Nose and sinus
As an organ of smell, the nose does the job of a pathway for air to pass in and out of the lungs. It also aids in warming, moistening and purifying the air before it enters the lungs. The sinuses on the other hand are four paired cavities in the head which are linked by narrow channels.
The largest sinus cavities are about an inch across. They are lined with soft and pink tissues called the mucous membranes consisting of cells that create mucus and have cilia. The mucus traps dust particles and then drains them out into the nose through a small pathway known as the middle meatus. Due to their tiny size, these pathways tend to get blocked by conditions like cold or allergy which causes the mucus membranes to swell up. This blockage of the sinus drainage may give rise to sinus inflammation and infection.
Generally the sinuses are void except for thin coating of mucus. The sinuses tend to reduce the weight of the facial bones and skull while retaining bone strength and shape. The air-filled chambers of the nose and sinuses also add vibrancy to the voice.
The bones located in one’s head near the nose and eyes contain hollow chambers called the paranasal sinuses. Paranasal sinuses are named after the bones that form their structure. There are four types of paranasal sinuses:
Ethmoid sinuses – Located between one’s eyes
Maxillary sinuses – Located below one’s eyes
Sphenoid sinuses – Located behind one’s eyes
Frontal sinuses – Located above one’s eyes
Maxillary sinuses are the biggest sinus cavities which are more prone to infections. Even though smaller in size, ethmoidal and maxillary sinuses are present at one’s birth, while both sphenoid and frontal sinuses are absent. The frontal sinuses start to form at an early age of two years but are non identifiable till six years of age. All the paranasal sinuses enlarge as one ages, especially during puberty and when the permanent teeth show up.
The inside of the nose has bones called nasal conchae which project into the nasal chambers, molding a series of ridges termed as turbinates. These structures greatly expand the surface area of the nasal chambers which in turn allows more effective exchange of heat and moisture. Turbinates prime function is to help the nose to filter, warm and humidify the incoming air quickly. One suffering with asthma, allergies or cystic fibrosis may suffer from the development of polyps between the turbinates.
The corroborating structure of the upper part of the external nose consists of bone and the lower part consists of cartilage. A thin wall called the nasal septum divides the nasal cavity into two passages which extend from the nostrils to the back of the nose. It is composed of both bone and cartilage.
Nose and sinus conditions
Nose and sinus conditions trouble millions of people, inducing pain, fatigue, headache, breathing difficulties and loss of smell, among other signs. The conditions related to nose and sinus can be summed up as follows:
In sinusitis the tissue coating the sinuses get inflamed or swell up. Usually sinuses are filled with air. But when the sinuses get blocked and filled with fluids, germs have a tendency to grow and cause infection.
Types of sinusitis:
- Acute sinusitis – The condition of acute sinusitis causes the gaps inside one’s sinuses to become inflamed and swollen. It also interferes with drainage and results in a mucus build up. Acute sinusitis starts with cold-like symptoms for instance runny nose or facial pain and can last 2 to 4 weeks.
- Subacute sinusitis – The condition of subacute sinusitis lies somewhere between acute and chronic sinusitis. It depends on how long the infection has been present even after undergoing medical treatment. Subacute sinusitis is usually supervised medically, but in certain instances surgical intervention becomes necessary.
- Chronic sinusitis – The condition of chronic sinusitis arises when the gaps inside one’s sinuses get swollen and inflamed for three months or longer. It makes breathing difficult and one’s eyes might feel bloated. Also known as chronic rhinosinusitis, it can affect both children and adults.
- Recurrent sinusitis – The condition of recurrent sinusitis arises when one suffers three attacks of acute sinus infection in a year. It leads to lost work or school days and discomfort.
Allergic rhinitis also known as hay fever or nasal allergy is the inflammation of the inside of the nose. It is usually triggered by allergens like pollen, dust, mold and pet dander. This condition causes symptoms like sneezing, congestion, itchy nose and sore throat.
