are the common ailments affecting the nose ?
Some of the common nasal
problems are :
* Nasal stuffiness or
* Nasal discharge
* Bleeding from the
* Sense of smell
2) What causes
nasal blockage and discharge ?
Some of the common causes
Infections : An average adult suffers from a common 'cold' 2
to 3 times a year. The common 'cold' is usually caused
by virus infection. During a virus infection, the nose has
poor resistance against bacterial infections. When the nasal
mucous turns from clear to yellow or green, it indicates that
bacterial infection has taken over and a physician should be
consulted. Sinus infections can cause nasal blockage,
discharge, pain and headache depending on which sinuses are
Structural Causes like deformities of the nose and the nasal
septum which separates the nose into 2 sides. If they cause
obstruction to breathing, they can be corrected by surgery (septoplasty). It can be combined with correction of external
deformity also (septorhinoplasty) In children, enlargement of
adenoids (tonsil like tissues which fill up the back of the
nose behind the palate) can cause nasal blockage. Other causes
include nasal tumours and foreign bodies. These diseases
may require surgery.
3. Allergy is an
exaggerated inflammatory response to an allergen like house
dust mite, pollen, moulds, animal dander or foods. Sometimes,
fleshy growths called polyps can also develop as a result of
exaggerated swelling of the membranes.
3) What is
Sinusitis is an inflammation or
infection of the lining of one or more air-filled cavities
around the nose called the Sinuses. Acute sinusitis results
from blocking of the opening of the sinuses following 'colds'.
Mucous collects in the sinuses and can cause discharge and
pressure pain in the forehead or face, between the eyes or
cheeks depending on which sinuses get involved. If the 'cold'
lasts longer and the discharge becomes yellow/green, a
bacterial infection has taken over giving rise to pain and
pressure and occasionally fever. Chronic sinusitis occurs when
the sinus opening is blocked for longer period. Headaches are
less prominent but congestion and nasal discharge usually
persist. Sometimes, fleshy growths called polyps can also
develop as a result of exaggerated swelling of the
4)What is the
cause of sinusitis ?
A common cold, pharyngitis,
allergies, an anatomical abnormality or infrequently an
infected tooth can cause sinusitis. Acute sinusitis lasts a
short time. Chronic sinusitis lasts longer and is associated
with allergies, anatomical abnormalities and repeated acute
5) What are
Typical complaints include
* Nasal congestion and
* Facial pain or
* Impaired sense of
6) Should I see a
doctor for sinusitis?
Bacterial sinusitis can be
treated with antibiotics and medications to relieve symptoms.
If left untreated, it can lead to chronic sinusitis, rarely
leading to infection of bone around the eyes or
7) What is the
Indicators of sinus diseases are
nasal obstruction, nasal discharge and sinus headaches.
Medical treatment in form of antibiotics, antihistamines,
decongestants, may help in eliminating symptoms and disease.
If problems persist or are recurrent
or are caused by anatomical abnormality, a CT Scan is usually
performed to elicit more information. If these studies
indicate extensive disease surgical treatment in
the form of correction of septal deformity, or endoscopic
sinus surgery may be required.
8) What is
functional endoscopic sinus surgery(FESS) ?
Endoscopic sinus surgery is
the use of modern technology to treat age-old problems of the
nose like sinus blockage. Fibreoptic telescopes with good
illumination and magnification enable the ENT. surgeon to
visualize directly the blocked nasal passages and sinuses for
removing infection, polyps, diseased mucosa to help the sinuses
to drain properly, whenever medical therapy has not been
successful in alleviating symptoms.
9) When is
functional endoscopic surgery indicated ?
Nasal endoscopy is commonly
done for sinusitis, nasal polyps, in cases of bleeding from
nose, for diagnosis and follow up of tumours, for sinus
headaches. It is also being used for neurosurgical operations
like CSF leakage, optic nerve damage and ophthalmic conditions
10) What are the
benefits of the endoscopic operation over earlier treatment ?
Nasal endoscopy offers
several advantages over earlier treatment
a) A more
precise evaluation of patients with sinusitis, nasal blockage,
headache, decreased smell, bleeding from nose is possible
because all the nooks and corners of the nose and sinuses can
b) There is
better visualization of the structures and hence less chances
of complications and damage to vital structures during
operations which require external cuts can be
stay of the patient in hospital is reduced.
