Procedure-Based Treatment of Allergy Symptoms

One of the benefits for seeing an ENT doctor for allergies is that we have the capability to treat allergies and allergy symptoms with both medication as well as procedures.  Some patients may benefit from a procedure if he or she only has one main symptom, such as nasal drainage, sinus pressure, or nasal congestion.  It may be better for patients to undergo a short in-office procedure under these circumstances rather than being on allergy medications for the rest of their lives.  There are now several new therapies that can be performed in the ENT doctor's office which are very effective:

  • For nasal congestion: 
    • Turbinate reductions:  This in-office procedure utilized heat to shrink the inferior turbinates so that patients can breath much better.  After the nose is anesthetized using topical lidocaine spray, a heat wand is inserted into the inferior turbinates to heat shrink them.  The inferior turbinates are structures inside the nose that frequently swells and shrinks down.  As a result, some patients complain of alternating nasal congestion from one nostril to the other.  This procedure shrinks them down so that even when they do swell they do not cause complete blockage of the nasal airflow.  The procedure has minimal discomfort and is well tolerated and takes about 15 minutes to perform.  There is no significant complication associated with this technique.
  • For nasal drainage/post nasal drip:
    • Patients who have a persistent runny nose even after medical therapy may benefit from a new procedure recently FDA approved in 2017 which used liquid nitrogen (cold) inside the nose to help stop the post nasal drainage/nasal drip.  A small probe with a liquid nitrogen tip is placed inside the nose along a small area along the nasal sidewall where the nerves which controls nasal dripping (rhinorrhea) is located.  he cold is applied in this area for a few seconds stunning the nerve and "resetting" it so that it no longer causes excessive nasal drainage.  This procedure takes a few seconds on each side and is well tolerated in the clinic.  There is also no significant complication associated with this technique.  
    • Patients who have had sinus surgery and still has significant running of the nose may benefit from an in-office placed dissolvable steroid stent.  The benefit of the steroid stent is that it is placed directly where it is needed rather than taking an oral steroid.  The localized placement decreases the medication risk and complications associated with oral steroids.  As it is dissolving, it elutes a higher concentration of steroids on a regular, consistent basis, which differs from nasal steroid sprays.  It is also very effective in eliminating nasal polyps.
  • Popping/crackling of the ears:
    • Swelling from allergies can frequently cause the tube that connects the ears to the nose to swell which results in the crackling/popping sensation and decreased hearing in the ears.  If medications cannot control this, a small balloon can be placed into the tube in an in-office setting to dilate the tube.  The balloon is then removed.  There is minimal discomfort associated to the procedure.  Total procedure time is bout 15 minutes.  No significant complications associated with this procedure as well.
  • Sinus pressure/facial pain/sinus inflammation:
    • Sinus balloon dilation can be very effective in those patients with facial pressure/pain associated with changes in the weather (barometric pressure) or changes in altitude (such as on a plane).  Sinus inflammation can also be improved by dilating the opening of the sinuses to permit better sinus air flow and sinus drainage.  The dilation also helps get nasal spray medications into the sinuses better.  This is also an in-office procedure which takes approximately 30 minutes to do and is much safer than traditional operating room based sinus surgery.