Nasal Illness

The majority of benign nasal conditions treated by the head and neck surgeon are related to complaints of nasal obstruction with associated breathing difficulties. The majority of nasal obstructive problems are not from surgical illness and are best treated with medical therapy, immunotherapy and modification to the environment, (e.g. "allergic rhinitis"). However, a variety of other conditions may be characterized by nasal anatomical problems that are best addressed by the surgeon.

 For the discussion below, you may wish to refer to Learning - The Nose.

Obstructive Disorders Deviated Nasal Septum The nasal "septum" is the vertical wall of cartilage, bone and mucosa that separates the two nostrils from one another. A "deviation" or bend in this structure can be present at birth or may result from nasal trauma. The obstruction caused by septal deviation can be corrected surgically in one of a couple ways. In some cases the surgeon will straighten the septum in an operation called "septoplasty." At other times, particularly when the problem is severe, the doctor may employ a "submucous resection" of the septum ("SMR"). In this procedure he will remove a significant portion of the obstructing cartilage from beneath the mucosa, leaving an area within the septum that has mucosa but no underlying skeletal framework. When this is done carefully, the remaining structural framework of the nose is sufficient to maintain shape and stability of the nose.

Nasal Turbinate Enlargement

The nasal turbinates (also called "conchae"), are three bony and soft-tissue structures lining the sides of the nasal cavity. During a normal "nasal cycle," the turbinates alternately swell and shrink. In some patients, the turbinates can be excessively large, leading to chronic nasal obstruction. Most of the time, allergy treatment with nasal steroid sprays can help to decrease this swelling. However, when medical management doesn't provide relief to nasal obstruction, the inferior turbinates can be surgically reduced.This can generally be done as an out-patient procedure.

Nasal Polyps

Nasal polyps are abnormal, benign lesions that grow from any part of the nasal mucosa or that of the paranasal sinuses. They are an end result of varying disease processes in the nasal cavities and are thought to be the ultimate manifestation of chronic inflammation. Therefore, any conditions leading to chronic inflammation in the nasal cavity can lead to nasal polyps.Key among these are:

• Asthma
• Allergic rhinitis
• Non-allergic rhinitis
• Chronic rhinosinusitis
• Cystic fibrosis

Also, polyps are more strongly associated with non-allergic than with allergic diseases. A variety of theories exist about their pathogenesis, but regardless of the mechanism of generation, they are responsible for significant alterations in the quality of life, producing nasal obstruction, anosmia, chronic sinusitis, headaches, snoring, and postnasal drainage.

Many polyps can respond to medical therapy, particularly the use of corticosteroids. However, for those that prove refractory, surgical evaluation and treatment can become appropriate. The head and neck surgeon will likely supplement his physical exam of the patient with nasal endoscopy and CT scan of the nose and sinuses. When operative intervention is planned, Functional Endoscopic Sinus Surgery (FSS) is the method of choice and not only removes the polyps, but also opens the clefts in the middle meatus where they most often form. This helps to decrease the rate of recurrence.