@@user-jk5cl2oi1m This really depends on the specific nature of your septal and turbinate abnormalities. If you have overgrowth of bone in either (I.e. large septal bone spur or thick turbinate bone that is rigid) then addressing both would likely be needed to provide meaningful relief. If you straighten the septum and only soft tissue of the turbinates remains a problem, you might get relief over time with topical steroid sprays or rinses and sleeping at an incline to reduce vascular swelling that occurs in turbinates while lying flat. I’m very comfortable with turbinate surgery and usually recommend it as a path to lasting improvement in nasal breathing because it makes more room than just correcting a septum. And I haven’t seen any cases of ENS that I’m aware of after my procedures, as it is extremely rare with modern techniques. The safety of turbinate reduction comes down to technique - all surgeons will claim to be good. The best way to tell as an outsider is to ask how they do it and how long it takes, if they’ve had patients with ENS, and if they know how to treat ENS (if they can treat it, chances are they’re not causing it because they understand it). If they use a microdebrider or cautery probe (RFA) and spend 2 minutes per turbinate, it’s less likely to be permanent but in general is safe if done properly. If they trim with scissors and remove a large portion of the turbinates in less than 2 minutes, this is more concerning and may risk ENS. If they meticulously remove the turbinate bone through an incision but don’t remove much if any soft tissue/outer lining, this in my opinion is the best for lasting great results with demonstrated safety. There are many patients using steroid sprays, rinses, allergy meds, etc and still miserably congested with impact on their sleep, exercise, etc. If you’re in that category, then trusting a good surgeon to perform turbinoplasty can drastically improve breathing, sleep, and restfulness. You just have to decide if it’s impacting you enough to warrant it.

@@snotdoctx8742 Wow thank you for such comprehensive reply. I don't have any issues with obstruction during the daytime only when I lay down to sleep my left side turbinate swells up blocking the nose completely causing me to wake up every few hours during my sleep cycle and my septum is deviated to the right side. Is submucosal resection with microdebrider safe against ENS? Once again thank and wish you success for your youtube channel.

@@user-jk5cl2oi1m Often the turbinate opposite the septal deviation grows larger than the turbinate on the side of the deviation. Having not seen your images it’s difficult to give specific advice, but in general it’s better to get both problems corrected if you want better chances of a successful breathing outcome. The risk of ENS with microdebrider or any technique is very low as long as the surgeon knows what they’re doing when it comes to turbinoplasty. I wouldn’t hesitate to have my own turbinates reduced by a surgeon I trust, and wouldn’t be concerned about ENS in their hands.

@@snotdoctx8742 Thanks for the reply Doc. I would suggest if you can do a comprehensive video on ENS it would really help people who are the fence about the surgery. There are some people with scary stories online warning about ENS even with these modern techniques for turbinate reduction. I actually saw one story on yotube who recently had a septoplasty and turbinate reduction done and after 3 months started to show symptoms of ENS which subsided after a few weeks. The person mentioned how those continuous symptoms of suffocation were almost suicidal. link of the video kzbin.info/www/bejne/e5qpfJWmn7x6bq8. Hope people can have a better understanding about this condition.

@@tilakjoshi4180 Any further treatment recommendations would need to be based on a more thorough history and an exam including scoping your throat to look for signs of irritation linked with reflux and other “cough triggers.” If you want to try the simple stuff mentioned in this video, try sleeping at an incline, alginate therapy at bedtime (Reflux Gourmet is available on Amazon.com), avoid eating 3-4 hours before lying down. These help reduce acid exposure in your throat while sleeping, which may be an underlying reason your throat behaves as you described when eating. If that doesn’t work you should get checked out by an ENT doc to make sure you’re not missing anything more serious.

@@snotdoctx8742 I had seen gastro plus ent. ENT saw my throat through the camera to which he said it’s completely fine, you are facing this because of nose allergic and reflux.

@@snotdoctx8742 My throat is clear is what ENT said after examination. He said i have nose allergy plus reflux but what is causing the allergy is what i am unaware of.

@@neriahsartandfun5752 I see ages 10 and up. Afrin is a decongestant, which should be avoided for long term use. Nasocort is a topical steroid spray and is safe for ongoing or long term use to control inflammation such as in allergies

Please consider seeing my daughter. She is 9 1/2. I sent in a consultation request via your website. You are the most knowledgeable doctor I've found on this matter.

