis. A small and flexible deflated balloon is inserted into an inflamed sinus with the help of a guide wire. Once the balloon has been placed in the right position it is inflated, opening up the sinus. The inflated balloon is able to widen and restructure the walls of the sinus without affecting the integrity of the lining. Saline is sprayed into the opened sinus to flush out any trapped bacteria or mucus. The balloon is then deflated and removed, leaving a clean and open sinus behind.

A deviated septum, which is normally present from birth or caused by an injury to the nose, occurs when one nasal passage is larger than the other. This may make breathing from your nose difficult and can make your allergy and sinus infection symptoms worse. Surgery is needed to straighten your septum; this is called a septoplasty reposition. Some patients might also require their nose to be reshaped in a procedure called a rhinoplasty. Typically, these two surgeries can be performed at the same time.

Endoscopic Sinus Surgery

Those who do not find relief of their chronic sinus infections through medications may be candidates for sinus surgery. Endoscopic surgery is minimally invasive, takes only 30 to 90 minutes to perform, and improves drainage within the sinus passage. It is important to note that one of the benefits of sinus surgery is that proper medications are able to be delivered to the inflamed sinus. This means that sinus surgery will not completely prevent sinus infections in the future, but will make them less likely to occur and easier to treat. You may still need to take your medications after the surgery.Local or general anesthesia is needed for this surgery. An endoscope, a thin, flexible tube with a light on the end, is inserted into the nasal cavity. Once your doctor is able to visually confirm the source of your sinus issues—usually a narrow cavity—a surgical device is inserted into the nasal cavity. A small amount of bone, tissue or other materials that may be blocking the sinus is removed.

Most patients do not experience too much pain after surgery. Over-the-counter pain meds should be fine; stronger ones can be prescribed if needed. The discomfort, congestion and drainage should improve after the first few days; minor symptoms may linger for up to several weeks.