11) How is the
endoscopic sinus surgery performed ?
The operation is performed by
your ENT Surgeon trained in Endoscopic Sinus Surgery. The
surgery is performed through the nose with the help of special
telescopes called endoscopes which provide excellent
visualization. Local anaesthesia or general anaesthesia will
be required. It may or may not require hospitalization,
(generally one or two days) These procedures are being
performed routinely in our centre.
12) What are
the risks involved in nasal surgery?
Bleeding is a possibility
in any nasal surgery because of numerous blood vessels in the
nose. Any extensive sinus surgery runs the risk of
cerebrospinal fluid leak or loss of vision. Although these
problems are extremely rare with endoscopic sinus
surgery,especially in the hands of trained ENT. surgeons.
13) Is there an
alternative to nasal surgery ?
Medical treatment is the
initial treatment of choice. Surgical treatment is recommended
in patients who do not respond or have recurrent problems.
Untreated sinus disease can lead to orbital complications
(loss of vision), brain abscess or infection, loss of smell,
besides poor quality of life.
14) What is sinus
A 'sinus headache' is a
headache in the face, forehead, cheeks or around the eyes that
comes during a 'cold'. A vacuum headache can also occur in the
sinus areas during descent in an airplane, especially if one
has a cold or allergy. Migraine or 'tension' headaches can
mimic sinus headaches but they generally go away in a day or
two. Sinus headache usually last for days until treated with
antibiotics. All headaches that are severe or occur
frequently, or prolonged require diagnosis and treatment by a
15) What are the
causes of nose bleed ?
Bleeding from the nose is common,
unpredictable and often an inconvenience. The bleeding could
occur from either one or both nostrils and may result from a
variety of events like sinus infection,trauma,hypertension or
16) What can be
done to stop nasal bleeding at home ?
1. Sit up or stand
up, don't lie back. This reduces the pressure on the veins in
the nose, making it easier to stop the bleeding.
2. Pinch the
nose near the tip using the thumb and index finger for 5
minutes. Remember to do this gently. Breathe through the mouth
for 5 minutes.
3. Push the
pinched nostrils inwards and upwards. This will help to stop
the blood flow.
4. Apply ice
(crushed in a plastic bag) to nose and
consult your doctor for correct diagnosis and specific
17) When should the
doctor be contacted for nasal bleeding ?
One should always contact
the doctor if :
cannot be stopped or keeps recurring.
b) Bleeding is
rapid and the blood loss is large.
c) The patient
feels weak or faint.
d) Bleeding begins
by going down into the throat and not the front of the
18) How does
one prevent nose bleed from recurring ?
Avoid picking the nose. Avoid blowing the nose for
several hours after a nosebleed. Do not strain or bend down to
lift anything heavy. Keep head higher than the level of the
heart. Use a cotton tipped swab to gently apply petroleum
jelly directly on the septum (middle portion of the nose) once
or twice a day. Make certain, the fingernails are trimmed to
decrease nosepicking. One should always contact the
19) What is
allergic rhinitis ?
Patients of allergic rhinitis
complain of nasal blockage, sneezing, watery nasal discharge, loss of sense of smell, headache and post nasal drip.
Medical treatment can be divided
A) Avoidance of
C) Topical therapy
A) Avoidance of allergen
The causative allergen should be identified and whenever
possible avoided. This can be done by first taking a detailed
history and followed by Skin prick Test. Some of the common
2) Home dust
4) Animals like cat and
B) Drugs : The prime mode of
treatment of allergic rhinitis is with the help of
1) Anti-histamines : are very
effective in controlling sneezing, itching and watery
2) Decongestants : Systemic
decongestants in combination with anti-histamines are useful
in relieving nasal obstruction.
3) Corticosteroids : Use of
corticosteroids especially the topical form is highly
effective in treatment of allergic rhinitis.
C) Topical therapy for long term relief : Local non surgical treatment for allergic rhinitis in
the form of hydrocortisone injections into the inferior
turbinate, auto-haemo injections and chemical cautery with 15%
silver nitrate (all done once a week for 4-5 times) have been
effective in controlling sneezing and rhinorrhoea in large
number of patients.
