[HN Gopher] The truth about turbinates (and sinusitis)
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The truth about turbinates (and sinusitis)
Author : flreln
Score : 50 points
Date : 2021-11-28 20:18 UTC (2 hours ago)
(HTM) web link (westportfacialplasticsurgery.com)
(TXT) w3m dump (westportfacialplasticsurgery.com)
| blamestross wrote:
| Whelp, my chance to shine. I had my turbinates surgically removed
| as part of sinus reconstruction. About a year after I got my face
| smashed really well.
|
| Reading the surgery notes later I found out the surgeon gave me
| cocaine! This is apparently old fashioned but normal.
|
| The biggest consequence is that in the nostril that isn't blocked
| by my bowed septum, I can stick my finger a lot further up.
|
| Ask me anything!
| GDC7 wrote:
| tape your mouth during sleep
| drBonkers wrote:
| what tape do you use?
| vakili wrote:
| 3M Micropore Surgical Tape.
| elric wrote:
| Let me just chime in here, because while often a good idea,
| your comment is a little sparse, and this is an idea that can
| weird people out.
|
| Background: I was diagnosed with obstructive sleep apnea some
| years ago, and I've been sleeping with a CPAP device ever
| since. In general, CPAP follow-up and compliance rates are
| pretty terrible. Thankfully there's a very helpful community
| out there to help people with their various issues (reddit,
| apnea board, etc). I've basically tried everything and I've
| spoken to countless of people in the same boat. I'm just a guy
| on the internet, so take what I'm saying with a generous pinch
| of salt.
|
| One of the most common issues with snorers and apnics (is that
| a word?) alike, is that things get worse when the mouth is
| open. When you're on nasal CPAP, opening your mouth will cause
| a lot of the air to simply blow out your mouth, which will
| reduce your effective therapeutic pressure (i.e., CPAP is now
| practically useless). If you're using a full face mask, an open
| mouth can reduce the fit of the mask, allowing escape, usually
| near the chin. This, too, can result in a drop in pressure,
| though usually not as dramatic as with a nasal mask.
|
| There are basically zero good ways of preventing your mouth
| from opening at night. It happens to some people, not to
| others. No clue why. If it happens to you, nearly every
| "solution" sucks. Chin straps don't work, they will make your
| apnea worse by pulling your jaw into your airway, exactly where
| it's not supposed to be. Cervical collars are incredibly
| uncomfortable for sleeping. Mouthguards (like the kinds boxers
| use) are really uncomfortable for some people, but some people
| seem to tolerate them well enough.
|
| On to the tape: there's only one reason to use it: to keep your
| mouth shut at night. Mouth breathing = bad. Especially when on
| nasal CPAP. Use a low-stick tape that's skin safe. I use a
| piece roughly the size of a Charlie Chaplin moustache. That's
| wide enough to keep my mouth shut, and narrow enough so that I
| can still breathe out of the corners of my mouth if I really
| have to. I do occasionally suffer a corner-of mouth-leak, but
| as it's a narrow gap, the CPAP machine can easily cope.
|
| A word on aspirating vomit, as this seems to be a common
| concern. If you suffer from awful reflux, or are just unlucky
| enough to have to throw up while asleep, you're going to be
| having a bad time. Regardless of anything else. If you're on
| CPAP, there's a chance the pressure will be sending bits of
| goop down your airway. This is bad. If you're wearing a
| mouthguard, this will be worse. If you've taped your mouth,
| this too could make things worse. I once had threw up while on
| CPAP and mouth tape. Nothing bad happened, when the process
| started, it startled me and woke me up, I instinctively removed
| the tape and the CPAP mask before the vomit reached my mouth.
| Not fun, but no damage either.
| adflux wrote:
| This... Its so wierd, but it improves my sleep. I dream more
| vividly aswell...
| Traubenfuchs wrote:
| Dear diary, today hacker news made me tape my mouth shut
| before sleep.
|
| How am I gonna explain this to my partner? If it stops me
| from snoring and him from kicking me, that's a win for both
| of us though.
| toast0 wrote:
| I suggest "Hey partner, my weird internet friends told me
| if I tape my mouth shut while I sleep, it might help with
| snoring and improve my quality of sleep, so I'm going to
| try it, let me know if it works" and if your partner is
| snarky, be prepared with eye rolls for him to say "why only
| at night?"
|
| One of my neighbors recommended thiamine supplements for
| help with night breathing, and my spouse was happy to have
| me try something. I'm sure she'd be happy to have me try
| taping my mouth shut overnight too.
