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If you sneeze a lot, if your nose is often runny or stuffy, or if your eyes, mouth or nose often feel itchy, you may have allergic rhinitis, a condition that affects 40 million to 60 million Americans.
Allergic rhinitis develops when the body’s immune system becomes sensitized and overreacts to something in the environment that typically causes no problem in most people.
Allergic rhinitis is commonly known as hay fever. But you don’t have to be exposed to hay to have symptoms. And contrary to what the name suggests, you don’t have to have a fever to have hay fever
Allergic rhinitis takes two different forms:
Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also nonallergic causes for rhinitis including irritants such as cigarette or other smoke, perfumes, cleaning products and other strong odors.
Hay Fever Symptoms
Hay Fever Triggers
Hay Fever Management and Treatment
Avoid triggers by making changes to your home and to your behavior.
Diagnosing
To find the most effective way to treat allergic rhinitis symptoms, see an allergist Your allergist may start by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked, among other things, about your work and home environments (including whether you have a pet) your family’s medical history and the frequency and severity of your symptoms.
Sometimes allergic rhinitis can be complicated by several medical conditions, such as a deviated septum (curvature of the bone and cartilage that separate the nostrils) or nasal polyps (abnormal growths inside the nose and sinuses). Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist and another specialist, such as an otolaryngologist (ear, nose and throat specialist).
Your allergist may recommend a skin test, in which small amounts of suspected allergens are introduced into your skin. Skin testing is the easiest, most sensitive and generally least expensive way of identifying allergens.
Types of skin tests
Management and Treatment
Avoidance
The first approach in managing seasonal or perennial forms of hay fever should be to avoid the allergens that trigger symptoms. Outdoor exposure
Exposure to pets
Medications
Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them. If your symptoms can’t be well-controlled by simply avoiding triggers, your allergist may recommend medications that reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms — oral tablets, liquid medication, nasal sprays and eyedrops. Some medications may have side effects, so discuss these treatments with your allergist.
Intranasal corticosteroids
Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce
nasal congestion as well as sneezing, itching and a runny nose.
Talk with your allergist about whether these medications are appropriate and safe for you. These sprays are designed to avoid the side effects that may occur from steroids that are taken by mouth or injection. Take care not to spray the medication against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding. Some older preparations have been shown to have some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth.
Antihistamines
Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup. Antihistamines help to relieve nasal allergy symptoms such as:
There are dozens of antihistamines; some are available over the counter, while others require a prescription. Patients respond to them in a wide variety of ways.
Generally, the newer (second-generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time. If you find that an antihistamine is becoming less effective, tell your allergist, who may recommend a different type or strength of antihistamine. If you have excessive nasal dryness or thick nasal mucus, consult an allergist before taking antihistamines. Contact your allergist for advice if an antihistamine causes drowsiness or other side effects.
Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours. The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications. Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might have been effective.
Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury. Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy. For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.
A frequent side effect is excessive dryness of the mouth, nose and eyes. Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist if these reactions occur.
Important precautions:
Decongestants
Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis. Oral decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants. Patients with high blood pressure or heart disease should check with their allergist before using. Pregnant patients should also check with their allergist before starting decongestants.
Nonprescription decongestant nasal sprays work within minutes and last for hours, but you should not use them for more than a few days at a time unless instructed by your allergist. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder. Oral decongestants are found in many over-the-counter (OTC) and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure or heart problems, check with your allergist before using them.
Nasal sprays
Nonprescription saline nasal sprays will help counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing (douching) the nasal passage. There are many OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.
Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in all patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.
Nasal ipratropium bromide spray can help reduce nasal drainage from allergic rhinitis or some forms of nonallergic rhinitis.
Leukatriene pathway inhibitors
Leukotriene pathway inhibitors (montelukast, zafirlukast and zileuton) block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis. These drugs are also used to treat asthma.
Immunotherapy
Immunotherapy may be recommended for people who don’t respond well to treatment with medications or who experience side effects from medications, who have allergen exposure that is unavoidable or who desire a more permanent solution to their allergies. Immunotherapy can be very effective in controlling allergic symptoms, but it doesn’t help the symptoms produced by nonallergic rhinitis.
Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.
Eye allergy preparations and eyedrops
Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, swelling, watery eyes and itching. OTC eyedrops and oral medications are commonly used for short-term relief of some eye allergy symptoms. They may not relieve all symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen. Prescription eyedrops and oral medications also are used to treat eye allergies. Prescription eyedrops provide both short- and long-term targeted relief of eye allergy symptoms, and can be used to manage them.
Check with your allergist or pharmacist if you are unsure about a specific drug or formula.
Treatments that are not recommended for allergic rhinitis
Occupational Rhinitis
If you develop symptoms that resemble those of hay fever and that appear or become more serious at work, you may be suffering from occupational rhinitis.
Occupational rhinitis, or work-related rhinitis, is a condition in which symptoms are triggered or further aggravated by allergens in the workplace. These symptoms can include sneezing, a runny nose and watering eyes. Common triggers include cleaning products, chemical fumes, certain types of dust, and corrosive gases.
If your allergy symptoms appear at work, or seem to get worse there, call your allergist, who can help you identify potential triggers and develop a treatment plan.
What is allergic rhinitis?
Allergic rhinitis is an allergic reaction to airborne allergens, like seasonal grass or ragweed pollen or year-round allergens like dust and animal dander. Allergic rhinitis is sometimes called “hay fever,” especially when caused by seasonal allergens. Hay fever shares many of the same symptoms as a common cold, but is not caused by a virus or bacteria. Instead, it is caused by your immune system reacting to allergens you breath into your body.
What is hay fever?
Hey fever is another name for allergic rhinitis, most commonly used to describe a seasonal allergic reaction to pollen such as ragweed. However, the term is often used to refer to nasal allergies caused by any inhaled allergen. Despite the name, hay fever is not necessarily a reaction to hay, and it does not cause a fever.
Is allergic rhinitis contagious?
No. Allergic rhinitis (or hay fever) is caused by your immune system’s response to allergens breathed into your body. It is not caused by a virus or bacteria and is not contagious.
What are hay fever symptoms?
Hay fever, or allergic rhinitis, symptoms are similar to the symptoms of a common cold. Some common symptoms include sneezing, congestion, coughing, sinus pressure, itchy watery eyes, and itchy nose, mouth, and throat, and fatigue. It can be difficult to tell the difference between a cold and hay fever. If you have hay fever, your runny nose will likely have a thin, watery discharge, and, despite the name, you will not have a fever. If you have a cold, you may have a thicker or yellowish discharge from your nose, and may have a low-grade fever. Hay fever symptoms can begin immediately after you are exposed to allergens like House dust mite, pollen or animal dander, and will continue as long as your exposure continues. A cold will most likely begin a day or two after exposure to the virus, and can last a few days to a week.
Broadly there are two types of sinusitis; based on the duration of the symptoms, these are acute sinusitis and chronic sinusitis
Acute Sinusitis
Overview
Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.
With acute sinusitis, it might be difficult to breathe through your nose. The area around your eyes and face might feel swollen, and you might have throbbing facial pain or a headache.
Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve within a week to 10 days. In most cases, home remedies are all that's needed to treat acute sinusitis. However, persistent sinusitis can lead to serious infections and other complications. Sinusitis that lasts more than 12 weeks despite medical treatment is called chronic sinusitis.
Symptoms
When to see a doctor
Most people with acute sinusitis don't need to see a doctor.
Contact your doctor if you have any of the following:
Causes
Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, a bacterial infection develops.
Risk factors
You may be at increased risk of getting sinusitis if you have:
Complications
Acute sinusitis complications are uncommon. If they occur, they might include:
Prevention
Take these steps to help reduce your risk of getting acute sinusitis:
Diagnosis
Your doctor will feel for tenderness in your nose and face and look inside your nose.
Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:
Treatment
Most cases of acute sinusitis, those caused by a viral infection, resolve on their own. Self-care techniques are usually all you need to ease symptoms.
Treatments to relieve symptoms
Your doctor may recommend treatments to help relieve sinusitis symptoms, including:
Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.
Antibiotics
Antibiotics usually aren't needed to treat acute sinusitis. Even if your acute sinusitis is bacterial, it may clear up without treatment.
doctor might wait and watch to see if your bacterial acute sinusitis worsens. However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.
Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms.
Lifestyle and home remedies
These self-help steps can help relieve sinusitis symptoms:
Alternative medicine
No alternative therapies have been proved to ease the symptoms of acute sinusitis, but products containing certain combinations of herbs may help. These combination therapies, sold under brand names such as Sinupret and SinuGuard, contain cowslip, gentian root, elderflower, verbena and sorrel.
Possible side effects include stomach upset, diarrhea and allergic skin reactions.
Preparing for your appointment
When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.
What you can do
Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 12 weeks, despite treatment attempts.
Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus buildup. Breathing through your nose might be difficult. The area around your eyes and face might feel swollen, and you might have facial pain or tenderness.
Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.
Symptoms
At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:
Other signs and symptoms can include:
Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis. When to see a doctor
You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.
Schedule an appointment with your doctor if:
See a doctor immediately if you have any of the following, which could indicate a serious infection:
Causes
Common causes of chronic sinusitis include:
Risk factors
You're at increased risk of getting chronic or recurrent sinusitis if you have:
Complications
Chronic sinusitis complications include:
Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.
Prevention
Take these steps to reduce your risk of getting chronic sinusitis:
Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
Manage your allergies. Work with your doctor to keep symptoms under control.
Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages. Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.
Diagnosis
Your doctor will feel for tenderness in your nose and face and look inside your nose.
Other methods for diagnosing chronic sinusitis include:
Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses. This also is known as rhinoscopy.
Imaging studies. Images taken using a CT scan or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical obstruction that's difficult to detect using an endoscope.
Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as bacteria or fungi.
An allergy test. If your doctor suspects that the condition might be triggered by allergies, he or she might recommend an allergy skin test. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.
Treatment
The goal of treating chronic sinusitis is to:
Treatments to relieve symptoms
These treatments include:
Antibiotics
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.
Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens might improve the condition.
Surgery
In cases, resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.
Depending on the source of obstruction, the doctor might use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.
Image guided surgery:
The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult.
Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the United States armed forces to guide bombs to their target.
Image guided surgery:
Caldwell Luc operation:
Another option is the Caldwell-Luc operation, which relieves chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A “window” is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.
Lifestyle and home remedies
These self-help steps can help relieve sinusitis symptoms:
A deviated septum occurs when the thin wall (nasal septum) between your nasal passages is displaced to one side. In many people, the nasal septum is displaced — or deviated — making one nasal passage smaller.
When a deviated septum is severe, it can block one side of your nose and reduce airflow, causing difficulty breathing. The additional exposure of a deviated septum to the drying effect of airflow through the nose may sometimes contribute to crusting or bleeding in certain individuals.
Nasal obstruction can occur from a deviated nasal septum, from swelling of the tissues lining the nose, or from both. Treatment of nasal obstruction may include medications to reduce the swelling or nasal dilators that help open the nasal passages. To correct a deviated septum, surgery is necessary.
Symptoms
Most septal deformities result in no symptoms, and you may not even know you have a deviated septum. Some septal deformities, however, may cause the following signs and symptoms:
When to see a doctor
See your doctor if you experience:
Causes
A deviated septum occurs when your nasal septum — the thin wall that separates your right and left nasal passages — is displaced to one side.
A deviated septum can be caused by:
In infants, such an injury may occur during childbirth. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum — from tripping on a step to colliding with another person on the sidewalk. Trauma to the nose most commonly occurs during contact sports, active play or roughhousing, or automobile accidents.
The normal aging process may affect nasal structures, worsening a deviated septum over time. Also, changes in the amount of swelling of nasal tissues, because of developing rhinitis or rhinosinusitis, can accentuate the narrowing of a nasal passage from a deviated septum, resulting in nasal obstruction.
Risk factors
For some people, a deviated septum is present at birth — occurring during fetal development or due to injury during childbirth. After birth, a deviated septum is most commonly caused by an injury that moves your nasal septum out of place. Risk factors include:
Complications
If you have a severely deviated septum causing nasal obstruction, it can lead to:
Prevention
You may be able to prevent the injuries to your nose that can cause a deviated septum with these precautions:
Diagnosis
During your visit, your doctor will first ask about any symptoms you may have.
