Nose & Sinus

Nose & Sinus

Nose & Sinus

Your nose and sinuses are important to your health. They filter the air you breathe by removing dust, germs, and irritants. Your nose also contains the nerve cells that help your sense of smell. When you experience a problem with your nose or sinuses, your whole body can suffer. For example, the stuffy nose of the common cold can make it hard for you to breathe, sleep, or get comfortable.

Many problems besides the common cold can affect the nose. Click a condition or disorder below to learn more.

Sinus Pain

What is it?

The sinuses are hollow spaces around the nose, eye, cheek, and forehead bones. When they are blocked due to inflammation and swelling associated with a cold or infection, sinus pain typically presents. Pain may be accompanied by tenderness, throbbing, and other uncomfortable symptoms.

How is it treated?

In order to relieve sinus pain and accompanying symptoms, patients can use a variety of treatment options, including:

  • Acetaminophen. An over-the-counter (OTC) pain medication.
  • Saline nasal spray. When sprayed into the nasal pathways, normal saline breaks up mucus and decreases sinus pressure.
  • Decongestants. OTC medications that relieve sinus congestion.
  • Warm compresses. A heating pad or warm cloth can be used to reduce swelling, throbbing, and pain.

Sinus pain caused by a common cold generally decreases over the course of 1-3-days. Sinus pain caused by a bacterial or viral infection may take longer to go away. If sinus pain does not respond to treatment or gets worse, an appointment with our office should be made.

Sinus pain that does not respond to conservative treatment may require surgical intervention. During a Balloon Sinuplasty procedure, an ENT surgeon removes sinus blockages and drains mucus. After surgery, the sinuses are opened and the pain goes away.


What is it?

The sinuses are tiny hollow spaces that allow air ventilation and mucus drainage between the nose, eyes, cheeks, and forehead. When viral or bacterial infections cause the mucosal lining of the sinuses to become inflamed and swollen, the condition is known as sinusitis or rhinosinusitis. Acute sinusitis lasts for a maximum of four weeks. The most common symptoms are:

  • Sinus pressure and pain
  • Congestion
  • Thick, discolored mucus discharge

Additional symptoms may include postnasal drip, coughing, fatigue, and fever. When properly treated, symptoms usually decrease or are eliminated within 3-5-days.

How is t treated?

Determining the cause of sinusitis is an important treatment step. Sinusitis caused by a virus is treated by managing symptoms while the immune system eliminates the virus. Any, all, or any combination of the following treatment options may be used:

  • Corticosteroid nasal sprays. Reduce inflammation and swelling.
  • Acetaminophen. Over-the-counter (OTC) pain medication.
  • Saline nasal sprays. Decrease sinus pressure, pain, and congestion by breaking up mucus.
  • Decongestants. Medications that relieve congestion.
  • Warm compresses. Reduce swelling, throbbing, and pain.

Sinusitis caused by bacteria may be treated using these treatment options and antibiotic medications that kill bacteria. Sinusitis that lasts more than four weeks is considered sub-acute or chronic sinusitis and an appointment with our office should be made.

Chronic Sinusitis

What is it?

Sinusitis, or rhinosinusitis, is the inflammation of the sinuses caused by a viral or bacterial infection. Sinusitis that lasts for up to four weeks is said to be acute. Recurrent sinusitis or sinusitis that lasts for more than twelve weeks. Chronic Sinusitis may be caused by any of the following:

  • A partial or complete nasal obstruction
  • Mucus build up
  • Chronic inflammation
  • Chronic infection
  • Persistent allergies

Symptoms typically present as:

  • A runny nose
  • Discolored mucus discharge
  • Sinus pain
  • Sinus pressure
  • Congestion

For some patients, these symptoms may cause breathing and sleeping problems.

How is it treated?

Common non-surgical treatment options include:

  • Corticosteroids (nasal sprays and oral medications)
  • Pain medications (over-the-counter and prescription)
  • Saline nasal sprays
  • Decongestants
  • Warm compresses

Long-term antibiotic treatment (3-4-weeks) may be used in some cases.

Sinusitis that remains unresolved following non-surgical treatment may require surgical intervention. Two minimally invasive procedures used to effectively treat chronic sinusitis are:

  • Endoscopic sinus surgery. In order to clear the sinuses and allow them to drain properly, an ENT surgeon performs a procedure known as functional endoscopic sinus surgery (FESS). A tiny camera and special instruments allow the surgeon to locate and remove tissue and mucus that are blocking the sinuses.
  • Balloon Sinuplasty. Similar to a cardiovascular angioplasty, a Balloon Sinuplasty uses a guide wire to insert a balloon into a blocked sinus pathway. When the balloon is inflated, the blockage is resolved and the pathway is opened.

