Our Program

The sinus and nasal disorders program at Keck Medicine of USC in Los Angeles is a leader in treating the broad spectrum of nasal disease from allergies and deviated septums to more severe cases of chronic rhinosinusitis, polyps, nasal tumors and allergic fungal sinusitis. We often treat patients who have not been able to find relief elsewhere, need difficult, advanced surgery or whose polyps keep returning.

Chronic Nasal Obstruction
Our program has access to all the latest technology, including image-guided systems and balloon sinuplasty, which can be performed in an office setting with local anesthesia for patients with chronic sinusitis. This helps our patients find significant relief with minimal recovery or side effects.

We provide targeted, appropriate care for each patient with allergies of the ear, nose and throat, including home immunotherapy treatment for eligible patients. We also provide comprehensive services for patients who have lost their sense of smell.

As leaders in the endoscopic removal of sinus tumors, either benign or malignant, Keck Medicine of USC neurosurgeons and rhinologists team up to perform minimally invasive endoscopic treatment for sinus tumors, which allows for tumor removal without any incisions to the patient’s face.

Our Approach

Patients suffering from nasal disorders generally seek improved quality of life and the ability to breathe. Many of our procedures are minimally invasive and allow our patients to return to activities of daily life the following day. Using a collaborative, multidisciplinary approach, we offer tailored, conservative and minimally invasive treatments for a range of conditions of the nasal region. Additionally, patients are presented with all treatment options and are involved in making treatment decisions with guidance from our rhinologists.

As pioneers in the field of treating sinus and nasal disorders, surgeons at Keck Medical Center of USC were the first on the west coast to use a microdebrider, a tiny, high-speed tool designed to remove tissue, allowing for faster healing. Our surgeons can reduce the number of surgeries for patients with severe chronic sinusitis and are among the most experienced in the Lothrop procedure, a complex procedure reserved for the most severe cases of chronic rhinosinusitis.

We are also among the first academic medical centers to gain approval for the use of intranasal steroid stents (post-surgical implants that provide localized, controlled drug delivery to the sinus tissue), which reduce recovery time and eliminate the need for patients to take oral steroids.

Conditions

Sinusitis is the inflammation of the sinuses as the result of an infection from a virus, bacteria or fungus. Sinusitis is “acute” when the symptoms last four weeks or less.

Symptoms include bad breath or loss of smell, cough, fatigue, fever, headache, pressure-like pain, pain behind the eyes, nasal stuffiness, discharge and postnasal drip.

Visit our online health library for more detailed information about acute sinusitis.

An allergy is an immune response to a foreign substance, or an allergen. While usually harmless, environmental allergens, such as dust, mold, and pet or animal dander, may often cause a stuffy nose, itchy nose and throat, mucus or cough.

Visit our online health library for more detailed information about allergies.

Acute sinusitis is the inflammation of the sinuses as the result of an infection from a virus, bacteria or fungus. Chronic sinusitis, or chronic rhinosinusitis, is more severe than acute sinusitis. A patient is diagnosed with chronic rhinosinusitis when inflammation and swelling in the sinuses lasts for more than three months.

In addition to an infection, nasal polyps or a deviated septum can cause chronic sinusitis. Symptoms include drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat, nasal obstruction or congestion, pain, tenderness and swelling a round the eyes or reduced sense of smell and taste.

Visit our online health library for more detailed information about chronic sinusitis.

A cerebrospinal fluid leak or CSF leak is characterized by dripping of clear fluid from the nose. Symptoms may include severe headaches and meningitis. Cerebrospinal fluid is a clear fluid that surrounds the brain and spinal cord. A leak may be caused by head trauma, previous surgery or may occur spontaneously.

Visit our online health library for more detailed information about CSF leaks.

A deviated septum is a disorder in which the septum (the bone and cartilage that divides the nasal cavity) is displaced making one side smaller than the other. A deviated septum may cause difficulty breathing and may lead to compromised drainage of the sinuses on the deviated side.

Turbinates are long thin bones located on the inside walls of the nose. Allergies may cause turbinates to swell making it difficult for patients to breathe. Large (hypertrophic) inferior turbinates and deviated septum can also contribute to snoring.

Nasal tumors, though rare, may be benign or malignant and vary in location and size. A nasal tumor may be the cause of one-sided nasal obstruction, bleeding and loss of smell.

Pituitary adenoma and inverting papilloma are the most common type of benign tumors that can be removed endoscopically through the nose. Malignant tumors in the nose include esthesioneuroblastoma (olfactory neuroblastoma), squamous cell carcinoma, lymphoma, adenoid cystic carcinoma, adenocarcinoma, juvenile angiofibroma and mucosal melanoma. These tumors may be approached endoscopically through the nasal passageway. Intracranial tumors such as meningiomas, chordomas, plasmocytomas, craniopharyngiomas can be addressed endoscopically, as well. Our head and neck surgeons collaborate with neurosurgeons in the Minimally Invasive Neurosurgery and Endoscopic Skull Base Center in the treatment of intracranial tumors.
 
