COVID-19 Update

Due to the COVID-19 pandemic, our office will be open for emergency visits solely. We have taken this step to protect our patients and our staff during this unprecedented time.  We are pleased to announce that we will be seeing patients via Telemedicine through iSalus Anywhere Care   If you wish to be seen, please call 775 322 4589 to schedule.


Sinonasal tumors

Tumors of the nasal cavity and paranasal sinuses are not common in the general population, but are commonly encountered in a rhinology practice.  When unilateral symptoms such as nasal obstruction, smell loss and epistaxis are present then evaluation by an otolaryngologist would be prudent.

The most common sinonasal tumor is an inverted papilloma.  These are also known as Schneiderian papillomas.  Fortunately these are benign tumors, but they can turn into squamous cell carcinoma eventually if not excised.  They can occur throughout the nasal cavity and paranasal sinuses.    Inverted papillomas can be quite large, but usually will have a distinct attachment site that can be identified on CT imaging by looking for an area of hyperostosis.  MRI imaging is helpful to further define the extent of tumor and to distinguish between tumor and blocked secretions.  Most tumors can be excised using traditional endoscopic sinus surgery techniques, and extended endoscopic approaches such as frontal sinus drillout and endoscopic medial maxillectomy can be used to remove tumors without external incisions.  Treatment of the attachment site should be treated with excision, drilling or cauterization to ensure complete removal of all of the tendrils of tumor to prevent recurrence.

Allergic fungal sinusitis can mimic a tumor with its unilaterality, however it is uncommon in the West.

Sinonasal malignancies are thankfully rare (1:500,000 to 1:1,000,000), but prompt diagnosis and management are key to ensure survival.  Squamous cell carcinoma, melanoma, sinonasal undifferentiated carcinoma, esthesioneuroblastoma, lymphoma and adenocarcinoma are the most common sinonasal malignancies.  For most sinonasal malignancies, except lymphoma, treatment is usually surgical resection, and depending on the tumor pathology, post operative radiation and chemotherapy.


Josh Meier, M.D. F.A.R.S.

Endoscopic Septoplasty

Endoscopic septoplasty is a newer technique where an endoscope is used to visualize the nasal cavity to straighten the nasal septum. Most people’s septum will be deviated to one side or the other, which is not a cause for concern. However in some people the deviation is significant enough that it results in nasal obstruction. If this is the case, then they would be a candidate for septoplasty. The incision is made on the side of the deviation, 1-2cm back from the most forward part of the septum. The mucosa is lifted up on this side, then the cartilage is incised and the flap is lifted on the other side. Deviated bone and cartilage is removed, and the deviation is reduced. The flaps are stitched together with an absorbable mattress suture. The vast majority of the time, stents and packing are not required.   This results in minimal post op pain, and Tylenol is adequate for postoperative pain control.   Neilmed rinses are begun the next day.   Not all people are candidates for endoscopic septoplasty, namely those with significant forward deviations, where a traditional approach is indicated. Please see the link below for an intraoperative video.   Frequently endoscopic septoplasty is performed concurrently with endoscopic sinus surger.y  In fact, inadequate septoplasty can be a reason for failure of surgery due to limited visualization of the sinuses while performing endoscopic sinus surgery.


Josh Meier, M.D. F.A.R.S.

Dr. Meier and Dr. Tolbert attend course on advanced endoscopic skull base techniques

Dr. Meier and Dr. Marshall Tolbert of Sierra Neurosurgery attended the University of Pittsburgh’s Endoscopic Endonasal Skull Base Course in December of 2018.  This four day course discussed the state of the art techniques involved in endoscopic management of cranial base disorders such as benign and malignant nasal tumors, CSF leaks, pituitary and other ventral skull base tumors.  The course involved lectures, prosections, live surgery and hands on dissections. This meeting was attended by dozens of rhinologists and neurosurgeons from around the world.  Dr. Meier and Dr. Tolbert are excited to return to Reno with the latest techniques to treat pituitary tumors in a minimally invasive fashion.




Ask the Doctor with Dr. Meier

How to Handle Your Summer Allergies

Allergies can make you miserable. From the itchy eyes and runny nose to the sneezing and congestion. Allergies make it hard to enjoy yourself during beautiful summer months. Try these simple tips to keep your summer allergies under control and have fun this summer!