To examine the inside of your nose, the doctor will use a bright light and sometimes an instrument (nasal speculum) designed to spread open your nostrils. Sometimes the doctor will check farther back in your nose with a long tube-shaped scope with a bright light at the tip. The doctor may also look at your nasal tissues before and after applying a decongestant spray.
Based on this exam, he or she can diagnose a deviated septum and determine the seriousness of your condition.
If your doctor is not an otolaryngologist (ear, nose and throat specialist) and treatment is deemed necessary, you may be referred to a specialist for further consultation and treatment.
Treatment
Managing symptoms
Initial treatment of a deviated septum may be directed at managing the symptoms of the tissues lining the nose, which may then contribute to symptoms of nasal obstruction and drainage. Your doctor may prescribe:
Decongestants. Decongestants are medications that reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent and continued use can create dependency and cause symptoms to be worse (rebound) after you stop using them. Decongestants have a stimulant effect and may cause you to be jittery as well as elevate your blood pressure and heart rate.
Antihistamines. Antihistamines are medications that help prevent allergy symptoms, including obstruction and runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require physical coordination, such as driving.
Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor's directions in using them.
Medications only treat the swollen mucus membranes and won't correct a deviated septum.
Surgical repair (septoplasty)
If you still experience symptoms despite medical therapy, you may consider surgery to correct your deviated septum (septoplasty). Septoplasty is the usual way to repair a deviated septum. During septoplasty, your nasal septum is straightened and repositioned in the center of your nose. This may require your surgeon to cut and remove parts of your septum before reinserting them in the proper position. The level of improvement you can expect with surgery depends on the severity of your deviation. Symptoms due to the deviated septum — particularly nasal obstruction — often completely resolve. However, any accompanying nasal or sinus conditions affecting the tissues lining your nose — such as allergies — can't be cured with only surgery.
Nosebleeds, also called epistaxes (ep-ih-STAK-seez), involve bleeding from the inside of your nose. Many people have occasional nosebleeds, particularly younger children and older adults.
Although nosebleeds may be scary, they're generally only a minor annoyance and aren't dangerous. Nose bleed in children less than 6 years are generally innocuous contrary to those in adults. Frequent nosebleeds are those that occur more than once a week.
Causes
The lining of your nose contains many tiny blood vessels that lie close to the surface and are easily damaged (commonest cause of nose bleeds in children)
The two most common causes of nosebleeds are:
Other causes of nosebleeds include:
Less common causes of nosebleeds include:
In general, nosebleeds are not a symptom or result of high blood pressure. It is possible, but rare, that severe high blood pressure may worsen or prolong bleeding if you have a nosebleed (seen in Adults).
When to see a doctor
Most nosebleeds aren't serious and will stop on their own or by following self-care steps.
Seek emergency medical care if nosebleeds:
Don't drive yourself to an emergency room if you're losing a lot of blood. Call your local emergency number or have someone drive you. Talk to your doctor if you're having frequent nosebleeds, even if you can stop them fairly easily. It's important to determine the cause of frequent nosebleeds.
Self-care steps for occasional nosebleeds include:
Tips to help prevent nosebleeds include:
Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both.
The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.
When planning rhinoplasty, your surgeon will consider your other facial features, the skin on your nose and what you would like to change. If you are a candidate for surgery, your surgeon will develop a customized plan for you.
Why it's done
Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.
Risks
As with any major surgery, rhinoplasty carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to rhinoplasty include:
Talk to your doctor about how these risks apply to you.
How you prepare
Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes:
Food and medications
Avoid medications containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon. If you smoke, stop smoking. Smoking slows the healing process after surgery and may make you more likely to get an infection.What you can expect
Rhinoplasty is not a procedure with a set series of steps. Each operation is unique and is customized for the specific anatomy and goals of the person undergoing the procedure.
Rhinoplasty may be done inside your nose or through a small external incision at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.
Your surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use cartilage from your rib, implants or bone from other parts of your body.
During the surgery
Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and your surgeon's preferences. Discuss with your doctor beforehand which kind of anesthesia is best in your case.