Patients typically see drastic symptom improvement or symptom elimination following these successful procedures.

Sinus Headaches

What is it?

The sinuses are tiny, air-filled spaces inside the nose, eye, cheek, and forehead bones. When their mucosal layer becomes irritated and inflamed due to an infection or allergies, air ventilation and mucus drainage pathways become blocked, resulting in pressure, pain, and headaches.

Because the symptoms of a sinus headache and regular headache often overlap, it is difficult to distinguish the two. The following symptoms may indicate that a headache is sinus related:

  • Increasing severity when bending over
  • Pain between the eyes
  • Decreasing severity over the course of the day

When headaches associated with an infection or allergies do not go away after 7-10-days or when their severity increases, an appointment with our office should be made.

How is it treated?

Effective treatment of sinus headaches revolves around determining the underlying cause of the sinus infection. Although pain-relieving medications, such as acetaminophen, can be taken to decrease headache severity, ultimate relief is achieved by treating the infection itself.

  • Sinus infections caused by viruses can be treated using corticosteroid nasal sprays, saline sprays, decongestants, and warm compresses.
  • Sinus infections caused by bacteria can be treated using the above-mentioned treatment options and prescription antibiotics.
  • Sinus infections caused by allergies can be treated using antihistamines.

Chronic or recurrent sinus headaches may be caused by chronic sinusitis that needs to be corrected surgically. It is best to discuss this matter with the doctor.

Nasal Obstruction

What is it?

Nasal obstruction refers the blocking of the nasal airway. Nasal obstructions can be caused by:

Anatomic Abnormalities

  • A deviated septum
  • Enlarged turbinates (bony structures in the nasal cavity)
  • A foreign object
  • Nasal polyps
  • Enlarged adenoids

Inflammatory processes

  • Sinusitis
  • Allergies
  • Infections

The most common symptom of a nasal obstruction is difficulty breathing through one or both sides of the nose. Other symptoms include congestion, snoring, mouth breathing, sleep apnea and fatigue.

Dr. Goldhaber uses a medical history, physical exam, and possibly medical imaging studies to accurately diagnose nasal obstructions and then create an effective treatment plan.

How is it treated?

Non-surgical treatment options are generally effective in treating mild to moderate nasal obstructions. Corticosteroid nasal sprays, antihistamines, and decongestants reduce or eliminate symptoms by decreasing inflammation and swelling.

Surgical treatment may be necessary for severe nasal obstructions. The most commonly performed procedures are:

  • Septoplasty. Surgical correction of a deviated septum.
  • Turbinate reduction. Reducing the size of turbinates by removing bone and/or tissue.
  • Foreign object removal. Various techniques and equipment can be used to remove foreign objects.
  • Nasal polyp removal. An endoscopic procedure to eliminate nasal polyps.
  • Adenoidectomy. Surgical removal of the adenoids.
  • Sinus surgery. An endoscopic procedure that enlarges nasal pathways to help improve airflow and breathing.

A decision regarding surgery is always up to the surgeon treating the condition and, of course, the patient. In many cases, surgery provides significant, long-lasting symptom relief.

Sleep Apnea

What is it?

Sleep apnea is a condition that occurs when patients breathe shallow or have breathing pauses during sleep. In most cases, patients are unaware of their problem until someone who sleeps with or near them notices their breathing. Because the condition disrupts sleep patterns, patients are typically fatigued and tired throughout the day. An airway obstruction is usually the cause of sleep apnea.

How is it treated?

Patients who seek treatment for sleep apnea are generally asked to participate in a sleep study. While spending the night in a sleep center, patients are monitored. Eye movement, muscle activity, heart rate, and respiratory processes help physicians determine the cause of sleep apnea and how to treat it.

The most common treatment option is a continuous positive pressure airway device (CPAP)—an air-breathing mask worn during sleep to keep the airway open. Other treatment options include hypoglossal nerve stimulation and surgery. In most cases, physicians will recommend lifestyle changes, particularly weight loss.


What is it?

Snoring occurs when airflow is obstructed during sleep. Severe snoring can be unpleasant for patients and those who sleep with them. Patients who notice their snoring or who have been told they snore loudly may need to be treated by an ENT specialist.

By taking a detailed medical history and performing a thorough physical exam, Dr. Neil Goldhaber is able to determine the cause of snoring and come up with a plan to effectively treat it. If it is determined that snoring is a sign of sleep apnea, a sleep study may be ordered.

How is it treated?

Nonsurgical treatment. A continuous positive pressure airway device (CPAP) may be worn at night to keep the airway open and clear. Oral appliances and lifestyle modifications, especially weight loss, may also be recommended.

