Why our patients love the SNOT20

Although not part of the normal coffee shop discussion, most of us ear nose and throat physicians find humor in the name Snot 20. This refers to a questionnaire that our patients, suffering from sinus and nasal problems, complete before and after treatment. They like it so much, that we put an interactive version of this questionnaire on our website (www.nscaustin.com) so that those suffering from sinus and nasal problems can put a number to their suffering! The acronym stands for the sinonasal outcome test, which makes sense, but this naming was clearly manipulated for humor. The purpose of this test is to try to numerically evaluate the severity of the sinus and nasal problems. Fortunately, the test seems to correlate very well, and is a wonderful way for us to measure how bad you feel and how much better you feel after we fix the problem. Our patients have always been extremely appreciative after we fix problems that have often been present for many years. However, we were unable to put a number to this improvement. With the SNOT 20, we can not only better understand our individual patients, we can now look at a broad cross-section of our patients to better understand trends. As we have more patients taking the questionnaires, we will also be able to accumulate data which will help future patients decide which course of therapy they would like to pursue. This is a very exciting time in our field with our new ability to fix sinus and nasal problems surgically in the office with minimal downtime. Our patients see the value of the therapy, and now we can begin to show them numerically, how much improvement they, and other patients like them, are enjoying. Christopher Thompson, MD

Not all congestion is Allergies

Look at any list of allergy capitals the US, and Texas will always be well represented. Surprisingly, not all nasal congestion is caused by seasonal allergies. More than half of the patients that I treat with self-diagnosed allergies actually have another diagnosis causing their nasal complaints. Most patients with typical seasonal allergies will have absolutely no nasal complaints except when their particular allergen is present. Cedar, which is pollinating now, is probably one of the worst central Texas allergens. Most patients will complain of itchy eyes, watery eyes, sneezing, clear nasal congestion, and nasal obstruction from nasal inflammation. When cedar season is over, patients with cedar allergies should have complete resolution of their symptoms. Many patients complain of nasal and sinus symptoms year-round. It is still possible that allergies to mold and dust will give the symptoms, but more commonly it is for other reasons. Patients who have unilateral nasal obstruction year-round most frequently have a nasal septal deviation which can be resolved with a simple 20 minute procedure. Patients with year-round congestion and postnasal drainage more frequently have chronic sinonasal inflammation or infection that has been undiagnosed. The correct diagnosis and proper medical therapy or balloon Sinuplasty will typically resolve these problems. Many adults will become “addicted” to topical nasal decongestants. These medications decongest the nasal turbinates, but over time have the opposite effect. Turbinate enlargement for any reason, to include allergies, can be resolved with a brief clinic procedure allowing patients to stop using oral and topical decongestants altogether as well as decrease allergy medication use. Patients that snore and have mouth breathing at night often have one or more of the above problems. Children most commonly have adenoid enlargement at the back of the nose which causes nasal obstruction, congestion, and loud breathing or restless sleep. If your child is “not responding” to allergy medications, she probably does not have allergies. Adenoidectomy will allow your child to breathe easy and sleep sound. Even if you have had positive allergy testing, a brief visit with the otolaryngologist will often times uncover diagnoses that can be permanently corrected with simple procedures alleviating long-term nasal congestion and nasal obstruction complaints. Zachary Wassmuth, MD