Managing Chronic Nasal Congestion and Stones: When to Consider Surgery?

Q: Managing Chronic Nasal Congestion and Stones: When to Consider Surgery?

Hello, since the image cannot be opened and I cannot see its content, based on your description, if it involves procedures such as septoplasty, functional endoscopic sinus surgery, or tonsillectomy, any hospital's otolaryngology department should be able to handle these. <br>It i

Unilateral swelling often occurs with bilateral stones?

Currently, as shown in the photo (the image is reversed because it was taken with a phone), you need to click "YES, I am over 18" to access this image: https://imgur.com/JrVRvzH.
On the left side, a small tonsillar crypt has formed, and after regular saline rinses, no more stones have developed.
On the right side, I experience nasal congestion 24 hours a day, with 20 hours of it being particularly severe due to a deviated septum and chronic sinusitis that has lasted for about 28 years.
I am hesitant to undergo surgery because most people say it tends to recur and is often ineffective.
Therefore, aside from eating spicy food and being able to breathe while exercising or lying on my side, I generally endure the discomfort of unilateral nasal congestion.

I have noticed swelling, along with small white spots resembling stones merging within the mass, accompanied by tiny streaks of blood.
There is no pain, and my throat feels comfortable while sleeping, with no adverse reactions that affect my daily life.
However, that tonsillar crypt seems to require rinsing every two to three days; otherwise, stones may still form.
Wearing braces and occasionally smoking reduces saliva production, increasing the likelihood of bacterial growth, which I suspect could be a contributing factor.

Should I maintain the current situation as long as I don't feel particularly uncomfortable, rinsing the crypt with saline daily? Or do you think I should consider surgery? Which hospitals have the capability to perform such procedures? It seems that small clinics are not interested in addressing my situation...
They just use cotton swabs to poke around and then are at a loss.
>_<

can, 30~39 year old female. Ask Date: 2023/08/07

Dr. Ji Zhaoyun reply Otolaryngology

Hello, since the image cannot be opened and I cannot see its content, based on your description, if it involves procedures such as septoplasty, functional endoscopic sinus surgery, or tonsillectomy, any hospital's otolaryngology department should be able to handle these.
It is advisable to seek a consultation for further evaluation.

Reply Date: 2023/08/07

More Info

Managing chronic nasal congestion and stones can be a complex issue, especially when it involves anatomical variations like a deviated septum and chronic sinusitis. Given your history of chronic nasal congestion for approximately 28 years, along with the presence of small stones and a deviated septum, it’s understandable that you are seeking a solution to improve your quality of life.

When to Consider Surgery
Surgery for chronic nasal congestion and related issues is typically considered when conservative management strategies, such as saline irrigation, medications, and lifestyle changes, fail to provide relief. Here are some key factors to consider when deciding whether to pursue surgical intervention:
1. Severity of Symptoms: If your nasal congestion is significantly impacting your daily life, such as causing sleep disturbances, affecting your ability to exercise, or leading to recurrent sinus infections, surgery may be warranted.

2. Anatomical Issues: A deviated septum can contribute to chronic nasal obstruction. If imaging studies (like a CT scan) reveal significant anatomical abnormalities that could be corrected surgically, this may be a strong indication for surgery.

3. Response to Conservative Treatment: If you have been consistently using saline rinses and other non-invasive treatments without significant improvement, this may suggest that surgical options should be explored.

4. Presence of Complications: If you experience complications such as recurrent sinus infections, nasal polyps, or significant discomfort due to the stones, surgical intervention may be necessary.

Types of Surgical Options
1. Septoplasty: This procedure corrects a deviated septum, which can improve airflow and reduce nasal congestion.

2. Functional Endoscopic Sinus Surgery (FESS): This surgery is performed to remove blockages in the sinuses and improve drainage, which can alleviate chronic sinusitis symptoms.

3. Sialolithotomy: If the stones you mentioned are related to salivary glands, this procedure can be performed to remove stones from the glands, which may also help alleviate discomfort.

Risks of Surgery
While surgery can provide significant relief, it is essential to be aware of the potential risks, including:
- Infection: As with any surgical procedure, there is a risk of infection.

- Bleeding: Some bleeding is expected, but excessive bleeding can occur.

- Nasal Obstruction: In some cases, surgery may not fully resolve nasal obstruction.

- Scarring: Scar tissue can form after surgery, which may lead to further obstruction.

Finding the Right Surgeon
It is crucial to consult with an experienced ENT (Ear, Nose, and Throat) specialist who can evaluate your specific condition and recommend the best course of action. Look for a hospital or clinic that specializes in sinus surgery and has a good reputation for treating chronic nasal conditions. Major medical centers or academic hospitals often have specialists with extensive experience in these procedures.

Conclusion
In summary, while your current management strategies, such as saline rinses, may provide some relief, it sounds like you are experiencing significant discomfort that may warrant surgical evaluation. It is advisable to consult with an ENT specialist who can perform a thorough assessment, including imaging studies, to determine the best surgical options for your situation. They can also discuss the potential risks and benefits of surgery, helping you make an informed decision about your health.

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