Bleeding from nose or epistaxis arises easily because of the location of the nose and the close-to-the-surface location of the blood vessels in the coating of the nose. It simply refers to blood loss from the tissue that lines the inside of the nose.
Turbinate hypertrophy also termed as enlarged turbinate is a condition in which turbinates (bony structures inside the nose) grow excessively. Enlarged turbinates lead to breathing difficulties.
The condition of deviated nasal septum arises when the thin wall (nasal septum) between one’s nasal passages gets displaced to one side. A severe case of deviated nasal septum can lead to blocking one side of the nose and reducing airflow which in turn results in difficult breathing. On being exposed to the drying effect of airflow through the nose, the deviated nasal septum may induce bleeding or crusting.
Nasal polyps are defined as delicate, painless and noncancerous growths which emerge on the lining of one’s nasal passages or sinuses. They arise from chronic inflammation and are related to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders. It can affect anyone, but is more common among adults.
Inverted papilloma is a benign but locally aggressive tumor. It usually arises in the nasal cavity or paranasal sinuses and is identified in patients with a history of seasonal infections. This nasal condition shows symptoms like nasal congestion, drainage, headaches and postnasal drip.
Cerebrospinal fluid (CSF) is a watery liquid that continuously circulates the brain’s hollow cavities. Contained by the meninges, the cerebrospinal fluid drains out impurities from the brain, transfers nutrients and provides protective padding to the brain and the spinal cord. A CSF leak can arise due to a head injury, brain injury or tumor removal from inside the sinuses. The leak causes fluid to drain through the ears, through the nose or into the spinal canal.
Nose and sinus surgeries
1. Balloon sinuplasty surgery
Balloon sinuplasty is a form of endoscopic nasal surgery. It involves the use of small balloon catheters that inflate. This surgery is a minimally invasive procedure, where the surgeon employs a catheter, placed through the nose to dilate the sinus openings. The results of the surgery are permanent and do not require any implants or additional support.
2. CSF leak repair surgery
Any form of rupture in the bone and the dura can lead to a CSF leak. This can trigger the fluids to leak through the ears or nose respectively or into the spinal canal. A CSF leak becomes evident when clear fluid starts flowing from the nose or into the back of the throat. It can arise as a result of a head injury, complication from sinus or brain injury or due to tumor removal from the inside of a sinus. CSF leakage through the ears or nose need to be detected and treated promptly to prevent meningitis, an infection of the meninges.
There are two definite types of CSF leaks:
- Spinal CSF leaks – It occurs when CSF starts leaking out from around the spine due to a hole in the dura.
- Cranial CSF leaks – When a region of the skull gets damaged or cracks, the dura is exposed and it can easily tear leading to a cranial CSF leak.
The trivial events that can lead to CSF leak are:
- Exerting to have a bowel movement
- Lifting heavy objects
3. Endoscopic dacryocystorhinostomy surgery
An endoscopic dacryocystorhinostomy surgery aims to eradicate fluid and mucus storage inside the lacrimal sac. This procedure tends to create a direct opening from the lacrimal sac into the nasal passage. It helps to create a direct drainage mechanism which inturn boosts the tear drainage for relief of epiphora. A telescope is used to look up the nose and locate the site of the obstruction, which is then opened up surgically. This method has the benefit of leaving no scar on the side of the nose. The assessment and management of an endoscopic dacryocystorhinostomy procedure may include both an ophthalmologist and an otolaryngologist.
The process is done to ease the symptoms of a blocked tear duct. These consist of extreme eye watering or crusting around the eye. If the tear duct is infected, one might suffer from:
- Swelling and tenderness around the eye
- Eye irritation
- Mucous discharge
The benefits of an endoscopic dacryocystorhinostomy surgery are:
- Minimal pain which can be controlled using medications
- Rate of infection is low after surgery
- No facial scarring
4. Functional endoscopic sinus surgery
In this procedure of functional endoscopic sinus surgery, an ENT specialist uses nasal endoscopes which are thin tubes with lights and lenses to soothe one’s sinus symptoms without making incisions around the nose. Functional endoscopic sinus surgery can be initiated under local anesthesia or general anesthesia on an outpatient basis. The complexity rate for functional endoscopic surgery is lower than that of conventional sinus surgery. Also the patients typically experience minimal discomfort. It is generally undertaken to bring aid from chronic rhinosinusitis that is not getting healed by antibiotics or other medications.