|
| I had some success with the thiamine, but the first
| suppliment pill is a B-complex with lots of stuff (all at
| pretty high RDA %s) and something in there makes my muscles
| ache in addition to seeming to help with night breathing
| and smelling like a vitamine shop. I've now got a liquid
| I'm supposed to dropper into my mouth, but it tastes and
| smells like a vitamin shop, which is hard for me to
| tolerate, and it doesn't seem to work as well (lower dosage
| and as bottle has been used, the dropper isn't so full).
| The first couple or times I used it, I noticed when waking
| up that I was breathing through my nose and it felt easy;
| that's not normal for me, I can breathe through my nose,
| but it usually takes some amount of concious effort to do
| so.
| AlbertCory wrote:
| I had a horrendous sinus infection in 2006, and got Prednisone
| for it, and various other drugs, and finally it went away.
| Fortunately, my allergy test didn't indicate much in the way of
| allergies. Before that, I had regular bouts of cold-like
| symptoms, was on Claritin, etc. etc.
|
| Then I heard something which (cliche alert!) changed my life:
| it's sinus-rinsing. I discovered that it's _not_ some woo-woo
| alternative therapy; lots of people do it, and your doctor will
| probably give it his or her blessing. You can get the kits in any
| drugstore (I use NeilMed). Everyone hears "sinus rinsing" and
| says "Neti Pot" and that's fine, although I think its major
| advantage is its Eastern-sounding name. I just use the squeeze
| bottle. Be sure to use distilled water. The powder is just saline
| and baking soda, which makes it not burn the inside of your nose.
|
| Since I started this, I get _maybe_ one cold a year, and it goes
| away in a week and a half or so.
|
| What's the technical, scientific explanation for this? "It clears
| the crap out of your nose" pretty well covers it.
| quercusa wrote:
| Life-changing for me too - highly recommended. It's kind of
| weird and a little unpleasant at first, but has significantly
| reduced my allergy symptoms.
| alfor wrote:
| If you like this reasoning absolutely read: A Hunter-Gatherer's
| Guide to the 21st Century
|
| https://www.amazon.com/Hunter-Gatherers-Guide-21st-Century-C...
|
| There is so much knowledge about how our modern world is causing
| much of our health problems.
|
| Wisdom teeth: food to soft Myopia: not enough exposure to UV
| light while growing
|
| Whe should know these things way before we think of medication
| and chirurgy. And yes, use science and technology to improve our
| lives when appropriate.
| flreln wrote:
| Thanks!
| seehafer wrote:
| I had turbinate reduction after a series of never-ending sinus
| infections. Lessened the symptoms somewhat, didn't abate. Went to
| an allergist, found out I was allergic to pretty much everything
| outside, went on immunotherapy for 5 years, haven't had a sinus
| infection yet. Best thing I ever did for my health.
|
| Moral of the story: Surgeons like to do procedures. ENTs are
| surgeons. Act accordingly.
| emptysongglass wrote:
| I have sinusitis. Been tested twice by two different ENTs for a
| common allergy screening. Nothing. Should I be doing something
| different?
| seehafer wrote:
| YMMV of course. Did you get skin and blood testing? I've
| found that dedicated allergists tend to be more thorough
| about this, but there's no guarantee that allergies are the
| cause of your sinusitis.
| eterm wrote:
| What do you mean by immunotherapy?
| [deleted]
| elric wrote:
| Not the person you're replying to, but probably allergen
| immunotherapy, aka desensitization. Basically you're given
| ever increasing doses of whatever it is you're allergic to.
| Over time, you should build up a tolerance. IIRC there are
| tablets available for common allergens like dust mites. For
| others, you need to get regular shots, which is a bit tricker
| and riskier.
| Lazare wrote:
| Interestingly, I went to an ENT recently with chronic sinus
| problems.
|
| Me: "My nose has been clogged since the 90s, I'm on three
| different antihistamine prescriptions, do you think surgery
| might help me?"
|
| ENT: "Surgery? I mean, it might help a little. Might make
| things worse. What I'd really recommend is figuring out what
| you're allergic to. Let me write you a referral to an allergist
| instead."
|
| Me, confused: "Wait, I'm allergic to something?"
|
| ENT, more confused: "You didn't realise? Did nobody tell you
| you've displaying obvious symptoms? Why did you think you were
| on the antihistamines?"
|
| Me: "Uh...."
|
| So yes. I'd certainly recommend checking allergies, but the
| good news is, _some_ ENTs are sensible. (Then again, this was
| the NZ medical system, which probably matters...)
| jghn wrote:
| I had mostly the same experience. Except my allergy tests all
| came up negative. Everyone pretty much shrugs. They all note
| the inflammation, even at the dentist when they do x-rays.