@@neriahsartandfun5752 We can definitely see her, just let me know if they don’t call soon or if they mention her age is a problem. I’ll tell them it’s ok on my end.

​@@snotdoctx8742 Awesome. Thank you.

​@snotdoctx8742 do you also work on throat issues? My daughter has very large adenoids after pnuemonia that is obstructing her breathing as well as turbinate hypertrophy. We went to 2 ENT's who keep wanting to spray flonase and other antihistamine sprays in her nose. Meanwhile it is causing incontinence, sleep (and awake) apnea, behavioral issues and she says DEPRESSION. Again, she is 9 1/2. We need help. Watching her sleep has been exhausting in fear that she will not be able to breathe. Once, she turned blue yet they want us to suffer and see what happens for another month. 😢

The Navage electric nasal rinse device might be a good alternative in your case, as it pulls the saline across with a vacuum rather than pushing with the squeeze bottle. This is better at avoiding getting liquids into the ears with rinsing. The only downside is that it limits head position such that you’re more upright. Fine for rhinitis from allergies, less ideal if you’ve had sinus surgery and you’re trying to get rinses into all of your sinuses.

@@johninrome I doubt the weather is directly influencing any reflux issues, is your nose congested at night while trying to sleep? I would get an ENT to evaluate your throat if you haven’t already, and to look for other causes such as breathing issues triggering the nighttime reflux, hiatal hernia, etc

@@rashidserker5426 I’m located in Houston and The Woodlands, Texas. If you live elsewhere, I do virtual consults, but generally in person is much better to allow for better care including imaging and nasal endoscopy when needed. You can set up an appointment by calling 713-791-0700 (My Houston Surgeons) or submit online at premiersinus.com

@@simonstones1918 could be allergies, chronic sinusitis, frequent exposure to airborne irritants such as dust, fumes, cigarette smoke, etc. if it’s persistent and you have other symptoms such as facial pressure, nasal congestion, smell loss, etc you should be evaluated by an ENT with nasal endoscopy and possibly CT Sinus to determine the underlying nature of the symptoms and guide treatment

@@snotdoctx8742 I’ve had a long standing issue with nasal polyps. I’ve had around 5 polypectomys. Just this last week my nose is morning inflamed than it has been and there’s a bit of white and very sticky mucus coming out. I lost my taste and smell completely about a week ago, too. Airways seem mostly clear though 🤔 I’m seeing an ent consultant tomorrow as it goes. Last consultant I saw said only small polyps up there so thought no need to operate. However, now I’ve lost my taste and smell….! 😖

@@ET4eva9487 the problem with Navage - it can only be used in a suboptimal head position. As I mention in this video, you can only rinse into your sinuses by tilting your head forward or back significantly. The squeeze bottles like NielMed can be used in any head position. Navage is designed to use with your head upright, which is essentially cleaning the lower nasal cavity and can help with allergy symptoms, but doesn’t clean or deliver meds into the sinuses. It’s also unclear if the suction of the machine might risk causing bleeds while healing from surgery. It’s not a bad product, but you should pick delivery system based on what you need to treat

@@ravinderjohal1088 anyone with hoarseness that persists after a respiratory virus, cough, surgery involving breathing tube, etc should be seen and scoped by an ENT to determine the cause. Treating reflux is usually one aspect of addressing hoarseness, but it may require other interventions depending on the cause of voice changes. In smokers this is particularly important to rule out laryngeal tumors that can affect voice

@@purplelil5450 If you have already tried topical nasal steroid sprays, then my next recommendation would be either nasal rinses with added medications (usually mometasone steroid and azelastine for allergy control) or for those that prefer not to continue using medications I would offer a conservative submucous resection. But I would have to agree that the turbinates are enlarged enough to cause the symptoms prior to offering the procedure. They can be evaluated by nasal endoscopy (prior to spraying decongestant) or by CT Sinus scan. They also enlarge while lying down, and I’ve seen patients where their symptoms were only present while trying to sleep. As long as the submucous resection is done carefully and sized to fit the patients needs, the outcome is improving breathing particularly while lying down at night and usually avoiding the need for nasal steroid sprays/rinses unless needed for control of other inflammatory symptoms.

@@snotdoctx8742 Are many of your patients who undergo submucosal resection often already had previous turbinate reductions using less invasive techniques that didn't work for them hence this approach?

