The Nose-Sinuses & Septum


The sinuses are probably the most confused area of ENT.  “Sinusitis” refers to an inflammation and infection in the sinuses (the air-filled cavities within the face that branch off from the nasal cavity). This is different from allergies, rhinitis (nasal drainage), and nasal polyps.  However, sinus infections often go hand in hand with nasal allergies. ENT physicians treat both the sinus and allergic conditions.


Headaches are often blamed on “sinuses”.  However, studies have repeatedly shown that most of the time headaches are NOT due to sinus congestion or infection. They can be migraine or other headache types (for example, tension), and often cause symptoms in the nose that mimic nasal/sinus disease.

Contrary to popular belief, patients themselves cannot differentiate a “sinus” headache from other nasal problems or other types of headaches purely from the symptoms.

Diagnosis of Sinus infection

Diagnosing a sinus infection is not always easy.  Often times, x-rays or CT scans will be done to evaluate a patient’s anatomy and to look for sinus disease. Acute sinus infections are usually treated with antibiotics, decongestants, nasal steroid sprays, antihistamines, and irrigations.  However, when infections are recurrent and/or not responsive to medications, endoscopic sinus surgery (ESS) may be recommended to enlarge the openings that drain the sinuses.

Sinus Surgery

Endoscopic sinus surgery (ESS) involves the insertion of a very thin fiber-optic tube (an endoscope), into the nose for a visual examination of the sinus openings.  With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed.  In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars.  The basic endoscopic surgical procedure is performed under local or general anesthesia. 

The advantage to ESS is that the surgery is less extensive than earlier invasive procedures where the surgeon would access the sinuses by entering through the cheek area, which often resulted in scarring.  There is often less removal of normal tissues with ESS and it can frequently be performed on an outpatient basis.  After the operation, the patient will sometimes have nasal packing.  For the ten days following the procedure, nasal irrigations may be recommended to prevent crusting.  There is typically very little swelling and only mild discomfort with this type of procedure.

Deviated Septum

The nasal septum is the vertical wall that divides the nose into two nasal cavities.  At birth the nasal septum is usually straight.  However, as we age there is a tendency for the septum to bend to one side or the other.  Often there is no history of injury to account for the irregular or deviated septum.  Few adults have a nasal septum that is completely straight.  Sometimes trauma to the nose can play a major role in a septal deviation. 

Nasal Surgery

Septoplasty is an operation to correct a deviated septum.  This procedure is usually done to improve the nasal breathing function but can also be done to provide adequate examination of the inside of the nose for the treatment and/or the removal of nasal polyps, inflammation, tumors, or bleeding.  Learn More...

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