F.A.Q. – Sinus Health & You
1. Where will my surgery with Dr. Bennett be performed and what can I expect on the day of surgery?
2. What is recovery like after nasal or sinus surgery?
3. Will smoking affect my recovery after nose or sinus surgery?
4. How do I know if I am healthy enough to undergo surgery?
5. How long is the procedure?
6. Should I take time off from work following my procedure?
7. When can I start exercising again?
8. Will Dr. Bennett perform more than one surgery in addition to my sinuplasty or rhinoplasty?
9. How long must I wait after my initial consultation until my surgery is performed?
10. Will my health insurance cover my rhinoplasty or sinuplasty?
11. What is a deviated septum?
12. What is a nasal value?
13. What is a nasal turbinate?
14. Does a deviated septum change the way my nose looks?
15. How do I know if my septum is deviated?
16. What is the cause of my difficulty in breathing?
17. Is my congestion a result of a deviated septum or merely allergies?
18. What forms of treatment exist for a deviated septum?
19. What is a septoplasty?
20. What is a revision septoplasty?
21. What is turbinate surgery?
22. What is a nasal fracture?
23. When should I seek treatment for a broken nose?
24. How will Dr. Bennett diagnose a broken nose?
25. What forms of treatment are available to repair a broken nose?
Dr. Bennett performs sinus and nasal surgery at either a Hospital or more likely at a Private Ambulatory Surgery Center. The hospital is Lenox Hill Hospital or the Manhattan Eye, Ear and Throat Hospital. He will also perform surgery at one of two state-of-the-art Upper or Lower East Side ambulatory facilities, Midtown Surgery Center or Gramercy Surgery Center. Regardless of the location, the process on the day of surgery is identical. You will be required to bring a chaperone with you, and you both should arrive approximately one hour before the surgery begins. You will also meet with a nurse, who will ask you about your medical history, give you a hospital gown to change into, and make sure your clothes and other belongings are safely stored.
Dr. Bennett will meet with you briefly before the surgery to ease your nerves and go over the plan you created together. Afterwards, the board certified anesthesiologist will meet with you to discuss your medical and anesthesia history. You will be taken into the operating room and be administered anesthesia. After surgery, you will awake in the recovery room. Dr. Bennett will speak with you again before you leave and explain how the surgery went. About an hour later, you will be permitted to leave the hospital or ambulatory surgery center with your chaperone.
After you wake up from surgery, you will feel a bit disoriented for an hour or so. If you had the shape of your nose changed, you will notice a small, plastic sprint over your nose. Dr. Bennett places this to protect you from hitting the nose and the bones from moving while they are healing. You will likely have no packing in your nose. Dr. Bennett’s surgical technique rarely requires packing the nose to stop bleeding. This means that you should be feeling back to your old self in no time.
If you notice a slight headache the first couple of days, do not be alarmed. This is normal. If you experience any other pain or discomfort, you can either take the pain medication prescribed to you by Dr. Bennett, or use an over-the-counter pain medication like Tylenol. Avoid ibuprofen and other non-steroidal pain medications as they can make it hard for you to stop bleeding.
You will also be instructed to clean any fluid that may drain from your nose using Q-tips an hydrogen peroxide. You may experience a small amount of bleeding from the nose also, but do not worry, this is also normal. Simply tape the dressings under your nose that Dr. Bennett’s office staff provided you at the end of your surgery, and then change the dressing when it becomes dirty. Dr. Bennett will provide you with a “care package” that has everything you need to treat your nose after surgery including saline rinses, dressings and tape, hydrogen peroxide, oxymetazoline for nosebleeds, etc.
Congestion is a common symptom experienced by nose and sinus surgery patients. There is not much but time that will make it better until you see the doctor at one week after surgery. You may have swelling and bruising around the eyes and nose as well, but as the days and weeks go by, the swelling will decrease and you should feel less and less congestion. Remember not to blow your nose until your doctor tells you its OK so as not to cause any unnecessary trauma.
You will return to the office one week after surgery so that Dr. Bennett can assess how your healing has progressed. He will also remind you to continue to avoid strenuous exercise for three weeks and, if your nasal bones were broken, to avoid wearing glasses for six weeks.
Yes, smoking will negatively affect the way your nose heals after sinus surgery. The nicotine contained in cigarettes acts as a vasoconstrictor, meaning that it will decrease the blood supply to your nose and reduce the healing factors brought to the tissue. Without enough blood flow, your nose will not heal as quickly as if you had stopped smoking. Smoking will also drastically increase the chances of infection, crusting, and scarring, which could lead to the need for additional surgery. Note that it is the nicotine in the cigarette smoke as well as the harmful bi-products of the smoke that prevent healing. You should also avoid using the nicotine patch and gum as well. Many surgeons will refuse to operate on patients who are actively smoking.