Extended endoscopic approaches can be also used for drainage of the petrous apex granulomas.

Nasal polyps are tissue growths in the nasal cavity that may block the nasal passages. They often grow where the sinuses open into the nasal cavity. With polyps, patients may suffer symptoms similar to those of a head cold. Nasal polyps may cause chronic sinusitis.

Visit our online health library for more detailed information about nasal polyps.

Tearing eye may be caused by obstruction of the drainage pathway of the tearing system (lacrimal system), which is located inside the nose. An ophthalmologist will diagnose and determine the cause of tearing eye. If obstruction of tearing system is determined to be the cause for epiphora, the patient is a good candidate for endoscopic lacrimal sac surgery.

Proptosis is a bulging or protruding of one or both eyes. The disorder may affect one eye with tumors or both eyes, such as in Grave’s disease.

Treatments and Services

At Keck Medical Center of USC, we provide patients with allergy testing and immunotherapy. We also offer home immunotherapy for eligible patients for added convenience.

We offer balloon sinuplasty in an office setting using local anesthesia for select patients suffering from chronic sinusitis symptoms. In this procedure, a balloon is used to open the sinuses. The sinuses are cleared with a saline solution. This procedure is a minimally invasive procedure performed through the nose and removes the need for a patient to be put under general anesthesia in the operating room.
For selected patients with primary or recurrent sinonasal polyps, we offer in office polypectomy. A Small disposable microdebrider/shaver (Polypvac) is used after topical/local anesthesia is applied for in-office removal of the polyps.
In the event of a CSF leak, our surgeons can repair the leak in the tissue without any incisions to the face by performing the procedure endoscopically.

Our sinus and skull base surgeons work closely with our neurosurgeons in the Minimally Invasive Neurosurgery and Endoscopic Skull Base Center in the endoscopic removal of nasal and anterior skull base tumors. Via endoscopic (through the nose using an endoscope) removal, patients spend less time in the hospital and experience less post-operative pain.
The Lothrop procedure is a highly subspecialized, complex surgery reserved for the most severe cases of chronic rhinosinusitis affecting the frontal sinuses. This procedure involves endoscopic drilling through the bone that separates the frontal sinuses creating a large opening between frontal sinuses and the nasal cavity. This surgery is reserved for severe recalcitrant chronic sinusitis after failures of traditional endoscopic approaches, for patients with tumors in the frontal sinus and for severe polyposis, Samter’s triad (polyps, asthma, aspirin sensitivity), allergic fungal sinusitis and extensive mucoceles.
This is an endoscopic procedure, which treats epiphora (tearing eye) without cuts to the face.  When part of the lacrimal system is blocked, this procedure is used to restore the flow of the tears into the nose from the lacrimal sac. During the procedure, a new drainage pathway is created inside the nose so the tears can bypass the obstructed area.

Our sinus surgeons in cooperation with oculoplastic surgeons can provide endoscopic orbital decompression for thyroid related exophthalmos (Grave’s orbithopathy) or for proptosis (protruding eye) related to orbital tumors.
Septoplasty is a surgical procedure performed to correct a deviated septum that is causing symptoms or blockage. During septoplasty, the cartilage or bone causing the symptoms is relocated or removed. In severe cases of sinusitis with presence of septal deviation, septoplasty is performed alongside sinus surgery.

Visit our online health library for more detailed information about septoplasty.

Most procedures performed at the USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery can be performed endoscopically – through the nose with an endoscope – removing the need to make incisions to a patient’s face and reducing the time needed for recovery. Sinus surgery is used to open up passages that connect the nose to the sinuses. This detail-oriented surgery helps eliminate any partition in the drainage pathway, significantly reducing the chances of recurring issues.

Our surgeons create “open highways” in the nasal passages and then treat the disease on a systemic level with topical anti-inflammatories or intranasal steroid stents to keep the disease from recurring.

For revision cases when the anatomy of the sinuses is distorted by previous surgery, severe polyposis or sinonasal malignancies, our sinus surgeons use an image-guided system (IGS), which correlates the patient’s anatomy with preoperative CT scan images during surgery.

Resources

American Academy of Otolaryngology – Head and Neck Surgery
http://www.entnet.org

American Academy of Otolaryngic Allergy
http://www.aaoaf.org

American Rhinologic Society
https://www.american-rhinologic.org

Our Physicians

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Practicing Locations

USC Healthcare Center 4

Specializing In

Extended Midface Lift for Facial Paralysis; Botulinum Toxin for Facial Spasm, Synkinesis and Contralateral Hyperkinesis; Brow Lift and Eyelid Surgery for Facial Dysfunction

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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 4
USC Outpatient Surgery Center
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Practicing Locations

Keck Hospital of USC
USC Norris Comprehensive Cancer Center and Hospital