Understanding your nose and sinus symptoms

Start with the pattern

Tell us what bothers you most, when it began, and whether you ever feel completely well between episodes. Is the blockage consistently on one side? Does drainage follow meals or temperature changes? Does pressure come with light sensitivity or nausea? Which medicines have helped, and for how long?

These details direct the examination. They also help separate daily inflammation from distinct infections, allergy from nonallergic rhinitis, and a nasal breathing problem from headache or dental pain. You do not need to arrive knowing the diagnosis.

What nasal endoscopy adds

An ordinary look through the nostrils shows only the front of the nose. A small endoscope lets Dr. Fewins examine farther back: the septum, turbinates, drainage areas, polyps, swelling, crusting or other changes that are otherwise difficult to see.

He usually applies a decongestant and topical numbing spray first. The examination takes about a minute; many patients feel little more than pressure, although some notice brief discomfort. The scope passes through the nose, with no incision.

Endoscopy does not see through the walls into every sinus. After prior sinus surgery, opened cavities may be more directly visible. This is why an endoscopic examination and a CT sometimes answer different questions.

When a CT is useful

A sinus CT shows the drainage pathways, the pattern of inflammation and anatomy that matters when planning an operation. Dr. Fewins orders it when the result is likely to change diagnosis or treatment, using dedicated radiology facilities and reviewing the images himself alongside the radiologist’s report.

A small cyst or a thin area of lining swelling can be incidental. The report must be considered with your symptoms and examination; a scan finding alone does not explain every headache or justify an operation.

Other tests have specific jobs

• Allergy testing helps when the symptom pattern suggests an allergic contribution. Skin testing is commonly used; selected blood testing is an alternative when appropriate.
• Hearing testing and tympanometry can clarify ear fullness, pressure or reduced hearing. Those symptoms do not always come from the sinuses.
• A culture may help guide treatment in selected persistent or unusual infections.
• Another specialist’s assessment may be useful for migraine, dental problems, sleep disorders or unusually complex sinus disease.

Testing is selected for the question in front of us rather than ordered as the same package for every patient.

Leave knowing the next step

Hearing and allergy results can often be discussed during the testing visit. CT results are commonly reviewed at a follow-up, where seeing the images can make the findings easier to understand. Selected straightforward results may be discussed by phone or a virtual visit.

Your visit may be with Dr. Fewins or Jennifer Booker, NP, who evaluates patients under his supervision. Her patients’ care is reviewed with him; more complex concerns and surgical decisions come to Dr. Fewins. Our team explains who you will see and what happens after testing.