Look no further for entertaining and informative videos about all things nose, sinus, sleep, and snoring. I'm a Fellowship-trained Rhinologist in Houston and The Woodlands, TX specializing in these areas. I'm also a musician and hobbyist, and enjoy creating fun content such as musical parodies. I hope you enjoy the videos, and feel free to leave questions, suggestions, and requests for further topics. Thanks!
- Dr. Allen (SnotDocTX)
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Taking an alginate supplement like Nutritist Refluxter has been a literal life saver for me in my ongoing struggles with LPR. My GI doc just me to take omeprazole and didn't even want to hear about alginate therapy. Thank your for putting out this video. I will show it to him next time I see him!
Doctor please give me a percentage of risk of getting ENS , I know 1 in a thousand is the risk for FESS surgery and those odds aren’t very good if you ask me . Thank you
There haven’t been any large scale studies, particularly focusing on modern turbinoplasty techniques, that I’m aware of looking at the incidence of ENS. As I’ve mentioned, I haven’t seen it in my patients as far as I aware, and I follow many for years particularly if I’m managing their sinus problems as well. The key to safely improving breathing without risking ENS is to focus on preserving the mucosal lining and remove tissue inside of the turbinates, such as the bone, and only limited soft tissue removal. No procedure is risk free, but luckily the vast majority go according to plan. Nobody should have this surgery unless they really need it to improve quality of life (I.e. failed medication options, allergy control measures, etc).
Having experienced the factory, I appreciate this insight and guidance.
Thank you for the valuable information. Loving the video production as well
Shawn Allen is a great doctor and an amazing surgeon.
Good video. He's the most amazing doctor. Very good at his job.
What is your opinion on new techniques that reduce a septoplasty to a 20 minute in-office visit or the use of balloons? Why do some ENT doctors opt not to use nasal support strips at all post-op?
I’ve seen septoplasty balloons a few times and attempted to use them a few years ago in simple cases. I wasn’t a fan because without an incision you’re just fracturing bone and/or cartilage and hoping they heal in a good position and don’t have any access to remove bulky spurs, apply support sutures, etc. I’m sure fracturing over a deviation will help some patients, but it’s the lack of control over the eventual outcome I didn’t view as acceptable. If a patient only has a posterior septal problem such as a spur and the front of the septum is relatively straight, a limited incision just large enough to remove the spur or posterior deviation can be done in 5-10 min using the endoscopic equipment. The length of a septoplasty procedure depends on how challenging the front of the septum is (where structural support is needed) and how easy it is to raise the skin off the bone or cartilage (can be stuck down after trauma, prior surgery, etc). I use splints applied to the septum for 1-2 weeks when the front portion of the septum is worked on and needs help staying midline while initially healing, but only 20-30% of my patients end up needing those splints. The rest without splints have a slightly easier recovery as the splints can cause pressure and discomfort while in place. Nasal support strips (I’m guessing you’re referring to Breath-right strips on the outside of the nose) might open the nostrils better while the nose is swollen and improve airflow temporarily, but they’re completely optional and would not be advised if a Rhinoplasty was performed and the nasal bones are covered with tape/support already.
Love all the examples you went over!
Enjoyed the video production which led to a relaxing presentation of information!
So what is the solution sir, what to do in such condition prior goin into emergency to feel better
Mechanical solutions work best - sleep at an incline, avoid eating 3 hours prior to bedtime, fast as needed solutions for treating reflux such as Pepcid AC and Reflux Gourmet (available on Amazon.com) can be used temporarily, and see a GI doc if that isn’t quickly improving symptoms within a week or two.
I’m dependent on nasal congestion relief spray for better sleep
Avoid decongesting sprays (Afrin, Sinex, etc), and stick with the topical steroid sprays such as Flonase and Nasonex. If those fail, time for an ENT evaluation to figure out the causes. Using decongestants for any prolonged time will make the problem worsen progressively and make it much more challenging to treat.
Hi, thanks for the information. Do you use nasal plugs after submucosal resection surgery of the inferior turbinates?
I don’t use nasal plugs ever. I use septal splints after septoplasty when the anterior cartilage is repositioned or needs added support temporarily, and dissolvable nasal packing (PosisepX) in the upper portions of the nasal cavities adjacent to the sinuses or in the ethmoids following sinus surgery if I’m worried about bleeding post-op. After routine nasal airway surgery (turbinoplasty with or without septoplasty) no packing is generally needed unless the middle turbinates are also addressed and appear risky for ongoing bleeding. The inferior turbinates respond well to targeted nasal cautery during surgery.