Before you undergo surgery, you are required to have a thorough physical exam, to make sure that you are healthy enough for surgery. You may require blood labs, a chest X-ray, an EKG or other tests if you have pre-existing conditions. Generally, you will see your primary care physician or pediatrician for a physical. The goal of the testing and physical examination is to decrease the risk of surgery by making sure you are healthy enough for surgery. Everybody involved wants you to be as safe as possible during your procedure.
When undergoing a rhinoplasty or sinus surgery, the length of the procedure varies. Some patients require additional procedures along with a rhinoplasty or sinuplasty. A typical sinus procedure lasts anywhere from about two hours, but can take as little as a half an hour, or as long as four hours.
During your consultation, Dr. Bennett will be sure to explain which procedures are in your best interest, as well as the length of time it will take to complete all procedures.
It depends. Dr. Bennett recommends that patients most patients take one week off from work in order to get the proper amount of rest required after sinus or nasal surgery. Depending upon the nature of your job (i.e. if it requires strenuous physical activity or manual labor, or you work in a dusty or dirty environment) you might be better taking 2 weeks or more off from work, in order not to disturb the delicate healing process which must take place following your procedure.
The majority of Dr. Bennett’s patients are back to work within one week of surgery.
Dr. Bennett reminds patients NOT to exercise for two weeks following a rhinoplasty or sinuplasty procedure. Strenuous activity can seriously damage your newly-healed nose – causing excess bleeding, swelling and bruising. After a few days, some light activity is okay – like walking. However, you must wait at least two weeks and probably three before your next yoga, spin or aerobics class. If you compete in contact sports such as hockey or football, and your nasal bones were broken during surgery, you should wait six weeks before resuming these activities to let the nasal bones heal.
Yes. In fact, Dr. Bennett prefers to combine procedures. It not only saves patients money, since you do not have to pay double the fees for anesthesia and the operating room, but it also minimizes your downtime, since you only have to go through one recovery period. Common procedures that are performed together are sinus surgery, deviated septum surgery, rhinoplasty, inferior turbinate reduction, and repair of nasal valve collapse.
It depends. Normally, Dr. Bennett is able to schedule you within a few weeks after you decide to move forward with surgery. So long as you are in agreement about the goals of surgery and your physical exam clears you as a healthy candidate for surgery. Much of the time, the slowest part of the preparation process for surgery is your insurance approving your procedure for the surgeon’s office and the surgery center.This can and frequently does take ten days to two weeks and in some cases, longer.
Dr. Bennett and his staff pride themselves on offering the most advanced nasal and sinus surgeries at a price that fits your lifestyle and budget.
Dr. Bennett accepts most insurance coverage as an out-of-network provider, and Meaghan, his Office Manager, acts as a liaison to make sure you receive the maximum coverage. If Dr. Bennett determines that your procedure is medically necessary, such as the result of a past nasal trauma (i.e. a broken nose), a large portion of the total cost may be covered. Cosmetic surgery is not generally covered by insurance.
Insurance coverage varies from patient to patient. Our office will contact your insurance company to determine your benefits for you so there are no surprises. We understand your insurance and will let you know what you can expect to pay for your office visit before your initial consultation.
There is no such thing as a perfectly straight nasal septum. The nasal septum is a piece of cartilage and bone covered with mucosal tissue that separates the nose into a left and a right cavity. The condition of a “deviated septum” is when the twisting or bending of the septal bone and cartilage is severe enough to cause symptoms such as difficulty breathing through the nose. A deviated septum may be from trauma, from the birth canal, genetic from a parent, or the reason may not be known. A deviated septum may also cause snoring, sleep apnea, and sinus infections. Patients with a deviated septum which is symptomatic and has not responded to appropriate medical management may require a septoplasty to correct the problem.
There are two nasal valves on each side of the nose called the internal and external valves.
The internal nasal valve is the area where the septum and nasal cartilage meet under the nasal bones. It is the narrowest part of the nose, making it the area the most sensitive to congestion . Some internal valves are especially narrow, caused by a deviated septum or collapse of the cartilage into the airway. This can be corrected by placing “spreader grafts” to lift the cartilage away from the septum.
