Project Description
Nose & Sinus
Conditions involving the nose and sinus include nasal obstruction, nasal fractures, sinusitis, polyps and correction of the external nasal deformity (rhinoplasty).
Overview:
It is an exaggerated reaction of the nasal lining to the allergens in the air, which are usually harmless but can cause problems in sensitive people. Although it is not a life threatening condition, it can significantly impair quality of life and work and school performance.
Common Causes:
When it is caused by outdoor allergens such as pollens from grass, weeds or trees, it is called seasonal allergic rhinitis (hay fever). When it is caused by indoor allergens like house dust mites, moulds or cockroach droppings, it is called perennial allergic rhinitis. One can have either seasonal or perennial allergic rhinitis, or a combination of both.
Medical Symptoms:
Common symptoms are sneezing, runny nose, itchy eyes, blocked nose, postnasal drip and decreased sense of smell. Allergic Rhinitis can contribute to other problems such as bronchial asthma, sinus disease, ear disease and sleep disturbances.
Familial Tendency:
Allergic rhinitis may coexist with other allergic disorders such as food allergies, bronchial asthma and eczema. You are more likely to develop these diseases if there is a strong family history of allergic disorders.
Medical Treatment:
There is no cure for Allergic rhinitis but different options are available to control the symptoms.
- Allergen avoidance is the most effective way to control the symptoms but it is not always possible. Because of the widespread presence in the outdoor air, pollens can be difficult to avoid. Reduction of outdoor exposure during the season can be somewhat helpful. Indoor allergens can be controlled by appropriate measures. For dust mites, covering the mattresses and pillows with impermeable covers helps reduce exposure. It is very difficult to clear carpets and rugs from dust mites so they should be removed from house. Dust mites thrive when indoor humidity is more than 50%, dehumidification or air conditioning is helpful. For animal allergy, complete avoidance is the best option. Cockroach extermination may be helpful for cases of cockroach sensitivity. Nonspecific triggers like smoke, strong perfumes and rapid changes in temperature should be avoided as much as possible.
- Medication – Most cases of allergic rhinitis respond to medication. Patients with intermittent symptoms can be treated adequately with non-sedating antihistamine and decongestant. Regular use of intranasal steroid spray may be more appropriate for patients with chronic symptoms. In some cases short course of oral corticosteroid may be very helpful.
- Immunotherapy (Desensitization) – In some patients it is an effective and sustainable mode of treatment. It is a long term process, improvement is often not observed for 6-12 months. Immunotherapy is not without risk because severe systemic allergic reactions can sometimes occur. Therefore, careful consideration of risks and benefits of immunotherapy is required in every patient.
- Sublingual immunotherapy (SLIT) is an alternative way to treat patients affected by allergies without injections. Sublingual immunotherapy decreases the use of allergy medications, such as nasal steroids and antihistamines. Sublingual immunotherapy is more time-efficient for patients than subcutaneous immunotherapy. Treatments are kept and taken at home at the patient’s convenience. After the patient has had an allergy test to confirm the patients sensitive’s, an allergen extract is prepared in drop or tablet form and the patient is directed to keep it under the tongue for one to two minutes and then swallow it. The process is repeated from three days a week to as often as daily with recommendations that therapy is continued for three to five years to develop a lasting immunity.
Overview:
Deviated septum occurs when the thin wall (nasal septum) between your nostrils is displaced to one side. A deviated septum can block one side of your nose and reduce airflow, causing difficulty breathing. Nasal obstruction can occur from a deviated nasal septum, from swelling of the tissues lining the nose, or from both.
Medical Symptoms:
Most septal deformities you do not have symptoms, and you may not even know you have a deviated septum. The most common symptom is nasal congestion, with one side of the nose being more congested than the other, which results in difficulty breathing. Recurrent or repeated sinus infections can also be a sign of a deviated septum.
Medical Treatment:
If a person has a deviated septum and it causes breathing problems or sleep apnoea and snoring, surgery may be recommended to correct the septum. The other options are to manage symptoms with nasal sprays.
