Yanhee International Hospital

Charansanitwong, Bangok, ThaiandWebsite: dr-ornouma.comEmail: yanhee_ent@yahoo.com

Nose Problems

Nasal and facial symptoms are very common in ENT patients and Dr. Ornouma Sriwanishvipat provides a comprehensive advice and management. This would include the common surgery for nasal obstruction to straighten a bent internal septum, through to removal of nasal polyps and cosmetic rhinoplasty.

Septoplasty: this is usually performed to reposition the internal structures of the nose to improve the nasal airway. It does not involve any external incisions or scars, with over 400 procedures done.

  Functional Endoscopic Sinus Surgery (FESS) operations: this

one as well does not involve any external incisions or scars and is usually performed, using scopes for modern "nasal keyhole surgery", to clear sinuses and allow them to drain into the nose, but also to more accurately and precisely remove polyps causing nasal blockage, with over 300 procedures done.

The diagnosis and management of patients with ENT related facial pain

The assessment and treatment of allergic nasal diseases.

Let's be nosy and find out some more about the nose…

The nose is a specially designed part of the body that is involved in the special sense of smell. It is also the main gate to the respiratory system, your body's system for breathing. Most of us take our sense of smell for granted, because it is not necessary for our survival the way our other senses are... However we still rely on it more than you would probably think.

Smell affects many aspects of life such as attraction, memories, and emotions. Our sense of smell also adds a richness to our lives that we aren't always conscious of, but as soon as it's taken away it dramatically changes our quality of life as an anosmic (someone who has lost some or all of their sense of smell). Anosmics suffer from depression and their quality of life is severely affected.

Smell is one of the chemical senses and with these sense we sample our environment for information. We are continuously testing the quality of the air we breathe, like for potential dangers such as smoke from fires, or food and flowers.

 Although it looks little, a nose is a complicated gateway to the respiratory system that most people find difficult to keep healthy. Colds, hayfever, flu, nasal obstructions, sinusitis and sinus infections are evident to the complexity of the nose

The nose has two holes called nostrils. The nostrils and the nasal passages are separated by a wall called the septum (sep-tum). Deep inside your nose, close to your skull, your septum is made of very thin pieces of bone.

Closer to the tip of your nose, the septum is made of cartilage (kar-tel-ij), which is flexible material that's firmer than skin or muscle. It's not as hard as bone, and if you push on the tip of your nose, you can feel how wiggly it is.

Behind your nose, in the middle of your face, is a space called the nasal cavity. It connects with the back of the throat. The nasal cavity is separated from the inside of your mouth by the palate (roof of your mouth).

When you inhale air through your nostrils, the air enters the nasal passages and travels into your nasal cavity. The air then passes down the back of your throat into the trachea (tray-kee-uh), or windpipe, on its way to the lungs.

Your nose is also a two-way street. When you exhale the old air from your lungs, the nose is the main way for the air to leave your body. But your nose is more than a passageway for air. The nose also warms, moistens, and filters the air before it goes to the lungs. The sense of smell is sometimes temporarily lost when a person has a cold.

Nasal problems

Definition: Nasal polyps are those soft abnormal growths or tumor emanating from the sinuses cavities on the surface of the nasal mucosa. Nasal polyps usually develop on the surface of ethmoid sinuses, just in the roof of the nose and grow into the open areas. A polyp may develop singularly or in clusters, and when grown enough, they are visible in the nostrils. Nasal polyps can rarely become cancerous.

Polyps can be very painful and may cause an obstruction and heaviness in the nose. Some people even use their mouth to breathe instead of using the nose because their polyps have blocked there nasal passages. Mouth-breathing often causes sore throats. This is why a sore throat is also a symptom of nasal polyps.

Polyps are resultant from processes of various infections in the sinus and nasal cavities. Most cases of polyp development are associated with certain health conditions that are virally or bacterially transmitted such as hayfever, asthma and sinus infection.

Symptoms of nasal polyps include: Long-term nasal congestion Distorted sense of smell

A runny nose Chronic sinus infections Headaches Snoring

Visible Nasal Polyp

The best treatment option available for nasal polyps is treating allergic rhinitis and any other nasal disorders since polyps often develop after several nasal disorders.

The following are things that should be avoided: Avoid all medication that contain aspirin Avoid over-the-counter nasal sprays. Nasal sprays

are addictive and may only worsen your sinus infection.

Treat allergens that cause nasal disorders like: ◦ Molds◦ Pollen ◦ Dust mites ◦ Animal hair and dander

Surgery, such as functional endoscopic sinus surgery (FESS), may be necessary in some cases. But if polyps are surgically removed, there are chances of recurrence.

Nasal polyp is prominent

Nasal polyp with pus

What is Rhinitis medicamentosa? It is a condition of rebound nasal congestion

brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that work by constricting blood vessels in the lining of the nose.

This condition typically occurs after 5 to 7 days of use of such medications. The swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinate inflammation, which may block nasal breathing until surgically removed.

The treatment of RM involves withdrawal of the offending nasal spray. Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids may be necessary. Oral decongestant medications can also help with the transition.

