Your ENT Symptoms: When to Seek a Second Opinion - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Tony: Your issue is likely due to a deviated septum, which can also cause headaches.
However, please come to the clinic for a detailed endoscopic examination to gain a clearer understanding of your condition.
Attached is an article for your reference titled "The 'Cure-All' Surgery for Nasal Diseases That Makes You Sneeze." In the ENT clinic, symptoms such as coughing, headaches, dizziness, and nasal congestion are quite common.
However, due to their complex causes, treatment can be challenging, leading patients to flock to exaggerated advertisements promising "cures" and "guaranteed results." In the past two years, I have treated many patients who underwent the so-called "five-minute nasal disease cure," only to find issues like nasal mucosal adhesions, vestibular inflammation, nasal obstruction, and septal perforations—truly an overwhelming situation that leaves one feeling frustrated.

The causes of nasal congestion generally fall into categories such as "infection," "structural abnormalities of the nose," "allergic rhinitis," and "vasomotor rhinitis," each with its own pathogenic mechanisms and treatment approaches.
Of course, each condition has its limits in terms of treatment efficacy, which has allowed alternative practitioners to gain traction.
Below is a brief introduction to these conditions based on this classification.
◎ Infection: The most common cause of nasal congestion is the common cold, which resolves naturally as the cold improves.
Bacterial infections leading to sinusitis are more serious, often accompanied by nasal discharge, headaches, difficulty concentrating, and chronic nighttime coughing.
This can significantly impact children's sleep quality and academic performance.
When conservative treatments such as medications and nasal irrigation fail, doctors may recommend surgical intervention.
The previously common Luc's radical surgery, which required incisions in the lip to remove the entire sinus mucosa, has now been completely replaced by endoscopic sinus surgery.
This technique allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
◎ Structural Abnormalities: A deviated septum can occur naturally at birth or result from trauma causing cartilage distortion.
The degree of deviation does not always correlate with nasal congestion, and the decision to surgically correct it can depend on the patient's subjective experience.
"Chronic hypertrophic rhinitis" refers to the thickening of normal turbinate tissue, which can lead to nasal congestion.
The turbinates, also known as nasal conchae, are normal physiological structures located on the lateral walls of the nasal cavity, and patients can often see them when examining their own nasal passages.
Sometimes, patients are misinformed that these are nasal polyps and undergo inappropriate cauterization procedures.
◎ Allergic Rhinitis: Currently, there is no definitive cure for allergic rhinitis in medicine.
It is a disease caused by a specific predisposition, leading to edema of the nasal mucosa and resulting in nasal congestion.
Treatment can be tailored based on the severity of symptoms, utilizing oral medications, nasal sprays, immunotherapy, or surgery to alleviate congestion.
◎ Vasomotor Rhinitis: Various factors can trigger vasomotor rhinitis, including work stress, hormonal changes during pregnancy, certain antihypertensive medications, and even irritants like perfumes, temperature and humidity changes, or cooking fumes.
These factors can cause vasodilation and congestion of the nasal mucosa, leading to symptoms of nasal obstruction.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis may include conservative oral medications, nasal sprays, traditional inferior turbinate reduction surgery, or advanced laser surgery.
There are also techniques using thermal probes placed submucosally in the turbinates, where radiofrequency generates low heat to cause protein denaturation and subsequent fibrosis, effectively reducing the enlarged turbinate tissue.
Nasal congestion is not classified as a disease, but it is a highly bothersome symptom.
It not only makes breathing difficult but can also lead to dizziness, headaches, difficulty concentrating, snoring, insomnia, or sleep apnea.
Consulting a professional ENT specialist to identify the true cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
I sincerely hope to no longer see patients seeking so-called cure-all surgeries for nasal diseases in the clinic.

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Reply Date: 2003/10/29