Good job
I can barely breathe through my nose.
Amazing doctor.
I’m not trying to be funny doctor, but I would seriously rather have a total rhinectomy than deal with my nose. I really want one.
Im having pain in my jaw snd ear from tooth. Is it fune to maje extraction as after the wisdom toith im having to extract the neighbours treth as there are cavities. But still cant duagnose wat is giving me this ear pain frombthe jaw,? Antibiiticcis supressing it but the pain us still there.
Any problems with your teeth can cause you to clench, grind your teeth at night, and otherwise chew differently in a way that overworks the chewing muscles. Stress can similarly cause this overworking of the chewing muscles. As the muscles get inflamed, they spasm and ache, and the pterygoid muscles transmit some of this pain deep behind the mandible where it is felt as ear pressure/pain and difficulty clearing the ear pressure due to eustachian tube dysfunction. Addressing the dental disease, warm compresses/heat to relax the chewing muscles, NSAIDs (such as Advil, if safe to use) to relieve pain/inflammation, and having a dentist fit a mouthguard to prevent grinding teeth at night can all help relieve these symptoms. If the hearing is dull, have it checked for fluid/ear infection as well.
Thk u so much
Im having pain in my jaw snd ear from tooth. Is it fune to maje extraction as after the wisdom toith im having to extract the neighbours treth as there are cavities. But still cant duagnose wat is giving me this ear pain frombthe jaw,?
also, severe allergies and sinus infections can cause mouth breathing which dries out the mouth and makes you more prone to cavities. ive had this issue my whole life despite taking really good care of my teeth😢
That form of nasal obstruction leading to mouth breathing is often responsive to nasal steroid sprays and allergy pills when used regularly. When those fail, nasal airway surgery such as septoplasty and turbinoplasty can reestablish good nasal airflow. Might be time for an ENT evaluation if you’ve had that going on for years!
I dont have pain I never could smell my hole life and it clear liquid down the back of my throat I can breath through my nose but there is holes swelling shut something top my throat by my nose is very watery its gray and clear it bad tho can't sleep cuz my lungs keep getting plugged I don't wanna go to the Dr waste there time but iv herd there nothing I can do for a week just make sure it's not getting worse if it does then I should go Dr but I wanna know how this happened allergies never got me cuz my nose is so bad can't smell so what viral infection or whatever is it can I stay away from something or place ?
Best next steps depend on how long your symptoms have been present, what treatments you’ve already tried, and if any imaging (CT Sinus) has been done to help clarify the problem. If this has lasted more than a week I would head to an ENT and be evaluated. Meds often work, and imaging can uncover if your condition warrants surgical intervention should meds fail. Hope you find relief! If you’re near Houston/Woodlands TX we’re happy to help (visit premiersinus.com for info).
Nice video ❤ I finally got rid of my chronic bad breath smell from the stomach when I talk with someone face to face with alternative medicine and diet tips from Dr Emovon on KZread.👍👍
Promo_SM
And if the turbinate reduction fails ?
Depends on which technique was initially performed and if ongoing control of inflammation with steroid nasal sprays isn’t working. If radiofrequency ablation fails, time to consider a formal turbinoplasty with bone removal for a better result. If a formal turbinoplasty fails (which generally takes a long time if ever), then the bone is already absent from the turbinates and a simpler office procedure to shrink soft tissues should suffice. It’s also important to image or scope the nose and rule out other factors such as sinusitis that can cause congestion symptoms. Any significant septal issues would also need to be addressed if not already done.
What about empty nose syndrome it's a lot of people hurting from past surgerys and another question I believe the nasal turbinates is one of the most important organs what else can we do natural to help breathing 💯
@@goodtimesbeatz6718 Empty nose syndrome is luckily very rare. I haven’t seen anyone develop ENS after turbinate surgery in my career, thus far, and the cases I’ve seen that were seeking help from past aggressive turbinate surgery were obvious over-resection of turbinate tissues, not subtle reductions. The key to prevention is careful resizing, primarily via bone removal or soft tissue only at the bottom of the turbinate, with the ability to “touch up” the results with a cautery tool such as radiofrequency ablation or laser volume reduction should the soft tissues of the turbinates enlarge again.