An external nasal valve can really be thought of as the floor of the nose with the lateral and middle part of the nostril. External valve collapse occurs when the nostrils collapse when breathing inward due to lack of support in the area above and at the edge of the nostril. Cartilage can be placed in the lateral nostril to “stiffen” the external valve.
If you pull on your cheek a lot to help you breathe then you may have nasal valve collapse.
The nasal turbinates are the tissues that surround the nose. There are three types: inferior, middle and superior turbinates. They primarily consist of bone and tissue, and are lined with a mucous membrane. The outer membrane of the turbinates works as a filtration system: they clean the germs and other debris from the air and also work to humidify and warm the air once it passes into the nose.
Signs of congestion and difficulty breathing typically mean that there is a problem with the inferior turbinate. The inferior turbinate is the largest of the three and is located from the front to the back of the nasal airway along the floor. This turbinate can also increase in size based on certain conditions, including infection, allergies and sharp changes in temperature. An enlarged turbinate can obstruct the airway and will cause difficulty breathing through the nose especially when lying down. The middle turbinate can also be enlarged and can block the airway or sinuses and may predispose you to sinus infections. Turbinate reduction surgery may be performed as a course of treatment for this condition to allow for proper drainage and normal breathing.
An internally deviated septum that does not deviate near the outer surfaces of the nose will not affect the outward appearance of the nose, and many people do not realize that their septum is deviated since their nose looks symmetrical.
However, if the septum is deviated near the outer surface of the nose, then there may be deviation of the outside of the nose. A tip that is crooked to one side may be due to a septum that is fractured to the other side of the nose along the floor of the nose. A nose that is crooked from the front may have a severely deviated septum that causes the outside of the nose to twist. These septums are the most difficult to straighten and may require more extensive surgery. Straightening of these septums will change the shape of the nose and you may want to consider an otolaryngologist with additional training in facial plastic surgery.
First, you need to have symptoms of a deviated septum. Usually this means trouble breathing from one or both sides of the nose but a deviated septum can also cause sleep apnea or sinusitis. During your examination, Dr. Bennett will use a headlight and nasal speculum to observe inside your nose. He will be able to determine if your nasal septum is deviated. Many times he is able to show you the deviation with a mirror. There can be other causes of obstruction observed like nasal polyps, inferior turbinate hypertrophy, or sinusitis. An endoscope may be used as well at the visit to look deeper inside your nose. You should never need radiology imaging to diagnose a deviated septum.
Feeling congested and having difficulty breathing could be due to many different factors. Most commonly, patients with allergies report these symptoms. You may also have a common cold or sinusitis but you expect to have additional symptoms like facial pressure and nasal discharge. You may have a more permanent structural obstruction as well from a deviated septum, inferior turbinate hypertrophy or valve collapse. If you have had previous surgery you need to consider scarring inside the nose as well. Growths inside the nose, like nasal polyps and adenoid hypertrophy can decrease your ability to breathe.
If your breathing is disrupting your quality of life then you may want to have a thorough evaluation. During your consultation with Dr. Bennett, he will perform a comprehensive exam to determine the most likely problem, and create a strategy for easing for your symptoms.
Allergies are a common condition in the United States, affecting over 150 million Americans. The most common allergies that patients’ suffer include mold, trees, grass, pollen, dust and pet dander. Treatment for allergies may take the form of environmental controls, nasal steroids, and antihistamines. You may also benefit from allergy shots, often called immunotherapy.
To determine whether your nasal congestion stems from a deviated septum or allergies. You may require allergy testing in addition to nasal and endoscopic examination. Note that some forms of congestion can be the result of both a deviated septum and allergies. After appropriately determining the cause of your nasal obstruction, Dr. Bennett works with you to develop a customized treatment plan tailored to your needs.
The three most popular methods of treating a deviated septum are environmental controls, medication and surgery, and sometimes a combination of all three. The form of treatment that is best for you depends on how severe your symptoms are, in conjunction with the degree of septal deviation.
Environmental controls involve removing allergens from your environment that may be causing you to have congestion. A HEPA (High Efficiency Air Particulate) purifier is never a bad idea. Its a lot harder to get rid of pets but removing carpeting and washing bedding and pillows frequently will make a difference. Rinsing the nose with saline daily can help decrease congestion as well.
Medication is a popular treatment method for those with only minor to moderate symptoms, and include the use of antihistamines, decongestants and steroid nasal sprays. In addition, there are other medications that can make you feel congested. Make sure to tell your doctor what you are taking so they can let you know about potential congestion side-effects.
Surgery is an option for those with more severe symptoms, or if the medication route has shown little improvement in symptoms. A septoplasty is typically the procedure used to treat a deviated septum.