Common issues that lead to overuse of: topical decongestants: Deviated septum Upper respiratory tract infection Cocaine use Pregnancy (these products are not

considered safe for pregnancy) Chronic rhinosinusitis Hypertrophy of the Inferior Turbinates

Nasal Deviated Septum

The nasal septum is the wall between the nostrils that separates the right and left nasal passageways. It supports the nose and directs airflow. The septum is made of thin bone in the back and cartilage in the front. Septal deviation is a common finding in which a part of the septum bends toward either the left or right. A deviated septum occurs when the cartilage or bone is not straight. A crooked septum can make breathing difficult. The condition also can lead to snoring and sleep apnea. At times, the deviation can cause nasal obstruction, headaches, and even sinusitis by blocking the opening.

The septum can bend to one side or another as a part of normal growth during childhood and puberty. Also, the septum can be deviated at birth (congenital) or because of an injury, such as a broken nose.

Goal The goal of this procedure is to correct

defects or deformities of the septum.

Fortunately a deviated septum can be corrected with an operation called a septoplasty.

Septoplasty is a surgical procedure in which a deviate nasal septum is straightened. There is no other medicine or cure for a deformed nasal cartilage, septoplasty is the only effective treatment.

When the nasal septum is deformed, there is no medicine that will cause it to be straightened, so surgery is the only solution to this problem. Septoplasty takes about an hour to be performed, but swelling and irritation may delay final improvement for about four to six weeks.

Septoplasty is sometimes referred to as septal reconstruction or submucous resection of the septum (SMR). When you septum is deviate, the examination of the inside of your nose for polyps, tumors, epistaxis , and sinus purposes is difficult. So septoplasty help straighten your nasal septum for both improved examination and breathing.

Septoplasty is performed to correct a crooked (deviated) or dislocated septum, often as part of plastic surgery of the nose (rhinoplasty). The nasal septum has three functions: to support the nose, to regulate air flow, and to support the mucous membranes (mucosa) of the nose. Septoplasty is done to correct the shape of the nose caused by a deformed septum or correct deregulated airflow caused by a deviated septum.

Before surgery, the doctor may use a thin, lighted instrument (endoscope) to look at your nasal passages and to see the shape of your septum. In some cases, the endoscope may be used during surgery. You will receive local or general anesthesia for the 60- to 90-minute operation, which is usually done in an outpatient surgery center.

The septum and nasal passages are lined with a layer of soft tissue called the nasal mucosa. To repair the septum, the surgeon works through the nostrils, making an incision to separate the mucosa from the underlying cartilage and bone.

During surgery, the patient's own cartilage that has been removed can be reused to provide support for the nose if needed. External septum supports are not usually needed. Splints may be needed occasionally to support cartilage when extensive cutting has been done. External splints can be used to support the cartilage for the first few days of healing. Gauze is inserted in the nostril to support the flaps and cartilage and to absorb any bleeding or mucus.

 

chronic sinusitis

Definition Sinusitis, commonly called a sinus

infection, is inflammation and infection of the air-filled spaces that are located within the bones in and around the nose. This results in swelling of the mucus membranes that line the sinuses, pain and pressure in and around the eyes and cheekbones, and a thick green discharge from the nose.

Generally, chronic sinusitis is diagnosed when symptoms of sinusitis persist for longer than 12 weeks despite treatment. In chronic sinusitis, the mucous membranes in the nose and paranasal sinuses are constantly inflamed and become thickened. The inflamed membranes can be seen upon examination of the inside of your nose by your health care provider.

In some cases, sinusitis can spread from the sinuses to the nervous system and lead to life-threatening infections and complications, such as meningitis or brain abscess

Symptoms of chronic sinusitis are similar to those of acute and recurrent sinusitis, but they are experienced on a continuous basis. Symptoms of chronic sinusitis last for about 3 to 8 weeks and may recur for months or even years. The general symptom of chronic sinusitis is pain in the sinus area accompanied by thin watery secretions.

Other symptoms of chronic sinusitis include: Severe headache Throbbing facial pains Runny nose Tiredness Sneezing Tenderness over sinus region Recurring sore throats Halitosis

Various factors contribute to the over-production of mucus and nose glands irritation, thus triggering nasal drip.

Sinus or nasal infections Pregnancy and changes in hormones Low humidity Side effects of other medication Nasal tumors Gastroesophageal reflux Cold temperatures

Treatment may include a humidifier, medications, or possibly surgery. Surgery should be considered when medical treatment fails or when an injury, structural problem, or obstruction is present. Chronic sinusitis with nasal polyps is a common reason for sinus surgery.

Sometimes, chronic sinusitis may be a sign of a serious underlying disease, disorder or condition. Seek prompt medical care if you have symptoms of sinusitis that are unexplained, do not respond to treatment as expected, last longer than 14 days, or recur.

Don't wait for sinusitis to attack. It is always better to prevent sinusitis from attacking rather than trying to recover from its severity.

There are certain habits that you must eliminate in order to prevent sinusitis. There are also foods and environmental factors that are not good if you suffer from sinusitis.

Minimize consumption of dairy products - An excessive consumption of dairy products may thicken mucus and narrow your nasal passages causing pain and headaches.

Take many hot showers and inhale steam - This will loosen your mucus and moisten your throat, enabling proper drainage of the nasal cavities.

Avoid temperature extremes - Very high and low, or sudden changes in temperature will increase sinus pain.