Nose As A Contributor To Sinus Disease

Deviated Septum Denver.jpgSeptal Deviation

The shape of your nasal cavity could be the cause of chronic nasal complaints and even sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

A "deviated septum" occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma, infections, and can be the result of previous unrelated nasal or facial surgery.

A deviated septum may cause one or more of the following:

    * Blockage of one or both nostrils
    * Nasal congestion, sometimes one-sided
    * Frequent nosebleeds
    * Frequent sinus infections
    * At times, facial pain, headaches, postnasal drip
    * Noisy breathing during sleep 

Nasal obstruction, the septum and sinusitis
Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

Your First Visit: After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.  A thorough examination of your septum and nasal cavity may also involve the use of endoscopic viewing of the back of your nose and the throat behind it.

Surgery may be the recommended treatment if the deviated septum is causing significant obstruction, debilitating and demonstrably related headaches, troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

Septal spurs
Septal perforation

Nasal Polyps

In some cases, polyps grow into the nasal passage. They usually originate at the sinus openings. Polyps are like teardrop-shaped collections of inflammatory cells, fluid, and tissue. They are covered by a mucous membrane. They can grow in response to infection, allergy, locations of abnormal contact, or for unknown reasons. When polyps are widespread, it is usually from some underlying mucosal abnormality.

One of the main causes of recurrent disease after sinus surgery is the regrowth of nasal polyps with subsequent obstruction and infections. Lasix TM (furosemide) has been shown to decrease the fluid volume of nasal polyps in studies from Italy . Studies are being started to investigate the potential role of topical furosemide for the treatment of nasal polyps.

Steroids
Lasix
Salicylate/ASA sensitivity
Salicylate free diet