A septoplasty is a form of surgery that corrects a deviated nasal septum. Generally, no external incisions are required to perform the procedure, as the surgeon typically works entirely with incisions inside the nose. For more complex deviated nasal septums a small incision may be required across the thin are under the nasal tip.
To repair the septum, the surgeon readjusts, removes or repositions the bone and cartilage that is causing the shift in the septum. The technique used depends heavily on each individual patient and the severity of the deviation.
Some patients may have persistent nasal and sinus symptoms after deviated septum surgery. The nasal septum has elasticity and in some cases after septoplasty will shift back into the airway and obstruct breathing. Sutures to hold the septum in place can also break or the nose may be bumped during healing which can deviate the septum .This can occur up to 10% of the time and is very frustrating for both the patient and the surgeon. A revision septoplasty is another septoplasty procedure to restraighten the septum after the primary procedure.
Turbinate surgery is a procedure that reduces the size of the inferior nasal turbinates. It is also sometimes referred to as turbinoplasty. Like septoplasty, it is another procedure that is often combined with other nasal surgeries, such as rhinoplasty.
There are many methods of inferior turbinate reduction. During the procedure, the turbinate outer tissue as well as some of the bone inside the turbinate may be removed which decreases the turbinate size. Another method is to fracture the inferior turbinate away from the septum to increase the area for air to flow inside the nose. Other methods use electricity to shink the covering of the turbinate. A laser can also be used to burn channels into the outside of the turbinate which decreases in size during healing. A combination of these techniques can be used as well.
Turbinate reduction surgery does not require exterior incisions. Following surgery, if the turbinates regrow, which can occur in some patients, an additional inferior turbinate reduction surgery may be needed. Complete removal of the inferior turbinates has a high risk of “empty nose syndrome” which feels like no air is going thru the nose even though it is wide open. Complete inferior turbinate removal is not recommended in most cases.
Simply put, a nasal fracture is a broken nose. A broken nose means that the interior nasal bones have been fractured. Often times, the cartilage or nasal septum also suffers trauma in nasal fracture cases. The most common patients who suffer nasal fractures are those who engage in contact sports or have suffered an assault or vehicle accident.
If you suspect you may have a broken nose, look for the following symptoms:
- The outward appearance of the nose appears twisted or deformed.
- Bleeding of the nose.
- You notice bruising and swelling of the nose.
- Your nose feels tender, especially near the bridge.
- You have one, or two black eyes, or the eyes are bruised.
If you have a change in the shape of your nose or you are having difficulty breathing then you should contact a facial plastic surgeon. If your nose looks the same and your breathing is normal then you should only seek emergency medical attention if you lost consciousness or had some other sort of injury. Non-displaced nasal fractures heal well without treatment. You should not need an X-ray or a CT scan just to tell you the bones are broken. An emergency room or clinic will just tell you what your already probably know, that your nose is broken, but they almost never will fix the fracture and will most likely refer you to someone else. You have up to 2 weeks to have a surgeon press the nose back into shape with a very limited procedure that can be done in the office. If you wait over 2 weeks then you need to wait 2 months until the bones heal and have a much more involved, and expensive, rhinoplasty. Some surgeons, including Dr. Bennett, will be able to reduce the fractured nose and have it looking back to normal within a few weeks of the accident.
In diagnosing a broken nose, Dr. Bennett will inquire about the details of your accident or sports injury, as well as ask you to describe your nose before the incident. If you have a frontal or lateral photograph from before the trauma that is helpful.
Dr. Bennett also performs a physical exam to review the condition of the nasal septum, cartilage, nasal bones and mucus membranes. If the nose has a new twist at the bones, and there is pain over the nasal bones to palpation, then your nose is most likely broken and the bones have been moved from their normal position.
A broken nose that has not changed shape needs no treatment. Leaving it alone and not rebreaking it are all that is needed besides time to make it h The most common treatment for a nasal fracture is a closed reduction of the nasal fracture. The nose is decongested and medicine is injected to decrease pain. The bones are then reshaped and re-positioned through the inside and outside of the nose with no incisions. You can elect to have local or general anesthesia, depending upon your and your surgeon’s preference. If the nose is severely deviated or the septum is badly fractured then it may be in your best interest to go to the operating room for a more extensive surgery. After surgery, Dr. Bennett places a splint-like cast over the nose to protect it and assist the healing process. You will wear the splint for approximately one week, after which Dr. Bennett will remove it during your follow-up appointment. The bones will take about 6 weeks to heal after a fracture.
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