Surgical Treatment. Severe snoring that does not respond to non-surgical treatment may require surgical intervention in the form of:

  • A thermal ablation procedure. Reduce bulky tissues in the airway.
  • Uvulopalatopharyngoplasty (UPPP). Remove excess tissues in the palate.
  • Septoplasty. Correction of a deviated septum.

Or other surgeries recommended by Dr. Goldhaber. In most cases, patients experience immediate, long-lasting results following surgery.

Allergy & Asthma

The symptoms of allergy and asthma attacks can be easily managed when proper caution is taken and effective treatment options are used. In order to avoid attacks, it is recommended that patients avoid allergens, specifically pollen and mold, by:

  • Staying inside when pollen counts reach their peak (usually around noon)
  • Closing doors and windows during pollen season
  • Washing clothes and showering after being outside for an extended period of time
  • Never drying clothes outside
  • Not going outside on windy or rainy days
  • Keeping gutters clean
  • Using humidifiers and air purifiers inside the home and car

Patients who experience an allergy or asthma attack can treat it using bronchodilators—prescription medications used to open the airways and lungs. Corticosteroids inhalers can also be used to decrease inflammation and swelling.

An additional treatment option is immunotherapy—allergy shots or sublingual tablets are used to expose the body to small amounts of an allergen so immunity can develop.

Nasal Allergies

What is it?

Nasal allergies occur when patients breathe in allergens that elicit an allergic reaction. Seasonal nasal allergies are caused by outdoor allergens, the most common being pollen, mold, and grass. Indoor nasal allergies are caused by dust, pets, mold, and indoor insects.

Nasal allergy symptoms typically present as any, all, or any combination of the following:

  • Sneezing
  • Congestion
  • Difficulty breathing
  • Sinus pain and pressure
  • Itching

Additional symptoms may include watery eyes, fatigue, and/or disturbed sleep. When self-care and over-the-counter medications do not eliminate or decrease symptoms, an appointment with our office is made.

How is it treated?

Depending on the type and severity of symptoms, the following medications may be prescribed to effectively treat nasal allergies:

  • Antihistamines. Slow down the allergic reaction by blocking histamine—a substance released by the immune system in response to an allergen.
  • Decongestants. Reduce nasal swelling. *Antihistamines and decongestants are often combined as one medication
  • Corticosteroid nasal sprays. Treat nasal inflammation.
  • Singulair®. Used with the above-mentioned medications to help relieve symptoms.

An additional treatment option is immunotherapy: Allergy shots are administered over the course of several weeks to expose the body to small amounts of an allergen. This allows the immune system to develop immunity and decreases the likelihood of a future allergic response.

Deviated Septum

What is it?

The nasal septum is a cartilaginous structure that splits the nasal pathway into halves. The majority of people have a deviated or crooked septum. In some cases, this condition can cause:

  • Breathing problems
  • Snoring
  • Sleep apnea
  • Nosebleeds
  • Nasal blockage
  • Chronic sinusitis
  • Facial pain
  • Headaches
  • Postnasal drip

A deviated septum can only be corrected by a surgical procedure known as a Septoplasty. Some patients may choose to have cosmetic nasal surgery (rhinoplasty) in conjunction with a Septoplasty. This combined procedure is referred to as a septorhinoplasty.

How is it treated?

A septoplasty is a 30-60 minute outpatient procedure done under local or general anesthesia. During the procedure, the surgeon moves the deviated septum into an anatomical position and removes pieces of bone and cartilage that block the nasal pathways. Once the procedure is complete, the nose is packed with soft cotton to hold the septum in place.


Results may be seen within a few days after the surgical related swelling goes down. They will continue to be seen for up to a year as the cartilage and bone heal. Following surgery, symptoms are drastically decreased or eliminated and patients are able to live much better lives. Non-smoking patients who protect their nose throughout recovery and lead a healthy life can expect long-lasting or permanent results.

Nasal Polyps

What is it?

Nasal polyps are noncancerous, sac-like growths on the lining of nasal passages or sinuses. While the exact cause of nasal polyps is unknown, they are commonly associated with allergies, asthma, and infections. Most polyps are soft and non-tender. Small polyps may cause no symptoms. Because large polyps can obstruct the nasal passages or sinuses, the following symptoms may present:

  • Breathing problems
  • Congestion
  • Sinusitis
  • Loss of smell and/or taste
  • Headache
  • Facial pain

Patients with symptoms that last for more than 7-10-days should contact our office for an appointment.

A medical history and physical examination are used to diagnose nasal polyps. In some cases, diagnostic tests, such as a nasal endoscopy and/or imaging studies, may also be used.

How is it treated?

Once a diagnosis is made, a treatment plan is prescribed. The goal of treatment is to reduce the size of the polyps. Non-surgical treatment options are tried first and are usually effective, they may include any, all, or any combination of the following:

  • Corticosteroids. Nasal spray or oral medication that decreases polyp size by reducing inflammation and swelling.
  • Antihistamines. Shrink polyps by decreasing inflammation associated with allergies.
  • Antibiotics. Bacteria-killing medications that cure infections that may cause polyps.