@@purplelil5450 They definitely present like that on a regular basis. The problem with the less invasive techniques - they don’t remove bone well, and soft tissue that is partially reduced can grow back if allergies aren’t well controlled. They get as much relief as anyone from submucous resection with careful bone removal from within the turbinate. This yields a more permanent size reduction and makes them sit to the side of the nasal airway (I.e. makes them more compliant and further from the septum). The result is much better than with less invasive techniques, which I only use if soft tissue growth is the only source of obstruction and the bone has already been removed previously

@@snotdoctx8742 I've had Diathermy first then Radiofrequency coblation, both didn't work due to allergies, but radiofrequency worked for less than a month. My next try would be to try Microdebrider-assisted submucous reduction, is that a good idea? After that I'd try submucos resection

@@karenkrevalis555 It’s been a while since I made a non-educational video…. I’ll see what I can do sometime soon!

@@johnathanmcfadden8978 there’s a lot of clinics doing balloon sinuplasty awake. A simple balloon of a few sinuses is feasible awake without too much discomfort as long as you don’t also have significant septal deviation. The reality is it won’t be pain free, but it is possible to numb the areas so you only feel the numbing process initially, then mostly pressure after that. Hope all goes well, if you get anxious you may want to ask for an anxiety medicine. Helps a lot!

@@snotdoctx8742 Thanks. They did give me 2 Triazolams but still. I just wish they'd do it under general anesthesia for people like me.

There haven’t been any large scale studies, particularly focusing on modern turbinoplasty techniques, that I’m aware of looking at the incidence of ENS. As I’ve mentioned, I haven’t seen it in my patients as far as I aware, and I follow many for years particularly if I’m managing their sinus problems as well. The key to safely improving breathing without risking ENS is to focus on preserving the mucosal lining and remove tissue inside of the turbinates, such as the bone, and only limited soft tissue removal. No procedure is risk free, but luckily the vast majority go according to plan. Nobody should have this surgery unless they really need it to improve quality of life (I.e. failed medication options, allergy control measures, etc).

I’ve seen septoplasty balloons a few times and attempted to use them a few years ago in simple cases. I wasn’t a fan because without an incision you’re just fracturing bone and/or cartilage and hoping they heal in a good position and don’t have any access to remove bulky spurs, apply support sutures, etc. I’m sure fracturing over a deviation will help some patients, but it’s the lack of control over the eventual outcome I didn’t view as acceptable. If a patient only has a posterior septal problem such as a spur and the front of the septum is relatively straight, a limited incision just large enough to remove the spur or posterior deviation can be done in 5-10 min using the endoscopic equipment. The length of a septoplasty procedure depends on how challenging the front of the septum is (where structural support is needed) and how easy it is to raise the skin off the bone or cartilage (can be stuck down after trauma, prior surgery, etc). I use splints applied to the septum for 1-2 weeks when the front portion of the septum is worked on and needs help staying midline while initially healing, but only 20-30% of my patients end up needing those splints. The rest without splints have a slightly easier recovery as the splints can cause pressure and discomfort while in place. Nasal support strips (I’m guessing you’re referring to Breath-right strips on the outside of the nose) might open the nostrils better while the nose is swollen and improve airflow temporarily, but they’re completely optional and would not be advised if a Rhinoplasty was performed and the nasal bones are covered with tape/support already.

Mechanical solutions work best - sleep at an incline, avoid eating 3 hours prior to bedtime, fast as needed solutions for treating reflux such as Pepcid AC and Reflux Gourmet (available on Amazon.com) can be used temporarily, and see a GI doc if that isn’t quickly improving symptoms within a week or two.

Avoid decongesting sprays (Afrin, Sinex, etc), and stick with the topical steroid sprays such as Flonase and Nasonex. If those fail, time for an ENT evaluation to figure out the causes. Using decongestants for any prolonged time will make the problem worsen progressively and make it much more challenging to treat.

I don’t use nasal plugs ever. I use septal splints after septoplasty when the anterior cartilage is repositioned or needs added support temporarily, and dissolvable nasal packing (PosisepX) in the upper portions of the nasal cavities adjacent to the sinuses or in the ethmoids following sinus surgery if I’m worried about bleeding post-op. After routine nasal airway surgery (turbinoplasty with or without septoplasty) no packing is generally needed unless the middle turbinates are also addressed and appear risky for ongoing bleeding. The inferior turbinates respond well to targeted nasal cautery during surgery.