| Yet no idea what's causing it.
| daveguy wrote:
| This has been my experience too. I have been to several ENTs.
| Every one was more interested in my allergies than any sort
| of surgery. YMMV, but ENT stands for Ear Nose and Throat
| specialization. There's no surgery inherent to the treatment.
| Sure ENTs have been trained in basic surgeries of their
| specialization, but that doesn't mean they're "surgeons".
| It's just one tool.
| polishdude20 wrote:
| I've been to an allergist a few times and I've got seasonal
| allergies for pollen as well as dust mites and such. I usually
| sleep with my mouth open because my nose is always blocked at
| night which causes me to wake up in the middle of the night
| with a dry mouth to get water. What did you get immunotherapy
| for? Which allergies did it help with and how did you convince
| your doctor you needed it?
| karanbhangui wrote:
| It could be non-allergic rhinitis like in my case. USC head
| of sleep surgery recommended I try the "Afrin test" which is
| trying Afrin for a night or two (avoid more to prevent
| rebound effect). Lying down can engorge nasal passages. Try
| elevating head via pillows or bed elevation. Use humidifier
| and take large dose vitamin D. Mouth tape and sleep on your
| side
| dinkleberg wrote:
| Thanks for sharing your experience, you've inspired me to go
| find an allergist. I'm tired of feeling like crap for months
| every spring.
| cryptonector wrote:
| I had something of a turbinate reduction surgery. More like a
| liposuction of the turbinate than a resection. The surgeon said
| it would be life-altering. It was, and it was a very good life
| alteration.
| PostThisTooFast wrote:
| Even if we accept this article's assertions, it doesn't say what
| the solution is AFTER vacuum-induced damage has occurred.
|
| And the primary assertion, that your turbinates are damaged by
| vacuum induced in your nose when you breathe through your mouth,
| doesn't make sense. If you're breathing through your mouth, what
| causes vacuum in your nose? It's being bypassed. Try it yourself.
| sendomatic wrote:
| My nose is almost permanently running or clogged. Eventually I
| went to see an ENT who sent me for a scan and was surprised to
| find that I didn't have an inferior turbinate on one side.
|
| When I was younger I smashed my nose and had surgery so either
| that doctor removed the inferior turbinate during that surgery or
| I was just born without one.
|
| Either way it seems to have left me in a snotty situation.
| klipt wrote:
| Seems obvious that a structure present in pretty much ALL humans
| has some evolved purpose.
|
| If you want to scare yourself, search for "empty nose syndrome"
| and you'll find horror stories of people feeling like something
| is horribly _wrong_ after surgeons removed their turbinates
| (often without telling them, while doing another procedure like
| deviated septum) ... some even end up committing suicide.
|
| Chesterton's Fence comes to mind:
|
| > The more modern type of reformer goes gaily up to it and says,
| "I don't see the use of this; let us clear it away." To which the
| more intelligent type of reformer will do well to answer: "If you
| don't see the use of it, I certainly won't let you clear it away.
| Go away and think. Then, when you can come back and tell me that
| you do see the use of it, I may allow you to destroy it."
| msla wrote:
| > Seems obvious that a structure present in pretty much ALL
| humans has some evolved purpose.
|
| Contrast with the length of the recurrent laryngeal nerve:
|
| https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve
|
| > The extreme detour of the recurrent laryngeal nerves, about
| 4.6 metres (15 ft) in the case of giraffes,[27]: 74-75 is cited
| as evidence of evolution, as opposed to Intelligent Design. The
| nerve's route would have been direct in the fish-like ancestors
| of modern tetrapods, traveling from the brain, past the heart,
| to the gills (as it does in modern fish). Over the course of
| evolution, as the neck extended and the heart became lower in
| the body, the laryngeal nerve was caught on the wrong side of
| the heart. Natural selection gradually lengthened the nerve by
| tiny increments to accommodate, resulting in the circuitous
| route now observed.[28]: 360-362
|
| Imagine how long the nerve must have been in long-necked
| sauropods:
|
| https://bioone.org/journals/acta-palaeontologica-polonica/vo...
|
| > The course of the recurrent laryngeal nerve appears to be an
| unchanging aspect of tetrapod embryology, being as
| developmentally fixed as the presence of a heart and paired
| vessels to the head. The existence of 28 m neurons in the RLN
| of Supersaurus may seem fantastic, but they appear unavoidable
| given what we know of tetrapod embryology and evolution. Other
| neurons in the bodies of sauropods were even longer, spanning
| the entire distance from the brainstem to the tip of the tail,
| and may have been the longest cells in the history of life.
