It is difficult to diagnose many nasal conditions without inspecting the inside of the nasal cavities fully. Your nose can be examined in clinic with a fine bore endoscope, which allows good painless visualization of all the areas necessary to make a diagnosis.
Common nose conditions can include:
Most people have suffered with a nose bleed in their life at some point. Normally they are short lived and resolve spontaneously, however in some people they persist and become troublesome. If this is the case a nasal examination is needed to ascertain the cause and treatment can be undertaken. Chemical cautery under local anaesthetic can be undertaken in the clinic if needed.
There are many reasons for a blocked nose – either due to inflammation of the nasal linings (Rhinitis) or a physical narrowing of the passageway. Inflammation due to allergy or other irritants can thicken the nasal linings so reducing your ability to breath easily through the nose. Your nose may also be physically narrowed by a septal deviation, large turbinates (the air conditioning bones in your nose), or nasal polyps.
Rhinitis is the inflammation of the nasal lining tissue. A variety of conditions may cause this – some which are due to allergies and others, which are not.
Rhinitis may cause nasal blockage, a feeling of congestion, a runny nose, itching or sneezing. The treatment is usually medical therapy in the form of nasal drops or sprays. Different causes of rhinitis may need slightly different treatments, so having the correct diagnosis made is vital to ensure you receive the correct treatment for your condition.
Allergy to a variety of airborne allergens may cause rhinitis. The allergens may be seasonal (e.g. various pollens or spores, giving what is commonly known as Hayfever) or may be present all year (e.g. pet dander or House Dust Mite).
Typical symptoms include nasal blockage, nasal itching, sneezing and a thin clear nasal discharge. Associated symptoms such as itchy/sore eyes or an itchy throat may also be present. It is not uncommon for patients to have a condition known as Atopy where asthma, hayfever and eczema all occur together. This predisposition may be inherited.
Treatment generally consists of allergen avoidance and medical treatment. The diagnosis of your own specific allergens is thus important so that you know which items to avoid. It should be noted that food allergies rarely cause nasal allergy symptoms. You can have allergy tests in clinic to discover what is causing your nasal inflammation.
In extreme cases where standard medical therapy does not work fully, newer treatments with allergy desensitisation are now available. If desensitisation is needed I can arrange referral to the appropriate immunological specialist.
The Nasal Septum is the cartilage and bone midline partition which separates the 2 nasal air passageways. It may be naturally a little deviated or may have been damaged by a nasal injury. If a deviated septum is causing persistent obstruction to your breathing a simple operation is available to centralize your septum and give increased airways.
Nasal Polyps are swellings in the nose, which cause breathing obstruction, clear discharge and a reduced sense of smell. If on both sides, they are generally benign in nature but one-sided polyps need investigation to exclude more serious conditions such as cancer.
Benign inflammatory polyps are excess amounts of the nose/sinus lining tissue that heaps up and causes obstruction. In many cases steroid treatment (either tablets, drops or sprays) cause shrinkage of the swollen nasal linings and restore the airways. Sometimes an operation is needed to remove the bulk of polyp tissues if they do not respond to medical treatment. Often the sinuses are involved with the polyp tissue and a sinus operation may also be needed in some cases.
Septal Perforation Repair
Perforations in the nasal septum often give a sensation of nasal blockage even if the passageways maintain a good airway. Sometimes bleeding or crusting may occur.
Perforations need investigating to find their cause, as rarely they may be caused by sinister pathologies. Most are however due to picking, trauma, inhalation of street drugs or previous surgery. Once a sinister cause has been excluded conservative treatment with emollients or rinses may be in order. Sometimes a silicone obturator may be placed in the hole to reduce the symptoms. Some perforations may be closed surgically.
Sinusitis is an inflammation of the nasal sinuses, which are hollow areas in your facial skeleton connected to your main nasal passageways. This condition can be acute and short lived, or a longer-term chronic condition. Sinusitis normally goes hand in hand with rhinitis.
Typical symptoms may include nasal blockage, discharge from your nose, discharge dripping backwards into your throat, a reduced sense of smell or facial pains.
Initial treatment is typically with medications such as antibiotics and nasal drops/sprays. If medical treatments do not settle your symptoms surgical options may be considered. These including FESS (Functional Endoscopic Sinus Surgery) or Balloon Sinuplasty, which I have recently introduced to my practice.
Functional Endoscopic Sinus Surgery ( FESS)
When medical management of chronic sinusitis fails surgery may be necessary. The newer type of surgery is called ‘FESS’ or Functional Ensoscopic Sinus Surgery. This is where all surgery is performed using an endoscope through the nostril so there are no external scars. The natural sinus openings may be enlarged and the diseased tissue, which has been blocking the natural sinus drainage pathways, is removed to allow the natural aeration and mucus drainage pathways to reestablish their correct function.
This is a new minimally invasive day-case procedure for certain types of sinusitis which can gently stretch the natural sinus drainage pathways with a balloon to enlarge them, allow rinsing out of any diseased sinus mucus and allow good sinus aeration and drainage to be re-established. It is particularly of use if your frontal sinuses are involved. Visit: www.balloonsinuplasty.com
Snoring is very common and often very intrusive to your bed partner. Snoring is the noise from the vibration of either the soft palate, or the tongue base, or a combination of the two. Tongue based snoring and palatal snoring need different treatments.
Tongue based snoring may be associated with obstructive sleep apnoea which may be damaging to your health long-term. Patients with apnoea feel tired in the morning after sleep and may be drowsy during the day.
I can facilitate investigation and treatment for apneic snoring as well as advise regarding non-apnoeic snoring.
Rhinophyma is a condition causing a lumpy overgrowth of the soft tissues of the nasal tip. In some cases it can cause significant overgrowth which is disfiguring and causes social embarrassment. Previously thought to be due to alcoholic overindulgence it is now thought to be the endpoint of acne rosacea and due to chronic infection of the sebaceous/grease glands in the skin. Whilst early cases may be treated medically with antibiotic lotions, surgery for Rhinophyma may be needed. I have been using the Coblation technique to reduce Rhinophyma with good results.