The conditions treated by a functional endoscopic sinus surgery are:
- Chronic rhinosinusitis that lasts for three months or more
- Nasal polyps
- Damaged smell sense
- Tear duct blockage
- Brain fluid’s leakage into the nose
- Frequent infections
- Sinus infections affecting eyes, face, brain or nose
- Sinus cavity tumors of both benign and malignant types
- Deviated septum
- Four or more events of acute sinusitis a year
- Enlarged nasal turbinates
5. Septoplasty surgery
People suffering from the condition of deviated nasal septum tend to have one nasal passage much smaller than the other. This results in difficult breathing and other symptoms like nosebleeds and facial pain. The only way to cure this is a septoplasty surgery. Septoplasty is a procedure performed by ENT specialists to straighten the bone and cartilage dividing the gap between one’s nostrils or septum. During a septoplasty surgery, one’s nasal septum is repositioned to the middle of the nose.
The ENT specialist may recommend septoplasty to:
- Remove nasal polyps
Correct deviated nasal septum
- Recover nasal obstruction
- Treat chronic sinusitis
- Stop persistent nosebleeds
The benefits a septoplasty surgery are:
- Cures breathing problems caused by a deviated septum, nasal polyps or other similar conditions
- Can reduce or eliminate snoring enabling one to have a good night’s sleep
- Allows the sinuses to drain better
6. Turbinate reduction surgery
Turbinates are small structures inside the nose which aids in cleansing, warming and humidifying the air as it passes through one’s nasal cavity and lungs. The turbinates can become inflamed and swollen as a consequence of irritation, allergy or infection.
The causes of turbinate enlargement are:
- Changes in weather
- Changes in hormones
A turbinate reduction surgery is performed by an ENT specialist to remove excess tissue around the turbinate bones. This procedure improves the airflow and makes breathing easier. It is also known as a nasal turbinate reduction or inferior turbinate reduction surgery.
The benefits of a turbinate reduction surgery are:
- Outpatient process
- Opens nasal airway
- Improves breathing
- Reduces snoring
- Treats critical nasal allergies
7. Nose tumor surgery
Nose tumor or inverted papilloma is a benign tumor that forms in the back side of the nasal cavities. As the inverted papilloma grows, it can sometimes spread into the paranasal sinuses or orbits. At times, the inverted papilloma can transform into an aggressive form of cancer called cell carcinoma.
The symptoms of an inverted papilloma are:
- Blocked nasal cavities (only on one side)
- Runny nose
- Sinus infections
- Bleeding from nose
- Pain or pressure in the ear
- Double vision
- Blurred vision
- Loss of vision
- Swelling around the eyes
- Loose teeth
To cure inverted papilloma, an endoscopic endonasal surgery is performed. This innovative and minimally invasive method uses the nose and nasal passages as natural corridors to access hard to approach tumors.
The benefits of an endoscopic endonasal surgery are:
- No incisions
- No disfigurement
- Faster recovery time
8. Nasal polypectomy surgery
Nasal polyps are soft, non cancerous growths found in the lining of the nasal cavity. They are semi translucent, pale and gray masses. It may be present in those who are suffering from perennial nasal congestion, obstruction and anosmia or hyposmia.
The symptoms of nasal polyps are:
- Difficulty breathing
- Loss of sense of smell
- Reduced sense of taste
- Postnasal drip
- Runny nose
- Facial pain
- Sinus pressure
- Itchy eyes
The surgical procedure to remove nasal polyps from the nasal passages is known as nasal polypectomy. This surgery lasts for a few hours and can prevent rare but serious conditions that can result from nasal polyps like complex sinusitis.