@@goodtimesbeatz6718 Other than surgical turbinate reduction, the only viable options are for patients to try nasal steroid spray, allergy medications, and possibly allergy shots/drops in the hopes that one day their allergy-related inflammation will be less severe, but none of those are as effective as careful surgery to resize the turbinates, and they often fail to provide any meaningful relief.
@@snotdoctx8742 thanks for information
Finally, an explanation 👏 😅
He completely did a wonderful job with my son. Great surgeon. I totally recommend him as a doctor. Amazing surgeon.
Amazing doctor.
Can this be done in office ? I have had my deviated septum straightened and inferior turbinates reduced and pushed out the way , I can breath so much better than before but I still have very bad headaches (daily) dizzy ness , ear pain , post nasal drip .. ect it just feels like something is not allowing my sinuses are not getting proper ventilation and can almost be sure it’s my middle turbinates. I’ve had a CT scan before showing concha bullosas on both sides but my surgeon has never addressed it
It can be done in office in some cases, really depends on the extent of sinus problems and if the sinus disease is appropriately managed with the office approach. We use office anesthesia and airway protection similar to a surgery center experience, which allows us to provide the same level of surgical care in our office OR. Not every practice will have that capability, which requires an OR built out, anesthesia cart, surgical instruments previously only seen in surgical facilities, etc. A recent CT would be the best guide to what is causing your symptoms and how to best manage them.
Hey Doc, got to keep up 😅
Hello, good info I appreciate you posting this information. I recently completed radiation therapy on the left side if my nose near the opening and now inside has healed shut except for very small openings. The ENT said I need surgery with a stent to fix it . Have you had any experience with this situation?
Depending on how much of the nostril/outer portion of the nose is involved in the scarring process, this can be a challenging problem to address. Plastic surgeons are more experienced with the grafting often required for this outside areas, and Rhinologists such as myself are well suited to handle any scarring and stenosis within the nasal cavity beyond the nostril area. I’ve corrected scars and adhesions within the nose, but not this problem specifically. If you’re near an academic center with an ENT department they might be a good bet for achieving a desirable outcome. If you’re in houston or The Woodlands, TX I’m happy to evaluate and see what you would need to correct the problem.
Empty nose with inflammation time to breath with the mouth :(
thanks doctor Empty nose Syndrome exist ents doctors still deny it leere nase Syndrom
It’s definitely real! There’s also a good test for it - in the clinic, we place a small portion of wet cotton into the nasal cavity where the turbinate would normally restrict airflow just inside of the nostril. If this makes them feel like they’re breathing better, and it’s someone that has had reduction of the turbinates before, then they most likely have some degree of empty nose syndrome even if the nose isn’t crusting or inflamed.
yes doctor thanks for helping peoples . we hope thatbwe meet more doctors like you . because all ents deny it snd throw us to Psychologe doctors . ❤️
Very informative! Love your videos Dr. Allen. Miss working with you 😢
which technique will be better for one side nose obstruction after septoplatsy operation...one of my ent doctor suggest SMD.....other one suggest microdivider
I always steer towards removing bone via incision, and haven’t touched the microdebrider in years because I don’t think it does as good of a job reducing volume long term. If the turbinate was already reduced with bone removal and the soft tissues are the only source of obstruction, then that would be an exception when I would consider microdebrider, RFA, or laser ablation of soft tissue approaches
Thank you for sharing this. I recently had surgery and was having difficulty figuring out how to do this correctly. Very informative.
So this is really fucking good needs to have more views. I’ll see what I can do.
I am cracking up 😂 I love this
This is insane 😆😆😆
I’m sorry doc, but this video almost made me sick! 🤢. How (or why!) you would ever pick this as a career, is beyond me. But I’m thankful for you and my other docs (especially my colon/rectal guy!) 😖
what about reducing turbinate size using laser? is that better/safer compared to radio-frequency?
Laser is a much less frequently used technique for turbinate reduction, but the availability of cheaper smaller lasers for in office use makes it appealing. I’m trying it out over the next few months and it might replace radio frequency ablation for awake turbinate procedures if I’m impressed. It’s the same concept - ablate within the soft tissue and watch it contract to reduce turbinate volume as it heals. Minimal bleeding with a laser, which is an advantage, and it can also be used in other areas within the nose to improve overall nasal breathing (reducing septal swell bodies, improving nasal valve collapse, ablating the posterior nasal nerves to reduce vasomotor drainage, reducing palate vibration and snoring, etc.). I’ll have more of a personal use-based opinion in a few months and if worthy of it I’ll make a separate video.
