NOSE

The nose is an extremely noble organ and, despite how it looks look, is very dynamic in its operation. It is responsible for our breathing and sense of smell and performs an important esthetic role being located in the center of the face.

Its function

One of the main functions of the nose, as well as breathing, is to serve as a protection mechanism of the lower airways through filtration, purification and humidification of the air inhaled, avoiding the possible emergence of pulmonary diseases, as well as other regular senses such as smell, that serves as security for the perception of smell, for example, food odor to better enjoy its taste.

Allergic Rhinitis

One of the most common diseases related to the nose is Rhinitis. Rhinitis can have several causes, the most common being allergic rhinitis, that is characterized by nasal obstruction, clear liquid catarrh, sneezing and itching. It normally arises when the patient comes into contact with certain substances that trigger the crisis such as dust, mold or perfume. Another cause of Rhinitis is medicamental, or as it were, is triggered by the continuous use of nasal drops based on vasoconstrictors, causing improvement of nasal obstruction for some hours, however after the effect of the drops the obstruction becomes even worse leading to dependence of this medicine several times a day.

Deviated Nasal Septum

The deviated nasal septum is without doubt the main anatomical cause of nasal obstruction. It consists of a deviation of the cartilage or bone of the nasal septum, thus obstructing the passage of air. The origin of the deviated of nasal septum can be genetic or from trauma. The main repercussions of nasal obstruction are the worsening of the physical performance, as the patient maintains supplementary breathing through the mouth, chronic irritability in the throat associated or not with the presence of a frog in the throat and repetitive sore throat, mainly in the morning which improves over the course of the day. Others signs and symptoms are difficulty to sleep, restless sleep, snoring and nocturnal apnea (respiratory pauses during sleep), that can lead to the appearance of illnesses such as high pressure, concentration difficulty and irritability and, after a consultation with an Otorhinolaryngologist, it is discovered that the cause is a deviated nasal septum.

Nasal Polyps

Other causes of nasal obstruction are nasal polyps, structures of jellylike consistency that grow inside the nose, and that can take up the entire nasal cavity leading to a total obstruction that can be I unilateral or bilateral. Still we should relate this to intranasal tumors which can be or not be of benign cause and that can be one of the first symptoms of nasal obstruction or repetitive bleeding.

Sleep disturbances, snoring and nocturnal apnea

The occurrence of a nasal obstruction, that causes sleep disturbances, associated with snoring and nocturnal apnea (respiratory pauses during sleep), alteration of oxygen saturation, can cause difficulty to control cardiovascular diseases like systemic arterial hypertension, which increase the chances of stroke and heart attack. Disturbances of behavior, such as anger crises, lack of emotional control and concentration difficulty can be related to a bad night’s sleep just because of the fact the patient has nasal obstruction with sleep disturbances. Repetitive nasal obstruction may also be a factor of rhinogenic headache, or as it were, headache of nasal origin, that can be related to difficult to control headaches, with no solution with the usual medications.

Nasal bleeding

The nose can still have other problems of great importance such as nasal bleeding, or epistaxis, that many times can happen in large amounts and can be related to other prior pathologies like systemic arterial hypertension, nasal tumors or hematological illnesses related to disturbances of coagulation. This bleeding in children is normally related to digital injury (finger inside the nose).

Sinusitis

In parallel to the nose we have the sinuses, bone structures that have direct communication with the nose and, because of that have many problems related to it. The most common one is sinusitis, pressure pain in the face that can be associated with catarrh varying from a clear thick to a green yellow colored liquid, associated with general unwellness of the patient. Sinusitis can be acute, as it occurs during a stronger, badly treated or chronic cold, leading to facial pain of the patient and pressure in face or whole head, nasal obstruction and anterior or posterior catarrh (as if the patient is always swallowing something that comes from the nose). Because of this, a video nasoscopy as well as computerized tomography of the sinuses makes the differential diagnosis between headache and chronic sinusitis in order to start the correct treatment for the patient.

Rhinoplasty, reparatory or esthetic surgery of the nose

It is clear that we cannot forget how beautiful the nasal structure is. It has the privilege of being in the center of the face, being responsible for its harmony. Many patients develop social and behavioral disorders, like when having photos taken, because of the fact that they do not feel at ease with their own nose, causing social isolation. Rhinoplasty or esthetic surgery of the nose can be reparatory, when the patient suffers some kind of facial trauma and consequently with a fracture of the nasal bones which can be associated with lacerations of the skin or esthetic correction of the nasal structure which the patient does not find pleasing . Rhinoplasty performed by Otorhinolaryngologists has the big advantage of being able to make esthetic corrections in the same procedure as the correction of a deviated nasal septum and with that associate improvement in nasal esthetics with an improvement in nasal breathing.