Any problems with your teeth can cause you to clench, grind your teeth at night, and otherwise chew differently in a way that overworks the chewing muscles. Stress can similarly cause this overworking of the chewing muscles. As the muscles get inflamed, they spasm and ache, and the pterygoid muscles transmit some of this pain deep behind the mandible where it is felt as ear pressure/pain and difficulty clearing the ear pressure due to eustachian tube dysfunction. Addressing the dental disease, warm compresses/heat to relax the chewing muscles, NSAIDs (such as Advil, if safe to use) to relieve pain/inflammation, and having a dentist fit a mouthguard to prevent grinding teeth at night can all help relieve these symptoms. If the hearing is dull, have it checked for fluid/ear infection as well.

Thk u so much

That form of nasal obstruction leading to mouth breathing is often responsive to nasal steroid sprays and allergy pills when used regularly. When those fail, nasal airway surgery such as septoplasty and turbinoplasty can reestablish good nasal airflow. Might be time for an ENT evaluation if you’ve had that going on for years!

Best next steps depend on how long your symptoms have been present, what treatments you’ve already tried, and if any imaging (CT Sinus) has been done to help clarify the problem. If this has lasted more than a week I would head to an ENT and be evaluated. Meds often work, and imaging can uncover if your condition warrants surgical intervention should meds fail. Hope you find relief! If you’re near Houston/Woodlands TX we’re happy to help (visit premiersinus.com for info).

Depends on which technique was initially performed and if ongoing control of inflammation with steroid nasal sprays isn’t working. If radiofrequency ablation fails, time to consider a formal turbinoplasty with bone removal for a better result. If a formal turbinoplasty fails (which generally takes a long time if ever), then the bone is already absent from the turbinates and a simpler office procedure to shrink soft tissues should suffice. It’s also important to image or scope the nose and rule out other factors such as sinusitis that can cause congestion symptoms. Any significant septal issues would also need to be addressed if not already done.

What about empty nose syndrome it's a lot of people hurting from past surgerys and another question I believe the nasal turbinates is one of the most important organs what else can we do natural to help breathing 💯

@@goodtimesbeatz6718 Empty nose syndrome is luckily very rare. I haven’t seen anyone develop ENS after turbinate surgery in my career, thus far, and the cases I’ve seen that were seeking help from past aggressive turbinate surgery were obvious over-resection of turbinate tissues, not subtle reductions. The key to prevention is careful resizing, primarily via bone removal or soft tissue only at the bottom of the turbinate, with the ability to “touch up” the results with a cautery tool such as radiofrequency ablation or laser volume reduction should the soft tissues of the turbinates enlarge again.

@@goodtimesbeatz6718 Other than surgical turbinate reduction, the only viable options are for patients to try nasal steroid spray, allergy medications, and possibly allergy shots/drops in the hopes that one day their allergy-related inflammation will be less severe, but none of those are as effective as careful surgery to resize the turbinates, and they often fail to provide any meaningful relief.

@@snotdoctx8742 thanks for information

It can be done in office in some cases, really depends on the extent of sinus problems and if the sinus disease is appropriately managed with the office approach. We use office anesthesia and airway protection similar to a surgery center experience, which allows us to provide the same level of surgical care in our office OR. Not every practice will have that capability, which requires an OR built out, anesthesia cart, surgical instruments previously only seen in surgical facilities, etc. A recent CT would be the best guide to what is causing your symptoms and how to best manage them.

Depending on how much of the nostril/outer portion of the nose is involved in the scarring process, this can be a challenging problem to address. Plastic surgeons are more experienced with the grafting often required for this outside areas, and Rhinologists such as myself are well suited to handle any scarring and stenosis within the nasal cavity beyond the nostril area. I’ve corrected scars and adhesions within the nose, but not this problem specifically. If you’re near an academic center with an ENT department they might be a good bet for achieving a desirable outcome. If you’re in houston or The Woodlands, TX I’m happy to evaluate and see what you would need to correct the problem.

It’s definitely real! There’s also a good test for it - in the clinic, we place a small portion of wet cotton into the nasal cavity where the turbinate would normally restrict airflow just inside of the nostril. If this makes them feel like they’re breathing better, and it’s someone that has had reduction of the turbinates before, then they most likely have some degree of empty nose syndrome even if the nose isn’t crusting or inflamed.

yes doctor thanks for helping peoples . we hope thatbwe meet more doctors like you . because all ents deny it snd throw us to Psychologe doctors . ❤️