@@snotdoctx8742thank you for the reply. A local DR is using both techniques. I was afraid that the laser due to much higher temps, might cause worse scarring that doesn't heal as well or could make a mistake by the Dr more probable.
@@ps7539 the laser I’ve seen used for this sort of work in the office is low risk, only damages tissues when very close to the beam emitter as the beam defocuses with any distance, and should be safe. It likely causes much less heat damage to surrounding tissues compared to radiofrequency ablation, because the heat is a smaller more localized area during ablation and the laser works much faster preventing spread of heat over time. If they’re using a device such as the one I’ve seen used, safety is not compromised and is comparable or better than cautery. They will likely provide eye protection, as any laser energy can damage the sensitive nerves in the eyes.
Great video.
Lol I love your @
Smartest Rhinologist in the world, too!
Best doctors always help his patients.
I haven’t seen any patients develop classic empty nose syndrome following nasal airway surgery performed by me. Specifically, none have presented back to me with complaints of nasal obstruction that on workup appears paradoxical (wide open nose), feeling short of breath, burning/irritation in their nose, etc. I rarely perform more extensive (extended) sinus procedures that create a MUCH more open nose and sinuses compared to standard surgery due to complexities of the diseases I’m treating, and rarely some of these patients will have issues with dryness/crusting or occasionally burning irritation that improves with topical sinus irrigations, emollients, etc. However, these cases represent a trade-off (required more extensive surgery for specific pathology knowing that this was a potential risk).
Hi Doc. Thanks for your video and the info. In your experience how often does Empty Nose Syndrome occur after turbinate reduction and/or septoplasty?
I haven’t seen any patients develop classic empty nose syndrome following nasal airway surgery performed by me. Specifically, none have presented back to me with complaints of nasal obstruction that on workup appears paradoxical (wide open nose), feeling short of breath, burning/irritation in their nose, etc. I rarely perform more extensive (extended) sinus procedures that create a MUCH more open nose and sinuses compared to standard surgery due to complexities of the diseases I’m treating, and rarely some of these patients will have issues with dryness/crusting or occasionally burning irritation that improves with topical sinus irrigations, emollients, etc. However, these cases represent a trade-off (required more extensive surgery for specific pathology knowing that this was a potential risk).
Thanks for the quick response. It's good to know you haven't seen any such cases. Would it be possible to perform a polypectomy without correcting a deviated septum with spur and enlarged turbinates? Or would that not be considered worth it unless the surrounding structures can be fixed as well? I was just wondering if removing the polyps could lead to a natural reduction of turbinates on their own when neither deviation or turbinates had given any prior problem. Look forward to hearing from you.
@@shore022 that really depends on how deviated the septum is and how large the turbinates are. If they’re in the way, then the straight scopes and instruments may not be able to access the sinuses and clear polyps reliably. The reason to have surgery should always be viewed in the context of what you need long term. For most with sinus disease and nasal polyps, the polyps are just a sign of more severe inflammation and polyp removal alone does nothing for them long term. The goal of surgery in that situation is to open up the nose and sinuses properly so that inflammation everywhere (including inside of the sinuses) can be better managed with topical steroids (which have to be delivered either in a medicated rinse or in certain cases by a nasal nebulizer or Xhance spray). With that in mind, I also generally recommend getting everything corrected at once. Same recovery, significantly less expensive compared to multiple procedures, less anesthesia time overall, less need to torture the nose removing polyps down the road when it’s open and easily accessible for these topical treatments. Most folks with deviated septum and enlarged turbinates are also used to that level of nasal obstruction and can only appreciate they had a problem once it is corrected and they can feel the difference in breathing.
Thank you for the detailed answer. I really appreciate it. Your videos are very informative and well done. You've got a new subscriber in me and wish you the best. Cheers
OMG!!
Great item during allergy season.
Great doctor
Cool!! Maybe I should do the same : /
First try nasal steroid sprays like Flonase and allergy medication like Zyrtec or Allegra. If that doesn’t help, and your nose is congested particularly while lying down (which can impact sleep and health more than just daytime congestion), then it’s a good idea to have your nose checked out. If you’re in or around Houston or The Woodlands Texas I’m happy to help!
Who’s the girl?
Tried to convince my wife to play the part…. Shot down…. So I had to improvise…. Now this is out there forever. Guess I’m never running for President!