By Franklyn R. Gergits MBA, DO, FAOCO
Sinus and Allergy Wellness Center of North Scottsdale
8573 E. Princess Dr. Suite B-111
Scottsdale, AZ 85255
Did you know that just 1 millimeter of reduced swelling inside your nose can feel like “miles” of improvement in breathing, drainage, and sinus function? Just ask any of our patients how they feel a week after our conservative in-office treatment.
When we think of how big a millimeter actually is, let’s compare some common references: one millimeter = 0.0393701 inch. One millimeter is roughly the width of a sharpened pencil tip. The tip of a Crayola® crayon is about 2 millimeters and finally, a pencil eraser width is approximately 5 millimeters. (1)
Millimeters play an important role in our nose and sinuses. Each of us has sinuses above, below, behind, and between our eyes. These sinuses are connected to the nose and are lined with the same mucous membranes that continue all the way down to our lungs. This helps explain why some patients who suffer from asthma, for example, will feel worse when they have sinusitis or allergy flare-ups. The openings into the sinuses, as viewed by us ENT specialists, look like the narrowest part of an hourglass. These openings normally range between 2 and 4 mm in diameter. (2)
Since these areas are covered with specialized mucous membranes, any swelling can cause closure or constriction. The cause of that swelling can include allergies, infection, or exposure to environmental irritants. If the opening to the sinus is occluded (blocked), the sinuses can become inflamed and infected, which leads to bothersome symptoms such as facial pressure, headaches, thick, purulent, discolored drainage, throat pain, and cough.
If the blockage becomes prolonged (recurrent), infection can set in. Chronic inflammation within the body leads to various disease states that can often be debilitating (3), leading to missed days at work, school, and important activities.
At Sinus and Allergy Wellness Center, we evaluate your nose and sinuses in a detailed, comprehensive manner. Patients are asked to complete a sinus and nasal questionnaire which helps us to focus on which problems are the most troubling for you. We use specialized endoscopic equipment for the most thorough exam and we share the findings with you in real time. Our expert evaluation helps pinpoint where your problem is occurring.
Further, a CT scan performed in our office provides us with crucial data that aids in putting the pieces of the sinus puzzle together to form a personalized, tailored treatment plan for resolution of your complex troubles. Our patients appreciate the convenience of having all these services performed at the initial visit.
Our goal at your first visit is for you to clearly understand whether the sinus and nasal pathways are open, closed, narrow, or normal. If the pathways are narrow or closed, we can offer a conservative procedure that is comfortably performed in our office under local anesthesia with mild sedation. Patients typically rate the entire experience as easier than a dental procedure.
For this procedure, we help you to feel less anxious about the “unknown” experience you are about to undergo by providing you with medication in pill form to take before you come in. We then carefully place numbing medication topically inside your nose. This combination helps our patients feel as comfortable as possible.
Once the narrow/closed drainage pathways have been gently expanded to the maximum dilation (opening), patients quickly notice the difference. Since the sinus openings are actually bony and encased in mucous membranes, patients typically will hear soft “popping and cracking” sounds during the procedure which are microfractures expanding the sinus openings. The mucous membrane compression and the small bony microfractures lead to a process called “remodeling” which accounts for the long-term benefits of the sinus procedure.
Nasal breathing also benefits from this procedure. Structures called “turbinates” are located on the inner sidewalls of your nose. Their job is to warm, clean/filter and humidify the air we breathe into our nose. By the time this processed air reaches your lungs, it has been optimized for oxygen delivery and carbon dioxide release. If these turbinates are too large, they inhibit and impair sleep quality, add to sinus and ear problems, and decrease your physical performance potential when you exercise. Just think of how maximized breathing through your nose could change your life in so many ways!
You may ask, “how do turbinates become abnormally enlarged?” This specific abnormality is most commonly due to chronic exposure to allergies, infection/illness, or irritants. Additionally, prolonged use of a topical decongestant such as oxymetazoline (Afrin) can cause “rebound congestion.” Lastly, the way the nose grew and developed can contribute to turbinate obstruction. Often, we will reduce the turbinates at the time of the sinus procedure. After healing, the turbinate size is decreased by 3-7 millimeters. (4)
Another area where millimeters matter is on the nasal septum (the bone and cartilage that divides the nose in half). Septal swell bodies are “turbinate-like” structures typically located along the upper part of the septum. We approach swell body enlargement similar to turbinate enlargement and work to reduce their obstruction in the nose, as well. When these procedures are combined and performed at the same time together, we are able to better open the nose and sinus areas to provide optimal relief and resolution of the blockage–creating additional millimeters of airflow.
Although a millimeter seems small, when we are able to combine the “millimeter gain” in various areas within the nasal and sinus passages, these small changes add up to huge benefits.
If you suffer with nasal congestion, poor sleep, decreased exercise/physical performance, sinus troubles, excessive nasal drainage, or facial pressure/head pain, give us a call at 602-492-2312 or visit our website at SinusAZ.com to schedule an appointment where we can explore your nasal/sinus anatomy and determine the best plan to resolve your troubles and let you begin a new day with those precious additional millimeters!
(1) How Big is a Millimeter? www.cancer.gov
(2) Paranasal Sinus Anatomy: What the Surgeon Needs to Know, Abdulmalik S Alsaied. Paranasal Sinuses, Published June 14, 2017.
(3) “Can Sinus Infections Cause Cancer?” , SAWC Blog, December 22, 2022. FRG
(4) In-Office estimated data