D) Immunotherapy :
immunotherapy involves the use of subcutaneous injection of
allergen extract in increasing concentrations and decreasing
Surgical treatment of allergic and vasomotor rhinitis : In patients with allergic rhinitis, the symptoms of
nasal obstruction are often compounded due to the presence of
anatomical abnormalities including bony and cartilaginous
deformities of the septum, hypertrophic turbinates or polyps,
which may need surgery.
20) Can snoring
result from nasal problems ?
The noisy sounds of snoring occur
when there is an obstruction to the free flow of air through
the passages at the back of the mouth and nose. This is the
collapsible part of the airway where the tongue and upper
throat meet the soft palate and uvula (the fleshy structure
that dangles from the roof of the mouth back into the throat).
When these structures strike against each other and vibrate
during breathing they produce snoring. Persons who snore have at
least one of the following problems :
1) Poor muscle tone (lack of
tightness) in the muscles of the tongue and
2) Excessive bulkiness of tissues
of the throat, the large tonsils and adenoids, for example,
commonly cause snoring in children. Overweight persons also
have bulky neck tissues.
3) Excessive length of the soft
palate and uvula.
4) Obstructed nasal airways : Deformities of the nose or nasal septum frequently
cause such obstruction. "Deviated septum" is a common term for
a deformity inside the nose in the wall that separates one
nostril from the other.
21) Is Snoring
Socially - yes. It is disruptive
to family life. It makes the snorer an object of ridicule and
causes other household members sleepless nights and
resentfulness. Snorers become unwelcome room-mates on
vacations or business trips. And medically - yes. It disturbs
the sleeping patterns of the snorer himself, so that he may
not sleep restfully. Furthermore, heavy snorers tend to
develop high blood pressure at a younger age than non-snorers.
The most exaggerated form of snoring is known as obstructive
sleep apnea, when loud snoring is interrupted by frequent
episodes of totally obstructed breathing.
This is serious if the episodes
last over 10 seconds each and occur more than 5 times per
hour. During the obstructive episodes, the heart must pump
harder to circulate the blood faster. This can cause irregular
heartbeats, and after many years it leads to elevated blood
pressure and heart enlargement. Persons with obstructive sleep
apnea may spend little of their night-time hours in the
deep-sleep stages that are essential for a good rest.
Therefore, they awaken unrefreshed and are sleepy much of the
day. They may fall asleep while driving to work or while on
22) Can Snoring be Cured?
Adults who are mild or
occasional snorers should try the following :
* Regular exercise to develop
good muscle tone and lose weight.
* Avoiding tranquilizers, sleeping
pills, and alcohol before bedtime.
* Avoiding heavy meals within
3 hours of retiring.
* Sleeping sideways rather than on
the back. Consider sewing a pocket on the pajama back to hold
a tennis ball. This helps to avoid sleeping on your
* Tilting the entire bed with the
head upwards 4" (place bricks under the bedposts at the
* Allowing the non-snorer to get to
When snoring becomes disruptive to the life of
the snorer or his family, medical advice should be sought,
especially if other household members suspect the obstructive
sleep apnea problem (very loud snoring with periods when all
airflow stops - even though the snorer is trying to breathe).
The heavy snorer deserves a thorough examination of the nose,
mouth, palate, throat, and neck. Studies in a sleep laboratory
are valuable to determine how serious the snoring is and what
effects it has on the snorer's health. Treatment will depend,
of course, on the diagnosis.
It may be as simple as
managing a nasal allergy or infection, surgically correcting a
nasal deformity (septoplasty), or removing tonsils and
adenoids. Or, snoring/apnea may respond best to surgery on the
throat and palate to tighten up flabby tissues and expand the
air passages, an operation called UvuloPalatoPharyngoPlasty
(UPPP). To the patient it feels like having a
tonsillectomy. This can also be performed by
If surgery is too risky, unwanted or
unsuccessful, the patient may sleep every night wearing a
nasal mask which delivers air pressure into the throat ("CPAP").
Every chronically snoring child should also be
thoroughly examined. Medical evidence suggests a tonsillectomy
and adenoidectomy will probably make an important difference
in the health and well-being of the child. Snoring means
obstructed breathing, and obstruction can be serious.