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Clinical CareAnatomy of the NoseThe nose is remarkably sensitive and complex and has two basic functions. It serves as the organ of smell (and is directly related to the sense of taste) and it is the primary passage for air into and out of the lungs, serving to warm and humidify the air to improve lung function. Adjacent to the nose are the paranasal sinuses—hollow, air-filled cavities in the bones of the face and skull about the size of a walnut, which are connected to the nose by a small opening (an ostium). Every person has four pairs of sinuses:
Lining the sinuses are membranes that secrete a special mucus that keeps the inside of the nose moist, entraps bacteria, and absorbs dust, dirt, and pollutants. Each person produces about one quart of mucus per day. This layer of mucus is propelled by tiny hair cells (called cilia) toward the back of the nose and throat, where it is swallowed. Mucus does not "drain" via gravity as is commonly thought; the cilia actually move the mucus in a genetically specific direction toward the esophagus. The nose and sinuses are composed of many anatomical features. This anatomy varies somewhat from person to person. Structural deviations or abnormalities, such as polyps, enlarged adenoids, cleft palate, tumors, or a deviated septum, may result in nasal blockage or breathing difficulties, contributing to sino-nasal disease requiring medical or surgical treatment by a rhinology specialist. SinusitisSinusitis (also called rhinosinusitis) refers to inflammation of the sinuses that may be caused by one or more problems with the normal functioning of the sinuses. Various conditions may impede the flow of air through the nasal passage, obstruct the sinuses, or cause the secretions to thicken and stagnate. If the mucus is prevented from draining and air flow is blocked, certain bacteria may grow, causing infection. According to the Centers for Disease Control (CDC), more than 35 million adults, or 14% of the U.S. adult population, are diagnosed with sinusitis, making it the most common chronic condition in the United States. Sinusitis can be categorized as acute - (symptoms which last two to eight weeks); or chronic - (symptoms last much longer). Acute sinusitis may be caused by bacterial or viral infections that produce congestion and nasal obstruction. Chronic sinusitis may be caused by an infection, structural abnormalities, or inflammation that results in chronic thick mucus that does not flow normally and therefore causes symptoms. SymptomsSinusitis symptoms depend on the location of the infection, i.e. which of the four pairs of sinuses are infected. Symptoms may include:
DiagnosisThe Rhinology Division makes use of the latest technological advances in the diagnosis of sinus disease. After reviewing a patient’s medical history and physically examining the nose, the physician will often further examine the sinuses utilizing a fiber-optic scope. This procedure, called nasal endoscopy or rhinoscopy, is performed in the examination room. To further assist in diagnosis, a computed–tomography or CT scan may be taken within the office setting. If still further information is required, an MRI (magnetic resonance imaging) may be necessary. TreatmentFor the medical treatment of sinusitis an array of therapies, from conservative measures such as nasal irrigation methods, nasal sprays and over the counter (OTC) medication, to more aggressive therapies such as prescription antibiotics and corticosteroids may be indicated. For those patients who do not respond to long-term medical therapy, sinus surgery may be required to relieve symptoms of chronic or reoccurring sinusitis. While open surgical approaches (requiring facial or oral incisions) may be indicated in a very small percentage of cases, most sinus surgery may be performed endoscopically through the nose. The object of functional endoscopic sinus surgery (FESS) is to restore normal drainage from the sinuses by removing the anatomical and pathological obstruction that contributes to chronic sinusitis. The benefit of FESS is the ability to allow for a more targeted approach to the affected sinuses, minimizing tissue disruption and reducing post-operative complications and recovery time. For more information, read the article titled “Battling Chronic Rhinosinusitis” from the Department of Otorhinolarygology – Head and Neck Surgery Newsletter, Volume 4 (Fall/Winter 2009), pg. 4. Sino-Nasal TumorsThe physicians in the Division of Rhinology have vast knowledge and experience in the diagnosis and minimally-invasive treatment of both benign and malignant tumors of the nose and sinuses. Most often, physicians are able to remove large tumors through a keyhole approach. Physicians often work in collaboration with other division and departmental medical and surgical staff in the treatment of complex sino-nasal and head and neck disorders, including consultation and referral for medical and radiation oncology to complement the minimally-invasive surgery and achieve a cure. CSF Leak/EncephaloceleIn some situations, the integrity of the fibrous surrounding of the brain can be compromised resulting in a brain fluid (cerebrospinal fluid) leak. In the past, neurosurgeons required external skull incisions and brain retraction to reach the point of repair. Now, using minimally-invasive techniques, physicians from the Division of Rhinology can reach these leak points through the nose and repair them, as well as any associated encephaloceles (sac-like protrusions of the brain hanging down into the sinuses).
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