Keep Indoor Air Clean

Unfortunately, there is not a product that can magically eliminate all allergens in your home. However, when using the air conditioning in the house or car regularly, changing the air filters and keeping the indoor air dry with a dehumidifier can greatly help.

Reduce Exposure

Try and reduce your exposure to things that can activate your allergies like staying indoors on dry or windy days. Understanding that spending all summer indoors is impossible, plan ahead by looking at local weather or pollen levels.

If outside chores are calling your name, either wear a pollen mask or delegate the chores like lawn mowing or weed pulling. After outdoor chores or activities, remove the clothes you wore outside and shower to remove all the pollen from your hair and skin.

Rinses Those Sinuses

Rinsing your sinuses, or nasal irrigation, is a beneficial way to relieve symptoms for those who struggle with allergies or just general nasal congestion. Nasal irrigation is flushing out your nasal cavity with a saline solution. The solution is a simple mixture of purified water and salt, used in combination with a squeeze bottle or a neti pot. Directly rinsing your sinuses or nasal passages will flushes out mucus and allergens in your nose.

Over-the-counter remedy

If the tips above are not cutting it, there are several types of nonprescription medications that can alleviate your allergy symptoms.

  • Oral antihistamines can help relieve sneezing, itching, a runny nose and watery eyes
  • Decongestants, such as pseudoephedrine, can provide temporary relief from nasal stuffiness
  • Nasal spray can ease allergy symptoms and doesn’t have serious side effects, though it’s most effective when you begin using it before your symptoms start

Consult a Doctor

For some, taking precaution or using over-the-counter medications isn’t enough to alleviate their allergy symptoms. So, consult your doctor to determine the best course of action for your allergies, whether they are seasonal or year around.

For more information on all Rhinology questions or to schedule an appointment with one of our physicians, please visit call 775.284.856.

How to Protect Hearing During Summer Outdoor Activities

Summer is the best time for outdoor activities like swimming, live concerts, fireworks and even yard work. While these activities can be fun, your hearing could be at risk, here are some preventative measures to keep in mind during these summer activates.

Live Concerts

Outdoors concerts are great during the summer but can be just as harmful because of the high volume of decibels during the concerts.

Decibels are a unit used to measure the intensity of sound or the power level of an electrical signal by comparing it with a given level on a logarithmic scale.

The typical person can accept 85 decibels for a maximum of eight hours a day, followed by at least a couple hours of recovery time. Most live concerts are at a volume of 100 to 110 decibels which decrease the length of exposure time.

There are two options for all concert goers, placing oneself as far away from speakers as possible or wearing ear plugs. Earplugs can decrease the noise by 20 to 30 decibels.

Both are good options to avoid ringing in the ears after the concert has ended.


Between Fourth of July, baseball games and local events, fireworks are a staple during summertime. Although fireworks produce between 140-150 decibels, they generally do not cause problems because the explosions are short-lived and happen in the sky.

However, it’s always better to be safe than sorry. Keeping your distance, around 500 feet, is a great way to still enjoy the beautiful show but also keep your hearing safe.

Using earplugs is an inexpensive and efficient way to protect your hearing. Various types of earplugs are able to reduce different level of decibels.

Water Activities

The best way to cool off can also be the most common cause of ear trouble during the summer. Swimming in any type of water can cause water to get trapped in the middle ear.

The middle ear is the part between the eardrum and the oval window. It transmits sound from the outer ear to the inner ear. Getting water trapped in the middle ear can cause an infection to develop.

Wearing earplugs or custom-molded ones can prevent trouble or pain.

Outdoor Equipment

Equipment like lawnmowers and weed whackers can produce up to 100 decibels so wearing earplugs is a key protective measure. Some people prefer to jam out to music through headphones while doing yardwork, this isn’t the same as using earplugs and can be harmful.

Listening to music requires the music to be louder and drown out the sound of the equipment.

Be aware of your proximity to the loud sound and remember to use ear plugs if you need to. There are a variety of earplugs that are best for different types of activities including swimming and attending concerts.

