Nose problems

1. Yanhee International Hospital
Charansanitwong, Bangok, Thaiand
Website: dr-ornouma.com
Email: [email protected]
Nose Problems

2. 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.

3. 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.

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

5. 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.

6. 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.

7. 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

8. 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.

9. 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).

10. 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.

11. Nasal problems

13. 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.

14. 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.

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



A runny nose
Chronic sinus infections
Headaches
Snoring
Visible Nasal Polyp

16. 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

17. 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.

18. Nasal polyp is prominent
Nasal polyp with pus

20. 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.

21. 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.

22. 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.

23. 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

24. Nasal Deviated Septum

25. 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.

26. Goal
The goal of this procedure is to correct
defects or deformities of the septum.

27. 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.

28. 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.

29. 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.

30. 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.

32. 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.

33. 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.
 

35. chronic sinusitis

36. 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.

37. 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

38. 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

39. 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

40. 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.

41. 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.

42. 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.