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11 February, 2019 00:00 00 AM

Rhinology

Medi-Info
Rhinology

Rhinology is the branch of medicine that studies disorders of the nose and nasal passages. Common problems include allergies (Allergic Rhinitis) and sinus disorders such as sinus pain or sinusitis. Some other disorders of the nose include:

nose bleeds

stuffy nose

loss of smell

nasal polyps.

Sinusitis

Sinusitis is the infection or inflammation of the sinuses. Sinuses are hollow air spaces located within the skull or bones of the head surrounding the nose. They are found in the cheeks (maxillary), forehead (frontal) and around the eyes (ethmoidal). The sinuses are joined together and linked via thin channels called ostia.

Each sinus has an opening into the nasal cavities for the exchange of air and drainage of mucus. These openings can be obstructed by the swelling of the lining of the nasal cavities that can occur with a cold or allergy.

Too much mucus or a swelling of the lining of the sinuses and nose obstructs the narrow channels and causes sinusitis. This can happen because of a cold, an allergy or inflammation of the linings of the sinuses. Bacteria can then develop inside the blocked sinuses resulting in an infection, causing pain, headache and sometimes fever. Air trapped within an obstructed sinus, along with pus or other secretions may also cause pressure in the sinus wall, resulting in pain.

Dr Chao Siew Shuen, Associate Consultant Ear Nose Throat - Head and Neck Surgery Department National Healthcare Group National University Hospital, Singapore attributes the causes of sinus problems to one of the following:

Infections

Most adults have cold (viral upper respiratory tract infections) about three times a year and children about six to 16 times a year. The change of mucus from clear to yellow or green may be an indication that bacteria infection has occurred. This can affect the normal sinus drainage, resulting in sinusitis.

Irritants and allergies

Air pollution, cigarette smoke and chemical irritants can cause swelling and blockage of the narrow channels between the sinuses and nasal cavities. Allergies also cause swelling and inflammation in the nose. Common symptoms of nose allergy include nasal stuffiness, runny nose, sneezing, and itchy and watery eyes. The swelling of the nasal and sinus mucosa leads to sinus infection.

Anatomic problems

In some individuals, the nasal septum (bone and cartilage in the centre of the nose) may be deviated to one side. If this deviation is severe, drainage from the sinuses can be affected, with resultant build-up of mucus which may cause sinus infection. Nasal polyps (growths in the nose) can also obstruct the drainage of the sinuses. The trapped or stagnant mucus provides a good breeding ground for bacterial growth and hence, infection.

Who are at risk?

Sinusitis affects any age group although the following groups are more susceptible to it than others:

allergy sufferers

asthma patients

people who have deviated septums (wall dividing the nasal cavity into two)

smokers

children with cystic fibrosis

people with immunodeficiency.

What are the symptoms?

The symptoms associated with sinusitis are:

blocked nose

feeling pressure, pain or swelling in the face

headache and feeling unwell

aching teeth in the upper jaw

yellow or green-coloured    mucus from the nose

loss of smell and taste

persistent cough

fever

Chronic sinusitis persists, sometimes resulting in infections in the bones and tissue near the sinuses. There may also be other complications affecting the nose, throat and ears. These may include middle ear infection and post-nasal drip.

How is it diagnosed?

Diagnosis of sinusitis in the early phase of the disease can be difficult. However, an initial diagnosis would include taking a complete and thorough history and examining the nasal cavities with a flexible endoscope.

Depending on the findings at endoscopy, a CT scan of the sinuses may be necessary. If a surgery is required, a CT scan will ordinarily be done prior to the procedure.

How is it treated?

Medications

antibiotics

nasal steroid sprays

mucous thinners and salt water washes for the nose

antihistamines and nasal decongestants.

Procedures

When there is failure of medical treatment or when complications occur, sinus surgery may be necessary.

Functional Endoscopic Sinus Surgery (FESS) - this minimally invasive procedure, unblocks and promotes drainage of the sinus. The process utilises an endoscope allowing the surgeon an inside view of the sinuses. FESS is carried out under general anaesthesia and can last between one to three hours depending on the extent of the blockage. The diseased tissues are removed and the drainage pathways of the sinuses are opened up. The sinuses that need to be opened up will depend on the extent of the disease

Image guided keyhole surgery - carried out using computers and specialised software to help view what the endoscope cannot. While such devices are not necessary during a sinus operation, it helps to confirm important landmarks and hence allow more effective clearance of the diseased tissue and can also improve the safety during the operation.

Nasal Polyps

Nasal polyps are growths in the nose, blocking the airway and the drainage of sinuses. These non-cancerous growths resemble grapes and can grow big enough to block the nasal passages. Although the exact reason of nasal polyps is not known, it is attributed to allergies to certain things in the environment and sinus infection.

Who are at risk?

Nasal polyps can occur at any age, but are common in men over 40 years of age.

What are the symptoms?

Polyps obstruct the nasal cavities and cause nose blockage. Patients also often complain of reduced sense of smell. When there is an infection, symptoms of green or yellow drainage from the nose and pressure or pain over the affected sinuses can occur. At times, the polyps become so large they actually protrude from the nostrils.

How is it treated?

Medications

Cortisteriods - to shrink the polyps in some cases and can be taken in three ways through injection, pill or nasal spray. Sometimes, when an infection is detected, antibiotics may be prescribed.

Procedures

If medication fails, surgery can be performed to remove the polyps. This is usually performed endoscopically with or without image guidance. Although surgery is effective in relieving symptoms, nasal polyps will recur 40 to 50 percent of the time, and repeat procedures may be necessary.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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