Polyps that do not respond to non-surgical treatment may require surgical intervention. During an outpatient endoscopic procedure, an ENT surgeon used a small telescopic camera to view the nasal passages and sinuses. Once polyps are found, they are removed and symptoms are relieved.

Nose Bleeds

What is it?

Nosebleeds occur when one or more of the blood vessels in the nose ruptures. Anterior nosebleeds are caused by ruptured blood vessels in the front of the nose. Posterior nosebleeds are caused by ruptured blood vessels in the back. Generally speaking, posterior nosebleeds are considered the more serious of the two, as they may cause blood to run down the throat.

The most common cause of nosebleeds is a dried nasal passage. Other causes include:

  • A foreign object being lodged in the nose
  • A blow to the nose during a fall, injury, or accident
  • Chemical irritants
  • Chronic sneezing
  • Infection
  • Cool air
  • High blood pressure

Noses that are scratched or constantly picked are at an increased risk to bleed.

If a nosebleed will not stop or is recurrent, you contact our office for an appointment. A medical history, physical examination, and possibly medical imaging studies will be used to accurately determine the cause of the condition and come up with a plan to treat it.

How is it treated? 

Uncontrolled nosebleeds may need to be cauterized. During a quick, in-clinic procedure, the doctor gently cauterizes ruptured vessels with silver nitrate to stop the bleeding. In some severe cases, the nose may need to be cauterized multiple times. Nosebleeds caused by foreign objects are treated by removing the foreign object, sometimes with special instruments, and then possibly cauterizing the bleeding vessels.

Following treatment, preventative measures aimed at keeping the nose moist should be taken. The two most effective are nasal moisturizer sprays and in-home humidifiers.

Balloon Sinuplasty

Balloon Sinuplasty is a safe and effective minimally invasive procedure used to treat chronic symptoms of a sinus infection that last over 12 weeks (chronic sinusitis). The procedure is performed under local anesthesia in our offices.

On average, the procedure takes less than one hour. Patients are able to return home shortly after and return to normal day-to-day activities within 2-3-days.

The Procedure

Following the administration of a local anesthetic, a typical Balloon Sinuplasty is a four-step procedure:

  • A soft, flexible guide wire is inserted through the nose
  • A balloon is advanced over the guide wire and into the blocked sinus
  • The balloon is inflated to clear sinus blockages
  • Fluid is sprayed into the sinuses to flush out pus and mucus

The balloon is then removed to complete the procedure.


Following a Balloon Sinuplasty, sinus pathways are open and clear. Symptoms are drastically decreased or eliminated. In most cases, results last at least 1-2-years. A key benefit of the procedure is that bone and/or tissue does not need to be removed from the sinuses—minimal pain occurs and recovery time is decreased.

Endoscopic Sinus Surgery

What is it?

Endoscopic Sinus Surgery is typically performed to treat Chronic Sinusitis that does not respond to non-surgical treatment. The goal of the procedure is to decrease chronic sinusitis symptoms, such as sinus pain, pressure, and congestion, by widening the nasal pathways. During the procedure, any, all, or any combination of the causes of chronic sinusitis are treated:

  • Nasal obstructions
  • Mucus build up
  • Chronic inflammation
  • Chronic infection
  • Persistent allergies

Following the commonly performed procedure, patients report significant symptom relief.

How is it performed?

Endoscopic Sinus Surgery is an outpatient procedure that is done under local or general anesthesia. During the procedure, the surgeon inserts a nasal endoscope, or telescopic camera, into the nostrils to view the sinuses. Once a nasal obstruction or blockage is found, it and damaged tissue and/or bone are removed to widen the nasal pathways. Additional procedures that may be performed in conjunction with endoscopic sinus surgery include:

  • Septoplasty (correction of a deviated septum)
  • Turbinate reduction
  • Nasal polyp removal

There may be discomfort and swelling after the procedure. Recovery time depends on what is done during surgery and the healing processes of the patient. Because Endoscopic Sinus Surgery is tailored to treat patients on a case by case basis, patients who want to learn more should contact our offices.

Neil Goldhaber, MD

Since 1997, Dr. Goldhaber has been practicing in the diagnosis and treatment of ear, nose, and throat conditions in South Florida. As a native to New York, he received his medical degree from the Mt. Sinai School of Medicine in 1991 and completed his general surgery residency at Beth Israel Medical Center in New York City and his Otolaryngology-Head and Neck Surgery residency at The New York Eye and Ear Infirmary also in New York City.

Located in Boynton Beach, FL.

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