Rhinology

Rhinology is the subspecialty branch of ENT that involves the management of disorders and conditions of the sinonasal cavity and the nose. Patients requiring a rhinologist often complain of nasal obstruction (blockage of airflow) and congestion, nasal discharge, post-nasal drip, facial pressure and discomfort, loss of sense of smell, nasal polyposis, sinonasal tumors and cancers, and frequent nose bleeds. These conditions are often managed both medically and surgically.

What is nasal obstruction?

Nasal obstruction (blockage of airflow) is a symptom where people feel like they cannot move air through their nose. One or both of the person’s nostrils may be partially blocked. Nasal obstruction can be caused by simpler things such as a septal deviation and foreign bodies in the nose, or it can be caused by more involved problems like inflammatory polyps, sinonasal tumors, or autoimmune diseases.

What is nasal discharge?

Nasal discharge is also known as rhinorrhea. It essentially means that a person has a runny nose. Extensive nasal discharge can originate from a variety of sources, including acute or chronic infections, vasomotor rhinitis (a dysfunction of the autonomic nerves in the nose that stimulate it to secrete mucous), allergies, or—more rarely—cerebrospinal fluid leaks (brain fluid leaking through a breach in the base of the skull).

What is post nasal drip?

Post-nasal drip is the sensation that fluid is draining down from the back of the nose down into the throat. Patients experiencing post-nasal drip often also complain of chronic cough, throat irritation, congestion, or an abnormal taste in their throat. There are multiple causes for post nasal drip, and it can at times be challenging to treat. Causes of this can include chronic infection, cerebral spinal fluid leaks, vasomotor rhinitis, and more commonly gastroesophageal reflux disease, to name a few. However, sometimes the problem can be a sensation issue and more neurologically based.

What causes facial pressure, pain and discomfort?

Facial pressure, pain, and discomfort can originate from a variety of sources. Sometimes, they can originate from the sinuses, and other times, they can manifest as a result of a neurological condition or headache syndrome. Identifying the cause of a patient’s symptoms is very important before implementing any treatment.

What are Anosmia, Hyposmia, and Phantosmia?

Anosmia is the medical term for complete loss of sense of smell. Hyposmia is the medical term for diminished sense of smell. Phantosmia is the medical term for recognizing smells that do not actually exist. Disorders of sense of smell can happen for many reasons. Common causes include issues of diminished air flow such as nasal polyps or tumors. Other causes can include viral causes such as COVID-19, head trauma, stroke, neurological conditions and tumors, either from the nose or the brain. It can also occur as a result of age-related changes. When this occurs it is important to have it properly investigated. Some treatments are available to help with improving recovery.

Nasal polyposis

Nasal polyps are most frequently and most commonly an inflammatory reaction that occurs in the nasal cavity. These arise from a combination of genetic and environmental factors that trigger an inflammatory cascade that leads to their formation. Quite often, people with nasal polyps, complain of nasal obstruction, nasal discharge, congestion, post-nasal drip, and/or loss of sense of smell. Rarely, nasal polyps can manifest as a type of tumor, either benign or malignant. In all these cases, the treatment is a combination of both surgery and medical therapy. Our team has extensive experience
managing nasal polyps and often works as part of our multi-disciplinary team with our allergy and immunology to help provide treatment that is appropriate to each patient’s needs.

Septoplasty

Septoplasty is a surgery involving the correction of a deviated nasal septum which means the septum is deviated in one direction or both causing the person to have difficulty with nasal airflow, feeling blocked. In some cases, a deviated septum can lead to turbulent airflow in the nose, causing the lining (mucosa) to dry out and leading to nose bleeds. In either case, a symptomatic deviated nasal septum requires surgery. The surgery can be done either openly or endoscopically, and the procedure is most frequently done in the operating room, but can also be done in the office. Depending upon the location of the deviation, the patient may require a more-extensive surgery to correct it, specifically a functional septorhinoplasty (which is sometimes referred to as a functional nose job).

Functional Septorhinoplasty / Rhinoseptoplasty

A septorhinoplasty is a type of surgery that involves altering the external architecture of the nose. This is done for specific forms of nasal obstruction where making changes to improve airflow will affect the overall architecture of the nose, or if there is dynamic collapse of the nose on inspiration (breathing in). As a result, the load-bearing forces of the nose require reinforcement to either increase space or strengthen weaknesses. Sometimes, this requires borrowing cartilage from other parts of the body such as the ear or rib. Septorhinoplasty may change the outside appearance of the nose. Consequently, septorhinoplasty can also be performed for cosmetic reasons.

Functional endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is a type of surgery involving endoscopes that is performed through the nostrils, designed to open the paranasal sinuses widely to allow for improved medication delivery into the nasal cavity and therefore allow for improvement in a patient’s sinus symptoms. FESS is most frequently performed on individuals who have chronic rhinosinusitis, with or without polyps, but can be done in other instances as well. Sometimes, the procedure involves the use of balloons. FESS is most frequently performed in an operating room, but parts can be done in the clinic. FESS has four main components: maxillary antrostomy (opening the maxillary sinus), ethmoidectomy (either complete removal or partial removal), sphenoidotomy (opening the sphenoid sinus), and frontal sinusotomy
(opening the frontal sinus). Each component is completed on each nostril, depending upon the patient’s symptoms and treatment needs.