The sinuses are air-filled cavities connected to the main nasal cavity. These include the maxillary sinus, ethmoidal sinuses, frontal sinus and the sphenoid bone. Acute and chronic paranasal sinusitis can occur due to an obstruction in the outflow of the sinuses. The chronic form has become more prevalent in past decades, and is considered one of the most common conditions in Western industrialised countries. Typical symptoms include: frequent sinus infections; excessive secretions at the back of the throat; loss of sence of smell; nasal discharge; a compulsion to clear one’s throat; morning expectoration; a swelling sensation in the nose; a feeling of pressure above the sinuses; and a decline in general well-being.
I will offer a medical or surgical plan of treatment depending on the patient’s needs following a thorough history and clinical examination and CT scan.
If surgery is required, this is usually functional endoscopic sinus surgery (FESS). The infected material is rinsed out of the sinuses and the blocked passageways are opened. Healthy tissue is preserved so that the nose and sinuses may continue to function normally.
Most patients describe this process as painless. Nasal tamponades, still frequently used in some practices, are not necessary in the majority of cases. Review and care of the mucous membrane is required in an outpatient setting, and the patient will have nasal spray, rinses, and balms to apply at home.
I work alongside an ophthalmologist in cases where there is narrowing and obstruction of the tear ducts to open them up via and endoscopic approach (DacryoCystoRhinostomy DCR).
Obstruction to breathing through the nose may be caused by a deviation of the nasal septum, septal deformity with bony protrusions, or enlarged nasal conchae. In most cases there are various pathologies. Surgical correction of the nasal septum to improve nasal breathing may be an option for those with chronically obstructed nasal breathing or following failed medical therapy.
Rarer causes for obstructed nasal breathing are: foreign matter (mostly unilateral and in children), deformity of the nose, polyps, tumours, trauma and pharmaceutical side effects.
Surgery, so called Septoplasty, is performed under general anaesthesia. A small incision is made in the mucosa of the nasal septum, excess material such as ridges and spurs are removed, and uneven areas straightened. At the end of the surgery, the wound is closed with dissolvable sutures. In rare cases small foils are sewn onto both sides of the nasal septum that remain in the nose for 5-to-7 days. No nasal tamponades are required. Following surgery, you will be in instructed in an after-care regime including saltwater rinses, inhalation treatment, nasal ointment and decongestant nose drops.
It is most likely that at the time of the septoplasty, I will reduce the size of the inferior turbinates as well. This is done with a very gentle, non-cutting technique.
Obstruction to nasal breathing may also be caused by a perforation of the nasal septum. Other symptoms of septal perforations can also be: recurrent nasal bleeding, discharge, crusting, loss of sense of smell or even change in the shape of the nose. If topical therapy does not relieve the symptoms, surgical closure and if needed aesthetic reconstruction can be considered. This can be done via and open or closed approach; same incisions that are used for cosmetic septal or rhinology surgery. In some cases, tissue such as ear cartilage, muscle fascia or biologically designed tissue is needed to close the perforation. This is always preceded by individual consultation and surgical planning.
At the end of the surgery small foils are sewn on both sides of the nasal septum which will remain in the nose for 10 to 14 days. No nasal tamponades are required. After surgery you will be instructed in an after-care regime including salt water rinses, inhalation treatment, nasal ointment and decongestant nose drops. It is extremely important not to blow the nose for several weeks.