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Disorders of the Nose and Sinuses
Robert T. Sataloff, MD, DMA is a professor of otolaryngology, head and neck surgery at Jefferson Medical College, and an adjunct professor of otorhinolaryngology at the University of Pennsylvania. He also holds a doctorate in musical arts and specializes in otology and evaluation of voice disorders. Here, he describes the "interesting" anatomy of the nose both inside and outside, which often predicts the problems that afflict it. He discusses the function of turbinates and the region known as Kiesselbach's plexus in rhinosinusitis, and the risk factors, causes, and management of nasal disorders. The author discusses the anatomy of the nose and the factors leading to epistaxis, as well as types of nasal obstruction, especially deviated septum and polyps. He notes that the nose is an easy target for nasal fractures which can lead to brain hemorrhage or cerebrospinal fluid leakage since "the top of the nose is the floor of the brain." Dr. Sataloff warns physicians not to ignore loss of ability to smell since this may herald serious disease. Devoting a section to rhinosinusitis, he says this accounts for 25 million office visits annually, with voice users such as singers, teachers, and actors particularly susceptible. He discusses its formal definition and its causes, including inflammation leading to mucociliary transport impairment. Diagnosis is based on clinical signs and the major and minor symptoms of sinusitis, with no need for radiologic imaging, although nasal endoscopy can be useful as an adjunct, and a CT scan can confirm a diagnosis. The mainstay of treatment is antibiotics, decongestants, and antihistamines for patients with allergy-induced sinusitis. Endoscopic sinus surgery may be indicated as a last resort, and although complications are rare they may include CSF leak and blindness in sinusitis. Read More from Dr. Sataloff and the Journal of Voice. |
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