Anesthesia and nasal surgery

Otorhinolaryngology is, without doubt, one of the areas of the medicine that has evolved the most in recent years. As well the evolution in diagnostic technology, such as the use of the surgery by video, causing minimal invasive surgery, surgical procedures, mainly related to rhinology, havw had a massive evolution. At present the majority of nose surgeries are performed with local anesthesia and sedation, with the exception of very small children, large intranasal tumors or to access tumors at the base of the skull. As well as that, the use of the post-operative nasal plug has been eliminated, something that, without doubt, represented one of the biggest discomforts for the patient.

Video Nasoscopy and complementary examinations

In consultation with the Otorhinolaryngologist the diagnosis is performed with complementary examinations in the consulting room along with clinical images using computerized tomography or magnetic resonance of the sinuses. Video Nasoscopy is an examination performed in the consulting room using a 2.7mm flexible fiber optic, making for a comfortable exam, linked to lighting systems and video allowing for greater viewing of all the nose structures.

Clinical treatment

Nasal diseases can be treated using medicines or surgical procedures. Medicines are based on antihistamines, systemic corticoids or nasal sprays.

Septoplasty

Septoplasty is a procedure for correction of deviated cartilage or bone of the nasal septum and is performed with anesthetic sedation, where the patient sleeps during the procedure, using local anesthesia. The surgery consists of a small incision inside the nose with displacement of the nasal mucous membrane and removal of the deviation. Instead of a nasal plug, intranasal stitches with absorbable threads are used, greatly increasing post-operative comfort.

Turbinectomy

Turbinectomy consists of the partial removal of the nasal turbinates, which are the structures responsible for filtration, humidification and heating of the air that passes to the lungs, however they are also responsible for the symptoms of allergic rhinitis, and with their partial removal the nasal function is preserved, however the symptoms of the disease are greatly reduced.

Endoscopic surgery of the sinuses

Endoscopic surgery of the sinuses is performed for surgical treatment of chronic sinusitis, polyps and removal of intranasal tumors. Surgery consists of increasing the link between the sinuses and the nasal cavity, in case of sinusitis, in this way draining the secretion from inside the sinuses and avoiding it recurring once again. With the removal of intranasal tumors or nasal polyps the surgical approach is much more precise due to the fact that a video system with lighting is used which enlarges the image permitting a more complete removal of the lesion avoiding as much as possible the recurrence of the illness. The procedure is performed with local anesthesia and sedation and also does not necessitate the use of post-operative nasal plugs.

Control of nasal bleeding

Still associated with endoscopic surgery, there is Surgery to control nasal bleeding in patients where the situation occurs as a result of systemic arterial hypertension, changes in blood coagulation or intranasal hemorrhagic tumors.  Nasal bleeding in children is normally due to digital trauma and for this the immediate solution is to "tightly hold" the nose with the fingers for 10 minutes to control the bleeding and afterwards consult an Otorhinolaryngologist; chemical cauterization can be performed in the consulting room.  Chemical cauterization consists of a topical anesthesia using cotton soaked in anesthetic solutions and subsequently the placement of small amount cotton with a haemostatic solution. In case of Surgery, the procedure consists of the identifying the precise location of bleeding with the help of a nasal endoscope; the procedure is performed in the surgical center with sedation and local anesthesia, and with the cauterization of the blood vessel causing the nasal hemorrhage.

Nasal Fracture Reduction

The procedure for nasal fractures follows two stages, one immediately and a second later on. The immediate step is nasal compression, with the fingers or cloths, together with the placement of ice in the region to help to control the nasal bleeding and reduce immediate swelling and go to an emergency room with an Otorhinolaryngological service. And after 5 to 7 days with improvement of facial swelling and with a better evaluation of the esthetic deformities that have occurred in the nose, surgery can be scheduled for the reduction of the nasal fracture. This surgery is performed with sedation associated to a local anesthesia and consists of positioning the nose as close as possible to its position immediately before the trauma. In cases where nasal fracture reduction cannot be done within a period of two weeks after the trauma, then reparatory Rhinoplasty can be scheduled for 6 months after the fracture.