Nose

While all of these may share some common symptoms, the cause and treatment for each is different.  A sensation of nasal or sinus congestion, runny nose, yellow or green drainage, loss of smell, loss of taste, post-nasal drip, morning/nighttime cough, sore throat, drainage from the tear ducts, pain behind the eyes, feeling of fullness in the ears, distorted hearing, dizziness, itching in the ears or nose, sore throat, tickle in throat, headache, facial pain, jaw pain, nasal sores, fatigue.....any one of these symptoms can be uncomfortable and a source of aggravation, but suffering from sinusitis, rhinitis, allergies, or the common cold typically leaves you struggling to manage several of the symptoms at the same time, and affecting your normal daily living.  

Dr. Brill can evaluate your symptoms, perform an examination, and provide you with a treatment plan to provide quick relief of your most bothersome symptoms and treatment options to resolve your illness.

Sneezing is an involuntary response from our immune system in an attempt to quickly and forcefully expel irritants from the airway.  Airborne bacteria and viruses as well as allergens and other irritants can trigger this reaction and is our next line of defense when the body detects that an invader has made it past the filter consisting of hair and mucous in our nasal passages.  

Sneezing may occur at the onset of a cold (Infectious Rhinitis), or as a result of Allergic Rhinitis, also known as Hay Fever.  Although both Infectious and Allergic Rhinitis share many symptoms, A cold is a viral infection and will often present with yellow or green drainage indicating infection.  You may experience  a persistent cough, a fever, fatigue, general aches and pains with a cold.  Your body is typically able to recover naturally within a week.  Antibiotics are not effective, but there are many over the counter medications as well as prescription medications that will assist in reducing symptoms.  Infectious Rhinitis (common cold) is an airborne respiratory viral infection and is therefore extremely contagious.  You should stay home while experiencing symptoms to avoid exposing others to the virus, and to avoid potentially exposing your own immune system to other pathogens that your body may not be able to ward off efficiently while your immune system is already compromised.

Allergic Rhinitis (Hay Fever) will usually be accompanied by an itchy sensation in the nose, eyes, ears, and/or throat, headache, sinus pain or pressure, dark circles under the eyes (Allergy Shiners), watery eyes, throat irritation or dryness, and wheezing.  Your body releases histamine during an allergic reaction, so histamine blocking allergy medication (antihistamines) can be very effective in treating and preventing symptoms of Hay Fever.  Corticosteroid nasal sprays are effective in reducing symptoms caused by inflammation and excess mucous production.  Many of these allergy medications are now available over the counter, but if symptoms persist then prescription medications may be required.

Congestion is the uncomfortable feeling of stuffiness and restricted breathing common with sinusitis, rhinitis, and allergies, but may be a symptom or result of other disease as well.  Congestion may be caused by an increase in the amount of mucous your body produces as it fights infection or allergens, or may be a "dry" congestion caused simply by inflammation of the nasal passage and sinuses.  

Congestion may be felt not only in the airway, but up thru the ears, behind the eyes and in the tear ducts, and in the top teeth.  It may be the primary cause of headache and facial pain as the pressure from the  airway and sinus cavities fill with mucous and inflamed tissue.  

Although decongestants and anti-inflammatory medications may help provide immediate relief of congestion, finding and treating the cause of the congestion is important to resolving the symptoms and avoiding recurrence.  

Rhinitis, or inflammation of the nasal tissue, will typically cause a clear drainage from the nasal passages.  Normal drainage is clear or white and thick when responding to an infection or irritant.  Drainage that is yellow signifies a bacterial infection, while green may indicate a severe bacterial or viral infection.  Dark colored drainage is not uncommon after exposure to a pollutant such as smoke or dust, but persistent dark colored drainage could indicate blood or a fungal infection and should be evaluated if clarity does not improve with continued drainage. Identifying the type and cause of drainage is important in identifying the most appropriate course of treatment.  

Post-nasal drip occurs when your body produces excess mucous due to irritants or rapid weather changes, causing drainage from your nasal or sinus cavities to accumulate in the back of the throat, usually while sleeping.  This accumulation often causes a feeling of irritation, sore throat, or cough (typical in the mornings).  

The nasal septum, the internal vertical cartilage that gives your nose structure and shape) influences more than just the appearance of your nose.  It is the framework for providing an open airway to your lungs.  A deviation describes when the septum is slanted to the right or left or has multiple curves, typically due to trauma to the nose.  A nasal fracture will typically result in a septal deviation that is visible externally, but less traumatic blows or injury can also result in a deviation that is not noticeable from the outward appearance of the nose but can still result in the same effects on your health.  A significant enough deviation may restrict airflow on one or both sides of the nose.  It also affects the size and shape of the nasal airway which may reduce the ability of hair and mucous in the nose to filter and trap dust, germs, and allergens from entering further into your airway, sinuses, and lungs.  A deviation may also prevent normal drainage of the mucous and sinus cavities, thereby collecting any foreign materials that may have been breathed in and allowing them to remain and proceed further into your body where they cause inflammation and infection.