| These incredible cells represent the interplay of evolutionary
| innovation and developmental constraint: the acquisition of
| giant, long-necked and long-tailed bodies built on a deeply
| conserved tetrapod bauplan.
| voldacar wrote:
| >Contrast with the length of the recurrent laryngeal nerve
|
| Yes but that is noteworthy precisely because it is the
| exception to the general rule. It is almost always (99%+)
| correct that a strange structure has some kind of meaningful
| purpose.
| PeterisP wrote:
| However, your own answer clearly lists the evolved purpose of
| that nerve - it was the simple and straight line from brain
| past the heart to the gills; and there is an obvious reason
| why it can't be changed - there's no direct mutation possible
| to route it to the other side.
|
| On the other hand, there generally _are_ possible direct
| mutations that would significantly reduce any tissue
| /structure, so if they aren't "chosen", then that does
| indicate that the tissue still has some purpose (which might
| have no relation to the purpose it had when it first
| appeared).
| klipt wrote:
| Hmm yes but a suboptimal nerve is still not the same as a
| useless nerve - I'm sure you wouldn't want a surgeon pulling
| yours out because "I don't see the use of this!" ;-)
| vecter wrote:
| I had a septoplasty (to fix a deviated septum) and a turbinate
| reduction via submucosal debrider. For the first two weeks
| after the operation, I experienced severe Empty Nose Syndrome.
| I felt like I was suffocating and short of breath all of the
| time. I slept two hours every night. It was excruciating in a
| way that I simply cannot put into words. After two days, I had
| thoughts of ending my life. It was that bad.
|
| Luckily I've healed since the operation but still have mild
| symptoms a few months after. For a while, I had too much
| "openness" in my nose which felt like there was little to no
| air resistance. I still get that sometimes. I'm lucky though
| because I'm back to 70% normal. However, I'm in a private
| Facebook group for ENS sufferers with over 3,000 people and
| reading about their daily struggles is absolutely brutal,
| especially since I was going crazy after experiencing them for
| only a week or two.
|
| For anyone considering a turbinate reduction, DO NOT DO IT. The
| risks are too great, and unfortunately the ENT community has a
| perverse incentive to hide the facts. To give you a sense of
| this, the week after my operation when I was struggling with
| the suffocating feeling, I told my ENT surgeon and he coldly
| offered to give me antidepressants. I was shocked and livid,
| because I knew that he knew exactly what was going on, but he
| instead of acknowledging the problem, he tried to sweep it
| under the rug and treat it as a psychological illness. I
| guarantee you as someone who's experienced, it is everything
| except for psychological.
|
| You won't find good data on ENS risk because almost no ENTs
| will actually diagnose it. My primary ENT (not the ENT surgeon
| who performed the operation) basically told me that I didn't
| have it because I still had my turbinates. This is also false,
| as research has shown [0].
|
| Feel free to reach out to me if you have more questions or are
| considering getting a turbinate reduction. My contact info is
| in my profile. I cannot urge you strongly enough to avoid this
| operation at all costs.
|
| [0] https://www.youtube.com/watch?v=BVWHOQ7P3wk&t=6m13s
| s5300 wrote:
| Came here to talk about empty nose syndrome.
|
| If you have any sort of general hypersensitivity or touch
| disorders, don't let anybody ever touch your turbinates. You'll
| likely go mad.
|
| Note: this isn't saying the only people to get ENS are those
| with a hypersensitivity/similar disorder
| colechristensen wrote:
| I wonder how much this has to do with humans rarely needing to
| chew tough food any more (weakening the jaw, causing the mouth to
| open in sleep)
|
| I had a lot of these problems growing up.
| Empact wrote:
| Anyone interested in following this line of thinking should
| look into Orthotropics[1] and Mike Mew.[2] A key insight is
| that bones are modeled not only according to a genetic program,
| but also in response to pressure - they move so as not to clash
| with one another, and reinforce themselves to deal with more
| demanding environments / greater pressures.
|
| Personally I grew up with difficulty breathing through my nose,
| and didn't realize until my 30s that I had an undiagnosed
| tongue tie[3]. I've been applying orthotropic practices for
| several years and now breathe easily through my nose.
|
| [1] https://reddit.com/r/orthotropics/
|
| [2] https://www.youtube.com/watch?v=TY3bIMRKil8
|
| [3] It was noted a few times over my life by dentists, but in
| the form of noticing the symptoms of the issue, such as a
| tongue thrust swallowing pattern. In my case, my breathing was
| restricted, but an ENT could not see why - my best guess as to
| why was that my airway was constricted front to back (ventral
| to dorsal).
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