An endoscopy with a rigid or flexible endoscope is always performed during the exhaustive inspection of the nose and sinuses (Nasofibroscopy).
The first test is performed using mild anaesthesia with cotton swabs soaked in anaesthetic liquid or by spraying of the nostrils and it is a procedure that is very well tolerated. The second does not tend to require anaesthesia and permits us to also access and inspect the throat and vocal chords (Fibrolaringolscopy).
At times it is necessary to take nasal swabs or biopsies.
Nasal obstruction is the inability to breathe correctly through the nose, which is the part of the respiratory system responsible for said function. When the nose becomes obstructed we are able to breathe through our mouths but, as it is not meant for this purpose, there are negative consequences such as dryness of the throat, mucus, alteration in the shape of teeth and palate and snoring.
There are many causes of nasal respiratory insufficiency and we are now going to review the most frequent.
Rhinitis is one of the most frequent causes and it consists of the inflammation of the nasal mucosa which produces obstruction, mucus, nasal itching and sneezing. It normally is a result of catarrhal infections, allergies, tobacco smoke or the consumption of certain medications such as decongestive nasal sprays and some antihypertension drugs.
Rhinitis is treated medically but if it is persistent or poorly treated it can develop hypertrophy of the turbinates, which are the structures on the inside of the nostrils. The treatment is medical but, if it remains unresolved, cauterization is necessary, in which the use of Radio Frequency is recommended.
Another frequent cause of nasal obstruction is sinusitis, although it is manifested more through headaches and nasal or throat mucus, loss of smell and coughing.
Nasal breathing is fundamental in order to allow the air which enters our lungs to be correctly conditioned; therefore, if hypertrophic rhinitis or sinusitis are not resolved with medical treatment, we recur to surgery. The same thing occurs if the nasal septum is deviated, as all nasal obstruction, in the long run, causes pharyngeal dryness, sinusitis, otitis of repetition, nosebleeds, snoring, alterations to the positions of teeth and loss of smell.
The only treatment of a deviated septum is surgery (Septoplasty), which occurs in a hospital setting with general anaesthesia or sedation on an outpatient basis. If, at the same time, the patient wishes to correct the external or aesthetic appearance of the nose, the plastic surgeon is collaborated with, who performs Rhinoplasty.
Nosebleeds or epistaxis is a condition which is very frequent in children, where it tends to occur spontaneously and is self-limited. In adults it is a more serious issue which can be linked to traumatic injuries, hypertension, bleeding disorders, infections or nose tumours.
In children, medical intervention it is sometimes required to block or cauterize the bleeding area. This procedure occurs under local anaesthesia in the clinic with no pain to the patient and it resolves the majority of mild cases in children as well as adults. In childhood and when it is occurs repeatedly we have always discarded causes such as adenoid vegetations or allergies which can be favourable. Although it is infrequent in children, a tumor, the Nasopharyngeal fibroid, also exists and presents itself as repetitive nasal haemorrhages.
Noises in the ear
Noises in the ear, also known as tinnitus, are a common disease and are very distressing for the patient. The Otolaryngologist will conduct the relevant tests in order to diagnose the cause and begin an early treatment.
This is the paralysis of the muscles of half the face that appears suddenly. The most frequent cause is Bell’s Palsy or frigore, but it can also be secondary to traumas, infections or tumors. Diagnosing and treating this on time usually leads to good progress.
Loss of the sense of smell and taste
The total or partial loss of smell (hyposmia or anosmia) usually occurs because of nasal conditions, congestion being secondary only to the common cold as the most common cause.
The loss of the sense of smell is usually associated with the loss of taste.
Other factors which cause persistent alterations to the sense of smell are allergies, rhinitis and chronic sinusitis, tobacco, nasal or brain trauma, nasal polyps, and the use of nasal drops (vasoconstrictors). Therefore, a complete scan should always be done in order to identify the cause if alterations to your sense of smell are persistent. There will be different treatments depending on the cause.
Snoring and sleep apnoea
Snoring can simply an irritating symptom, often for the patient’s partner, or it can be associated with the Sleep Apnoea Syndrome, in which case we are talking about a serious illness which can have grave consequences for the patient’s life.
Snoring in children is normally due to the hypertrophy of the tonsils and adenoids, and should, in this case be treated with surgery as it can have a significant impact on the development of the child.
In adults, the first thing which should be diagnosed is whether we face simply rhonchopathy or Sleep Apnea, and, secondly, the level of its severity. Numerous factors influence snoring, including being overweight, consumption of alcohol and tobacco, and once these factors are corrected, we will see if the cause is in the nose, due to a deviated septum or turbinate hypertrophy, or if it is in the throat due to acute tonsilitis or the uvula.
Depending on the severity of the symptoms and their effects on the patient’s life, measures are indicated which include surgical correction of the nasal septum (septoplasty) and the correction of turbinate hypertrophy and uvula by radiofrequency or surgery.
Radiofrequency is a simple outpatient technique which is performed in the doctor’s office, is painless, and does not require packing and has no side effects. It corrects most obstructions and therefore significantly decreases snoring. In cases which the physician deems necessary, uvulopalatopharyngoplasty surgery can be performed in a hospital setting, which is the removal of the tonsils, uvula and soft palate, with their subsequent reconstruction.
Another cause of nasal obstruction is nasal polyps and chronic sinusitis. The main symptoms in these causes are congestion, headache, cough, altered sense of taste and smell. The first treatment is medical but, if it is not resolved, we would turn to endoscopic sinus surgery, which is a complex procedure.
Protruding ears are an alteration of the shape of the outer ear. For cosmetic correction, a surgical procedure called otoplasty is required. It is an outpatient surgery which is performed with sedation and aims to make the ears stick to the skull symmetrically.