Decongestants should be avoided for long term use as they can lead to a rebound effect.
Nasal steroid are a prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect. Steriods are safe to use for long term use.
Overview:
Nasal polyps are benign, pedunculated swellings of nasal mucosa usually associated with allergic rhinitis or chronic sinusitis. Nasal polyp can be single or multiple depending upon the aetiology. The lining becomes increasingly swollen and then hangs down. Single polyps are usually caused by sinus infection or in rare causes nasal tumours.
Medical Symptoms:
Common symptoms are nasal congestion, rhinorrhoea, postnasal drip, snoring, insomnia, reduction with sense of smell and headaches. Nasal polyps can impair a person’s quality of life. Obstruction of the sinus opening frequently leads to recurrent sinusitis.
Medical Treatment:
Oral corticosteroids are the most effective medical treatment for nasal polyps but the effect is usually temporary. Nasal steroid sprays can reduce the growth of small polyps and are more effective in the postoperative period to prevent regrowth of polyps.
The standard surgical treatment is endoscopic removal of nasal polyps under direct vision with preservation of maximum amount of normal nasal mucosa. After surgical removal, future recurrence of polyp formation is still possible. In expert hands the risk of neurological or orbital complications are very rare.
Overview:
It is defined as inflammation of the mucosa of paranasal sinuses caused by a variety of disease processes. It is a common condition and a significant cause of morbidity.
Medical Symptoms:
Common symptoms are facial pain or headache, nasal congestion, nasal discharge, postnasal drip, chronic cough, malaise, fetid breath and hyposmia.
Following conditions may predispose to sinusitis:
- Nasal polyps
- Allergic rhinitis, Non allergic rhinitis
- Repeated upper respiratory infections
- Environmental pollution
- Smoking
Drainage of the nasal sinuses can be blocked by obstruction at the sinus opening or swelling of the nasal mucosa. Stagnation of mucus in the sinuses creates a favorable environment for bacterial growth that further contributes to mucosal inflammation. Sinusitis is rarely life threatening, although serious complications can occur because of the extension of infection to orbit and brain.
Medical Treatment:
The goals of treatment are to reduce swelling of nasal mucosa, promote sinus drainage and eradicate infection. This often requires a combination of topical or oral corticosteroid, decongestant, antibiotics and nasal irrigation with salt water. In some patients the disease is so extensive or associated with co-existing pathologies that medical treatment is ineffective and surgery is required.
Surgical Treatment:
The goal of surgery is to re-establish sinus ventilation by opening and widening the blocked sinus ostia and to restore the normal function of the mucociliary system. Functional Endoscopic Sinus Surgery is the procedure of choice for the treatment of sinusitis. It restores sinus health with complete relief of symptoms in over 80% of patients and majority of patients report a significant improvement in their quality of life. Supportive medical treatment is required in the form of nasal douches and nasal sprays.
Overview:
Paranasal Malignancies occurs when the cells lining the nasal cavity, the sinus passages and the nasopharynx – which is the area behind the nose above the back of the throat become cancerous. Generally, nose cancer affects men more than women, and typically occurs between the ages of 35 and 55.
A nasendoscope (a flexible tube with a very small telescope at the end, which is passed into one of your nostrils) is inserted through the nose to look for abnormal growths. If there are any signs of disease a biopsy is taken of the abnormal tissue to look for any cancer cells.
Medical Treatment:
Treatment for nose cancer various on the location of the cancer also the extent of the disease. As well as if it has spread and how far. Treatment options include Radiotherapy, Chemotherapy or Surgery. If detected early surgery may be the only treatment needed. Chemotherapy is used to improve the outcomes for the patient following their surgery. Chemotherapy may also be used in combination with radiotherapy to improve the efficiency of radiotherapy.
Surgery:
In majority of cases a neurosurgeon is present and the surgery is performed jointly. Following surgery a short stay in intensive care is recommended and the patient is usually discharged after 5 days if there are no problems.
The major post operative problems that we look for are CSF leak (cerebrospinal fluid leak), if this occurs the patient will need to stay in hospital for a longer period of time until it stops.
