Appt with you in July, Deviated Septum question
Dr. Houser, I know we've had many coversations about my problem. After experimenting with saline gel and looking at my CT before and after scans I believe that the problem is when the dr straightened my septum he removed too much bone. In the photo below can you tell me what part of the nose my deviated septum was at. Middle of the nose? I understand you'll do the cotton test and probably scope my nose to see where to put the cymetra injection but I'm wondering if where the old deviated septum was that is where the injection needs to be. When i inject the saline it feels like it's going in the middle of my nose (myguess is where old deviated septum was.) Could you tell me by looking at the following CT photo what part of my nose the deviated septum was located at , and do you think my theory may be correct. I know injecting the saline really helps add resonance to my voice when Im singing. Problem is I can't allows hit what I call the sweet spot. One time I shot it up too high into my nose and I couldn't hit my high notes. Here is the photo: http://www.flickr.com/photos/28165454@N05/ Please let me know what you think and I look foward to finally seeing you later this month.

a septal deviation with a spur to the left some mucosal thickeing in the sinuses - max and post ethmoids seen on the CT I do not expect that the bone removal (spur) would cause a detriment, but rather should improve the airway and singing resonance

Dr. Houser pic after surgery
Dr.Houser, I've now included a ct scan pic post surgery. Is there anything on the pic that would lead you to believe something could be causing ENS type symptoms on my left side. The only difference I can see between the left and right side is that my maxillary opening on the left is a bit bigger than my right. http://www.flickr.com/photos/28165454@N05/2635562400/ Last week I had an endoscopy done and it showed my vocal chords having laryngitis. Since your comments about the pre -surgery pic (your opinion that removing the deviation and spur should help my singing and resonance) I'm really confused. You know I was coming to see you in July for two reasons. 1) Ens type symptoms on left side, and 2) resonance issues with my singing I had mentioned before also that shooting saline in left nostril helped with my resonance when singing and with ens type issues. I'm just wondering now if I'm on too many drying agents and that is what is causing the whole dryness issue and resonance problem. With my vocal chords looking so dried out I believe that may be the issue. Maybe since surgery I have more of a tendency to dry out easier on the left side. Being on allergy shots (quit a few months ago) , flomax, detrol la, prilosec and zyrtec maybe that is causing the intense dryness I'm feeling in my nose and apparantly in my voice after getting the results of the endoscopy. I'm going to a new urologist this month to see about the possibility of getting off the detrol la and flomax (from what I understand both are drying agents). Which by the way I started on both around the same time as my sinus surgery occurred. It should also be mentioned I do have a very mild case of barretts esophagus which has improved tremendously since first being diagnosed in 2004. That was the reason for the endoscopy. I have to get my barretts checked once every three years. If you don't see anything in the ct scans that could be causing the dryness, resonance problems on that left side then it sounds like I just need to work on figuring out what Im taking or doing that is causing the dryness/resonance issues. I was convinced that injecting cymetra where the deviated septum/spur used to be would be the solution to the problem. It sounds like I am totally wrong. I have been to 5 ENT's down here that ran a scope on my nose and camera and all said nose is fine. I was just going by what I was feeling. I declared they were all wrong. Seeing now they may have been right. In your opinion do you think I should keep my appointment with you, or do you think I should just work on figuring out what is causing the dryness in my nose as well as my vocal chords? My appointment with you is scheduled for July 29th. I know my case is much different than the ones you normally see. I understand most of the patients you see have problems due to partial or full turbinate reduction. I know we've had numerous convesations through email about my problem. I can't tell you how much I appreciate you answering each one and trying to help me figure out what is going on with my dryness,resonance issues. As I've said in the past I'm a semi-professional singer and finding a solution to this problem has a huge priority for me. Singing is my life and without it I feel lost. I've gotten looks from various labels and publishers in Nashville over the years and my singing is much more than just a hobby to me. Not being able to sing to my full potential has really weighed on me. Not to mention the ENS type feelings on the left side that are so annoying. Sorry for such another long email , but I felt it was the only way to describe my situation. Please let me know if you think I should keep my appointment with you. Thanks as always, Gary P.S. I will be making a donation to the ENS foundation whether or not I come to see you. I'll actually be making two donations. One for all the help you've given me , and another one for all the help TE has given me.

I see nothing on the scan that explains dryness. Your surgery looks like it was done well. Yes, your ostia are opened up, but not to an obsene degree either. You are on meds that can certainly cause dryness which can affect the voice. I would have hoped the urologist would have mentioned the drying effect of those meds. To be honest I do not expect that a cymetra injection to the septum at the former spur site would be of much benefit. I am happy to see you in the office and do a cotton test, etc. but I want you to be fully aware of these issues.

About resonance
Dr. Houser, Do you think the cymetra injection would help with my resonance when singing. I don't understand why my voice sounds deeper/more full/more nasally when I use the saline. It sounds more likeit used to before I had the sinus surgery. I was just thinking that a cymetra injection would do the same effect as the saline does, but would be permanent. I was also thinking that the cymetra would keep more moisture in my nose. Ever since the sinus surgery I just get little flakes of boogers. I guess most people would consider that a good thing. To me though I liked it better when I actually had boogers and moisture in my nose. I've quit the Detrol LA this past week and have seen some reduction in dryness. I go see a new urologist next week to see about getting off both Detrol LA and Flomax. I still have an appt with you scheduled for July 29th. I just have mixed feelings about whether or not the cymetra injections are going to help me. The trip is getting more and more expensive as the airline prices go up. I know you can't really advise me about what to do. This trip isn't just about the singing issue , but also the emptiness feeling I get in my nose and overall feeling of being too open/dryness. I know in your last reply you stated that you weren't sure the cymetra injections would be of much benefit to me. I guess this is all just speculation until you examine me with the cotton test. Any thoughts/advice about what i wrote. Thanks as always, Gary

Cymetra can expand the existing tissue. It cannot be placed in a localized fashion - meaning cannot make a speed bump in front of the max outflow, but rather can inject into the IT and expand the whole area. I wish I could tell you it will work wonders, but I would be overstating the case. It should reduce the airflow which helps you trap moisture. It is good to get off the drying meds - they affect your vocal cords as well.

Understand more about the cymetra now
Dr. Houser, Okay, that makes a lot of sense to me. You're basically going to just fill up the space some on that left side by injecting the cymetra into the Left IT. Personally, I think that would help me a great deal. When I inhale individually through each nostril you can certainly tell that much more air is going through the left nostril. I've demonstrated this with other people and they can tell the difference easily. They can't believe the difference between the two nostrils. That's why I'm so frustrated with these ENT s in Houston. It's obvious that wayyyyy too much air is going through that left nostril and that's why the openness and dryness drive me crazy on that left side. That last email you sent me really cleared up for me what the cymetra is going to do. Thank you, Gary