Nasal and Sinus Problems
Nasal and sinus problems can broadly be divided into cosmetic and functional conditions.
Cosmetic problems – these affect how the nose looks
Functional problems – these are to do with how the nose and sinuses work
Cosmetic problems can affect any part of the nose, and most commonly include deviations of the nose to one side, a nasal hump, a ‘dip’ in the nasal profile, too wide or too a narrow nose, or problems with the soft nasal tip which can be over-protrusion, too broad or ill-defined a tip or irregularities. Often these abnormalities are caused by trauma to the nose that results in the shape of the nose changing from its original state. Such trauma can also occasion difficulties in breathing through the nose, which may mean that any treatment and/or surgery that may be required may well need to address both the functional and cosmetic concerns. On occasions there is no history of trauma and it is the case that the patient is not happy with the appearances of the nose. Rarely such concerns cause a degree of psychological difficulties for the patient, which may need to be addressed before any surgery proceeds.
Functional problems indicate that there is something wrong with the way the nose or sinuses are working. Most commonly patients complain of a blocked nose, although other symptoms also occur such as a runny nose, sneezing, reduced or absent sense of smell, headaches, facial pains or catarrh / postnasal drip.
There are a number of conditions that can cause functional problems:
- Deviated nasal septum: If the septum is deviated or angulated to one side or the other, it will cause a blocked nose, which is usually more so on one side. The treatment for this is a septoplasty (please see separate section).
- Sinusitis: This can be quite debilitating as it causes nasal block, facial pain and headaches, lethargy, generalised fullness in the face and head, and an offensive nasal discharge. Symptoms can be prolonged despite treatment and often repeated courses of antibiotics and topical nasal medications are necessary to bring about resolution of symptoms. Occasionally the problem recurs and may persist for many months or years. In such circumstances, it may be necessary to consider surgery to widen the sinus drainage pathways and prevent further sinusitis. There are a number of ways of achieving this, including conventional sinus surgery (FESS) or more recently balloon sinuplasty, which is a minimally invasive technique designed to widen the sinus openings with a high pressure balloon which to date has been proven to be highly effective and extremely safe.
- Nasal Polyps: These are grape-like swellings of the internal lining of the nose, usually caused by inflammation. They often originate from the ethmoid sinuses, one of the sinuses situated in between the eyes, which drain into the sidewall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known. They can completely block the nose and often cause a total loss of the sense of smell. Whilst steroid medication is sometimes effective at improving symptoms from polyps, surgery is frequently required to remove the polyps and restore a good nasal airway. Polyps however do have a natural tendency to come back regardless of which treatment is offered. Treatment is also not guaranteed to improve the sense of smell.
- Rhinitis: This means that there is inflammation of the inner lining of the nose. The most common cause of this is allergy, hence ‘allergic rhinitis’ Hay fever is a particularly common example of an allergy although there are many others, such as allergy to house dust mite, cats, dogs, tree pollen, moulds and fungi, dairy products and nuts.
- Narrow internal nasal valve: If you have a very narrow or pinched nose, you may find it difficult to breathe through the nose most of the time. This is because there is very little room for air to move in and out of the nose, which causes considerable resistance to air flow and hence blockage. A number of possible treatment options are available for this, ranging from nonsurgical methods such as breathe right strips, addressing any underlying nasal congestion or inflammation with medication, or possibly surgery to widen the internal aperture of the nose. Traditionally such surgery has been done using the patient’s own cartilage to recreate a wide inner valve, although results from conventional surgery have been disappointing. Other options include inserting a lightweight Titanium BreatheTM Implant, which is relatively straightforward and extremely effective at restoring a good nasal airway with minimal complications. Also it is possible to undergo minimally invasive surgery on the nasal valve that involves a keyhole approach using stitches and carefully fashioned local nasal flaps inside the nose to widen the nasal valve angle – this is called an intranasal z-plasty. Please see separate section on nasal valve surgery and Titanium Nasal Implants.