To schedule an appointment with one of our physicians at the Reno Tahoe Sinus Center, please visit call 775.284.856

Septal Deviation and Septoplasty

Septal deviation is a common condition, with a significant portion of the population having their septum deviate to one side or the other.  Commonly some degree of nasal trauma may cause a deviated septum.  Many people are asymptomatic from this, however a few can have nasal obstruction symptoms on the side that is deviated.  In these patients, septoplasty (i.e straightening the septum), can be performed.  It is usually an outpatient procedure, performed under general anesthesia.  After the operation, the patient can breathe better on the affected side.  If the deviated septum is more posteriorly placed, endoscopic septoplasty is a good option for the patient.  This approach can be done without packing or splints afterwards, and the recovery is easier.  Commonly an inferior turbinoplasty is performed concurrently because the turbinates can be swollen due to allergies, or to compensate for the extra space on the non deviated side.

Josh Meier, M.D. F.A.R.S


Dr Meier Gives Community Lecture on Chronic Sinusitis at Northern Nevada Hospital

Dr. Meier lectured to members of the community at Northern Nevada Hospital on April 25th, 2018.  Topics included nasal allergies, atrophic rhinitis, and epistaxis care.  Cutting edge medical and surgical management of chronic sinusitis was discussed.


Nasal Rinsing, or the Use of Neti Pots

The use of neti pots and similar methods of irrigating the nasal cavity is an old homeopathic remedy for sinus pressure and high levels of sinus mucus. Though the neti pot stems from ancient Indian Ayurvedic hygiene and wellness practices, doctors have recently been paying more attention to the method. What they have found is that it is both a safe and effective method for clearing the sinuses of mucus, and may also help to reduce inflammation by flushing small, irritation-causing particles out of the sinuses, as well as viruses and bacteria.

Usually a nasal rinse is some form of saline concentration. It is recommended that patients use an isotonic concentration, or a concentration that has saline levels similar to those in the human body. Patients can either purchase premixed salt packets for this or make their own at home. One common recipe calls for 2-3 teaspoons of iodine-free salt and 1/4-1/2 teaspoons of baking soda for one liter of sterile water. Including a small amount of baking soda in the rinse has been shown to yield better results than saline alone. Some patients prefer higher levels of saline concentration, but studies have shown that this can damage the nose’s cilia. Cilia are small, waving hairs that keep the nose clean. Increased salt levels in your nasal rinse can lead to increased nasal congestion and nasal swelling.

It is very important when flushing your nasal cavities that you use sterile water. Boiled, distilled, or well-filtered water are recommended. Do not use water from a wild or questionable source without appropriate filtration and sterilization. In very rare instances, amoeba present in a municipal water source has caused encephalitis in neti pot users. Encephalitis is a deadly brain infection. It is not common to find such amoeba outside of untreated water supplies, but the results are serious, so use caution and ensure your water is safe before using it in your sinuses.

In addition to sterile water, it is also important to use sterile equipment. To sterilize the bottle you are using, microwave it for two minutes in cold water. One study found this method more effective than a boiling water rinse. Using Milton’s antibacterial solution was also found to be an effective sterilization method.

Ideally, an effective nasal rinse will reach as much of the nasal lining as possible. There are a couple of factors in application that may improve the rinse’s effectiveness. First, when applying the rinse, place your head down. This can help the irrigation reach the top of the nose and forehead sinus. Second, a high volume of delivery tends to be more effective than a lower volume of delivery. The increased volume tends to result in the optimal coverage of the nasal lining.

There are a couple of treatments that can work in conjunction with nasal rinsing to improve patient results. One is sinus surgery. If there are nasal blockages present, surgery can lead to improved delivery and effectiveness of a nasal rinse. Another is medicated irrigation. In patients with chronic sinusitis who were using topical antibiotics or nasal steroid sprays, high volume rinses with diluted steroids improved their symptoms.

If you are having nasal issues, please call and make an appointment with one of the specialists at Nevada ENT and the Reno Tahoe Sinus Center. We can help determine the source of your symptoms and give you information on treatment options individually tailored to your circumstances.


Source: Nasal/Sinus Irrigation by Benjamin S. Bleier, MD