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Medical and surgical management of nasal and sinus disease is the focus of Tony Reisman, MD. Allergy. "It's important to determine the interplay between what is related to ongoing sinus disease and what is related to allergic disease. Once you get in that mindset, it makes it a bit easier to elucidate the components of the problems," he explains. Form and function of the nose is Dr. Ponsky's forte. Her specialties include rhinoplasty, septoplasty and repair of septal perforations caused either by trauma, previous surgery, polyps, infections, or chronic use of nasal steroid medications or illicit drugs such as cocaine. "The nose is the gateway into the sinuses," Dr. Ponsky explains. "If you have a very crooked septum and a lot of congestion from allergies or from turbinate hypertrophy, this will lead to sinus issues down the road. And sometimes just by fixing the septum or reducing the turbinates or removing polyps, you facilitate more airflow into the nose and can ward off any aggravation of sinus issues." Like Dr. Reisman, Dr. Ponsky also has a special interest in obstructive sleep apnea. She points out that many variables can contribute to this: septal and other anatomic deviations, obesity (leading to deposits of fat in the soft tissue around 20 | Cleveland/Akron/Canton MD NEWS ■ MDNEWS.COM ■ JANUARY/FEBRUARY 2014 the mouth and throat), polyps, tumors, enlarged turbinates, and compromised nasal valves. "As people age, their nasal valve area becomes more flaccid. There's less tone and less integrity of the cartilage. This contributes to resistance in airflow," she explains. "Surgically fine tuning the nose can eliminate or at least minimize these problems, so patients can use their CPAP (continuous positive airway pressure) machines more compliantly." The Technology Most treatments are minimally invasive thanks to advanced technology that's smaller, more streamlined and less traumatic for the patient. As a result, patients experience less pain and discomfort, less bleeding, and a quicker return to normal daily activities. For chronic sinusitis, microdebriders enable removal of diseased tissue with little to no trauma to surrounding healthy tissue and without significant bleeding. While removing and vacuuming away the diseased tissue, the newer microdebriders also irrigate at the same time. Balloon sinus dilation technology, while not new, has