Nasal Turbinate Hypertrophy | Septal Deviation | Sleep Apnea | Snoring

Nasal Turbinate Hypertrophy

Think of the inferior turbinate as a sausage filled with blood vessels. They naturally change in size. The size of the turbinates is unconsciously controlled so that they swell on one side at a time and shrink on the other side. Some people are annoyed by the stuffiness which shifts from side to side several times a day. Others notice that their nose gets stopped up when they lie down. That occurs because lying down allows more blood to collect in the turbinates.

Unfortunately, the size of the inferior turbinates can be too much to allow normal airflow through the nose. People cannot breathe properly when exercising, sleeping or even at rest. This is particularly noticeable for people who also have a deviated septum.

The most common cause of turbinate hypertrophy is the inflammation associated with seasonal and environmental allergies (link). Other causes include chronic sinusitis, second-hand smoke and chemical irritants.

How is Turbinate Hypertrophy Treated?

If medical treatment has failed, an effective treatment can significantly decrease the size of the inferior turbinates. The most common technique requires only a small incision inside the nose and a tool which removes some of the blood vessels, shrinks the turbinates, but leaves the mucosal surface intact. An alternative procedure is cauterization (coblation) of the inferior turbinates.

Usually the surgery is performed in an outpatient surgery center. The surgery is often performed under general anesthesia or with the patient made sleepy and forgetful by some IV medication. However, more and more often Dr. Sigari has been able to offer this procedure as an in-office treatment under local anesthesia.

In conjunction with the Pillar procedure this can be an effective treatment for primary snoring.


Septal Deviation

The wall the separates the left and right sides of your nose is called the nasal septum. In the front of your nose it is made of flexible cartilage. Farther back in your nose, it is made of bone. Almost no one has a perfectly straight nasal septum. Minor abnormalities are very common and usually don’t cause any problems.

People benefit from a septoplasty when they have:

  • A significant nasal septal abnormality
  • Symptoms that typically result from nasal septal deviations
  • Medications have not adequately relieved the symptoms

The most common reason for a septoplasty is when a patient doesn’t breath well though one or both sides of the nose. When a significant deviation is present, correcting this abnormality can improve the airflow.

Nasal septal deviations are common. In fact, it is rare to see a perfectly straight nasal septum. Septal deviations do not always cause problem. The main problem that is commonly caused by a septal deviation is airway obstruction. Nasal septal deviations can also cause sinus pain and contribute to infections.

The most common problem arising from nasal septal deviations is that you just can’t breathe well through your nose. This is especially likely to bother people at night. It is not usually clear that the problem is entirely from the septal deviation.

When a nasal septal deviation interferes with sinus drainage, it can be a contributor to repeated infections or chronic infections. In conjunction with endoscopic sinus surgery, correcting significant septal deviations can help improve drainage. In some cases it is necessary to correct septal deviations during sinus surgery simply to help access the sinus cavities.

Sinus pain can be caused when the septum is deviated such that it touches the side wall of the nose or indents one of the turbinates. Pain from a septal deviation may be felt in the ear or on the side of the face or near the eye.

How is Septal Deviation Treated?

If the symptoms do not improve after medical therapy, Dr Sigari can offer correction of the septal devation with relative short outpatient surgery in which the deviated part of the septum is removed while still preserving the septal anatomy. One advantage of Dr Sigari’s treatment is that he is often available to perform this procedure without any splints and/or packing. This results in better patient comfort and faster return to normal daily activity.


Sleep Apnea

Sleep is a basic function necessary for human survival, but for many people suffering from sleep-disordered breathing problems, the body is not getting the rest it needs. It’s estimated that 40 million Americans have disturbed breathing during sleep, ranging from moderate snoring to potentially life-threatening sleep apnea. And while mild snoring may be no more than an annoyance to your bed partner, chronic, loud snoring may indicate a more serious condition known as sleep apnea. In patients with sleep apnea, breathing stops repeatedly during sleep, sometimes up to hundreds of times every night. Sleep apnea, if left untreated, could lead to a host of significant health issues, including heart problems, hypertension and stroke.

What causes sleep apnea?

When we fall asleep, our body naturally relaxes. Unfortunately, for some people, when the soft palate tissue at the back of the throat relaxes, it narrows the throat. When air is drawn in through the narrowed opening, the soft tissue vibrates, resulting in a snoring sound. But sometimes snoring is only a symptom of a more serious condition known as obstructive sleep apnea. For people with obstructive sleep apnea, the soft palate tissue and tongue will relax and collapse into the throat during sleep, partially or completely obstructing the airway. The sleeper will stop breathing until the brain signals the body to wake up and resume breathing.

Factors that may contribute to sleep apnea include:

  • Excessive weight
  • Loss of muscle tone in throat, usually from aging
  • Anatomical structure of mouth and throat
  • Smoking
  • Excessive alcohol intake

What is the difference between snoring and sleep apnea?

Chances are, if you snore regularly, your sleep partner has probably already let you know. And while snoring can certainly be disruptive to your own sleep, as well as your partner’s sleep, sometimes the ramifications of snoring are more far-reaching than that. It’s estimated that 12 million Americans have diagnosed sleep apnea, with another 10 million who don’t even realize that they have the condition. And since untreated sleep apnea can give rise to a long list of serious health problems, it’s vitally important to find out if your snore is really something more.

While snoring can partially obstruct the airway, during sleep apnea episodes, the airway is completely closed and breathing stops. For many people who suffer from sleep apnea, breathing can stop as frequently as a hundred times an hour, and pauses typically last for 10 seconds or longer. This frequent disruption in the sleep cycle has been linked to a long list of potential health problems.

Sleep Apnea may contribute to many problems:

  • Sleepiness or exhaustion during the day
  • Poor concentration
  • Learning and memory difficulties
  • Depression
  • Irritability
  • Reflux
  • Difficulty staying awake while reading, working and driving
  • Increased risk for heart attack and stroke
  • High blood pressure
  • Diabetes
  • Sexual dysfunction
  • Weight gain
  • Headaches

How can I tell if I have sleep apnea?

While only a doctor can diagnose whether you have sleep apnea, there are symptoms that could signal a problem, such as excessive daytime fatigue and chronic, loud snoring. Not everybody who snores has sleep apnea, but the majority of people with sleep apnea do snore. If you suspect you may have apnea, you should ask your partner to describe your snoring. The goal standard for diagnosing sleep apnea is to undergo a sleep study (a polysomnogram). This can be done at a Sleep Study Center or even at home with a home sleep study system. A conversation with Dr Sigari will help you decide which one is best for you if one is indeed needed.

How is sleep apnea treated?

It’s extremely important for patients to treat sleep apnea in order to avoid potentially serious health complications. Treatment for sleep apnea will depend on each patient’s specific condition.


Snoring

How is snoring treated?

Chronic, heavy snoring should always be evaluated to determine if the snoring is a symptom of sleep apnea. But, even if snoring is not indicative of apnea, many patients want to eliminate snoring so that they and their partners can get a better night’s sleep.

Dr Sigari has offers several different options for treatment of snoring alone. First a full examination is done to evaluate for any signs of upper airway obstruction which can contribute. Nasal Obstruction can result from either septal deviation for hypertrophy of nasal turbinates. A floppy soft palate can also contribute to snoring. Dr Sigari incorporates in-office minimally invasive treatments for both.

Del Rey ENT accepts all major PPO's ENT Los Angeles Ear Nose Throat Los Angeles ENT Los Angeles United Healthcare and Medicare.