A deviated septum can be easily diagnosed upon examination and confirmed with a simple CT scan.  Treatment begins with medications and anti-inflammatory nasal treatments to reduce symptoms.  Many people find this level of treatment effective, but for severe deviation or chronic infections, only a Septoplasty that provides a correction of the physical deviation, a procedure performed in an outpatient setting, will provide relief.

For those with a recent or history of nasal fracture, correction of the deviated septum is typically performed along with reduction of nasal fracture.  These procedures do not usually provide correction to the outward appearance of the nose, but may straighten the nose and/or reduce any "hump" that may have been caused by the fracture depending on the nature of the fracture and your anatomical structure.  

Nasal Septal Perforation describes a hole in the septum, similarly affecting breathing by reducing airflow, causing inflammation, pain, sinus infection, epistaxis (nosebleeds), excessive  drainage, crusting, and oftentimes a "whistling" sound with breathing.  Perforations are areas of tissue death caused by trauma, exposure to chemicals, cocaine use, surgical complication, excessive nose picking, recurring sores, infections, or cancer.

Blowing your nose and seeing blood on the tissue may be a bit alarming, but having uncontrollable bleeding from the nose can be an unnerving experience.   

Small amounts of blood may be from a sore or small internal injury, but large amounts of blood that require more than one tissue could indicate a more significant injury, busted blood vessel on the nasal septum or in the nasal or sinus cavity.  This type of nosebleed is usually easily controlled with some tissue inserted in the nose and pressure application.  

Other type of nose bleeds originate from larger blood vessels in the back of the nose and can pose a problem by draining blood down the throat.  You should be seen right away if you have bleeding that will not stop with nasal packing using facial tissue tissue and 20 minutes of applied pressure.

Some nose bleeds may require cauterization of the vessel in the office, and more extensive treatment may be required in the operating room.

Our sense of smell is an evolutionary development for our survival.  An odor can alert us of food that has spoiled, dangerous gasses, and fire.  It can also lead us to food and water, and subconsciously affect our romantic relationship choices.  

Loss of smell, or anosmia, can affect nutrition by affecting interest in food, lack of interest in social engagement (such as sharing meals), and lead to depression and affect quality of life.  Temporary loss of smell can indicate infection, and usually resolves on its own, but persistent lack of the sense of smell can be an indicator of a more significant medical condition such as hormonal or thyroid abnormality, or neural damage from Alzheimer's, Parkinson's disease, or stroke.  

Persistent lack of smell should be discussed with your doctor to identify the cause and rule out other health issues.

Nasal lesions can range from simple skin irritation from blowing your nose when you have a cold  to cancer of the nose.  Symptoms can include visible lesions or sores, inflammation/swelling, tenderness, pain, nasal discharge or crusting, difficulty breathing, and epistaxis (nosebleeds).

Nasal polyps, benign teardrop shaped growths, may obstruct breathing but typically have no other symptoms.  Some medications can shrink polyps, but surgical excision may be necessary.  Polyps are likely to continue to recur, even after successful treatment.  

Most lesions will clear on their own as long as they are kept clean and left to heal.  Non-healing lesions, intranasal lesions that interfere with breathing, severely painful lesions, or lesions that frequently bleed or drain yellow or green fluid or material should be examined for appropriate treatment to avoid further complication.  

Any lesion removed in our office or during surgery will be sent for biopsy.  As a Board Certified Facial Plastic and Reconstructive Surgeon, skin cancer of the nose can be excised and expertly repaired/reconstructed by Dr. Brill.  He has many years of experience with repair of cancer defects including Mohs closures (repair of the large, deep layer holes left after a Mohs excision of skin cancer-excision is typically performed by a dermatologist and then repaired by a plastic surgeon.)

Foreign bodies may lodge in the nose and require assistance in removal.  Many times beads, small toys, and food are inserted in the nose by younger patients under the age of 5.  Children of this ager are often not yet capable of blowing their own nose to dislodge foreign objects.  The nasal passage is much smaller in young children and the object itself combined with any attempt to retrieve the object will likely cause irritation and inflammation, further increasing the difficulty of retrieving the foreign object.  

Adults will sometimes inadvertently inhale material or matter that will lodge in the nasal passage.  Irritation, pain, and drainage are indicators that a foreign object or material may be in the nose.  

A special microscope and tools are readily available in the office for removal of foreign bodies of the nose.  Younger children or patients who find the removal attempt in office to be intolerable may require excision under a form of anesthesia in an outpatient setting.

Rhinophyma is an inflammatory condition of the nose associated with Rosacea. The inflammation causes an enlarged, red, bulbous (bulb shaped) nose with a bumpy, crusty, and waxy surface with large visibly expanded pores and capillaries. Because the symptoms are so visible and cannot be concealed the conditions tends to not only affect quality of life and social interactions, but mental health as well. The inflammation and expanded tissue can also cause nasal and airway obstruction. 

The condition continues to progress and will not resolve on its own. Some treatments to reduce the redness and inflammation include prescription topical creams, such as retinol, to promote shedding of the upper layer of of the dermis and allow for the release of excess oil from the sebaceous glands. CO2 Laser therapy and deep, physician grade TCA chemical peels can provide significant improvement, but a surgical procedure may be required for correction.  Corrective procedures are often covered by insurance policies as medically necessary.