After the surgery, you'll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.
After the surgery
After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.
In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week.
Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose.
To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:
In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed. Use SPF 30 sunscreen when you're outside, especially on your nose. Too much sun may cause permanent irregular discoloration in the skin of your nose.
Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.
Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your "final result." However, most of the swelling is gone at a year.
Results
Very slight changes to the structure of your nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren't enough, and you and your surgeon might opt for a second surgery for further refinements. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can undergo changes during this time.
How is rhinoplasty different from septoplasty?
Rhinoplasty is a surgery to change the shape of the nose. Because both breathing and the shape of the nose are interrelated, sometimes a rhinoplasty is performed not only to change the way the nose looks but typically it's also performed to improve nasal breathing too. A septoplasty is a surgery to improve breathing by straightening the wall inside the nose that divides the nasal passages into a right and a left side (nasal septum). When the septum is crooked, it can make it harder to breathe through the nose. A septoplasty is often combined with a rhinoplasty.
Is rhinoplasty a simple operation?
No. Rhinoplasty is one of the most challenging operations there is. This is due to several factors. First, the nose is a complicated three-dimensional shape that is in the middle of the face. Changes made during rhinoplasty are often very small but, when added together, can make a significant difference in the way the nose looks and functions. Because these changes are small, so is the margin for error. Swelling and the placement of local anesthetic in the skin distort the nose during surgery, camouflaging many of the subtle changes made. Rhinoplasty is also not a procedure. In other words, there is no standard plan or set order of steps. Each operation is tailored to the needs of the patient.
Will I need to stay in the hospital?
Nearly everyone who has rhinoplasty is able to safely leave the hospital after surgery. In very rare cases, you may stay in the hospital for one night if you are having a hard time with nausea or have other health problems that need to be monitored.
How long is the recovery period?
Plan to take a week off from work, school or other obligations. You will feel progressively better each day during the first week. By the one week appointment, people usually feel like they are themselves again. After surgery, there will be some swelling. The swelling can take many months to resolve although most people stop noticing it after a couple of months. People are typically back to performing most activities after a week and resuming all activities after two to four weeks.
Are there risks?
All surgeries have risks. Fortunately, the risks for rhinoplasty are small and complications are rare. Your doctor will talk to you about the risks and benefits of surgery in detail before the operation.
Does insurance pay for a rhinoplasty?
Sometimes insurance pays for a rhinoplasty but that depends on the insurance policy. Before scheduling surgery, your doctor's office will help you obtain prior written authorization from your insurance company. Although this is not a guarantee of coverage, it is the only way to confirm that rhinoplasty is a covered benefit. Sometimes insurance will pay for a part of a nasal surgery but not other parts. In these cases, you can contact the business office to obtain a quote for the operation.
How much does rhinoplasty cost?
The cost of a rhinoplasty depends on several factors. The complexity of the surgery, the surgeon's training and experience, and geography can all play a part in how much a rhinoplasty costs. At Mayo Clinic, the cost of surgery will be the same regardless of which surgeon you choose.
Is rhinoplasty painful?
Not for most people. At the one day post-operative visit, most people rate their pain between 0-4 out of 10.
Will you pack my nose?
Yes. Packing can be uncomfortable to some patients. You will likely have some soft splints in your nose, however. These splints have a hole in them to make it possible to breathe through them, at least for a few days. These splints are easily removed at the one week visit.
How long will I be bruised?
Bruising is uncommon. If you do have some minor bruising, it typically lasts a week or so.
What should I look for in a surgeon?
Most rhinoplasties are performed by plastic surgeons, facial plastic surgeons or otolaryngologists (ENT). Training and board certification in one of these specialties is a good starting point. You want a surgeon who frequently performs rhinoplasty. You want a surgeon with a good reputation among patients and other doctors. If your surgeon has published numerous papers in the medical literature related to rhinoplasty and is invited to speak at educational conferences, that is one indication that their peers recognize expertise in rhinoplasty.
Make sure that your surgery will be performed in an accredited surgical facility or hospital. You should also feel comfortable with your surgeon. Your surgeon should be able to explain to you in understandable terms what is going to happen during your surgery.