Nasal obstruction can occur either for structural or inflammatory reasons. Structural causes include such entities as a deviated nasal septum or a crooked nose. In these situations there is an anatomical change that physically impedes air flow through the nose. Tumors may also affect the flow of air and these tumors may be benign, such as nasal polyps, or may be malignant, such as an epidermoid carcinoma.
Inflammatory conditions such as allergy and infection cause the nasal mucosa, that is the lining to the nasal cavity, to swell. When the mucosa swells, the area available through which air can pass is diminished, and therefore one experiences a sense of nasal obstruction. Allergy is the most common inflammatory cause of nasal obstruction, but infection, either by viruses such as the common cold or bacteria as often found in sinusitis, may cause nasal obstruction.
Symptoms of Allergic Rhinitis
- Itchy Nose
- Sneezing
- Runny Nose
Rhinitis means an inflammation of the nose but is used by most of us to connote a runny nose. The discharge from the nose can come through the front of the nose or it can drain through the back of the nose, a condition which we call post-nasal drip. The discharge may be clear or it may be colored, most commonly yellow or green. Allergy frequently produces a runny nose. In these cases the discharge will be clear or occasionally white. Infection also causes nasal discharge, and this will be a purulent discharge most commonly colored yellow or green. Irritation to the nose can also cause discharge. This discharge is most commonly clear or white and it is experienced by many people when exposed to nasal irritants. Many individuals exposed to cold air or to smoke will have nasal discharge and this is an irritative rhinitis.
A posterior nasal obstruction either from a tumor, a foreign body or a badly deviated septum will inhibit the normal flow of secretions from the front of the nose to the back. These secretions are normally carried out the back of the nose and swallowed down the back of the throat. If there is a physical obstruction to the flow of secretions through the nose such as one might expect with a tumor, then the secretions must drain anteriorly and flow out the front of the nose.
A very common cause of a runny nose is a condition called vasomotor rhinitis. In this condition, the nose responds to stress with a tremendous production of nasal secretions. Stress can cause many different physical complaints. Migraine headaches are caused by stress as are many cases of hypertension, peptic ulcer disease, diarrhea, constipation, and the list goes on and on. The nose can also be affected by stress. This often presents as sinus headaches and/or as a runny nose and the condition is called vasomotor rhinitis. Read a sample consultation with a patient who has allergic rhinitis.
Symptoms of Acute Sinusitis
- Pain/Pressure over one's sinus
- Feeling Sick
- Fever
- Nasal obstruction
- Nasal congestion
Symptoms of Chronic Sinusitis
- Nasal obstruction
- Nasal congestion
- Post nasal drip
- Cough
- Facial pain
- Smell loss
- Cough
- Halitosis (bad breath)
Chronic sinusitis is a condition in which the sinuses become inflamed, which means the mucosa has swollen and the mucociliary transport system is impaired. As a result, bacteria within the sinus grow continuously. People suffer from facial pains, pressure, nasal congestion, nasal discharge, post nasal drip, cough, fatigue, smell loss, bad breath, and just generally not feeling well.
Normally, sinusitis is treated with antibiotics. Some add a course of nasal steroids. I am opposed to a course of systemic steroids. If the treatment corrects the problem, wonderful, but all too often it does not. The reason that it does not is that the small drainage ports (the sinus ostia) are too small to keep the sinus aerated and the sinus fluids properly drained. Once you realize that medical treatment is not going to improve or relieve the chronic sinusitis, it is our practice to perform a complete nasal workup looking for anatomic deviations, allergies, irritations, tumors, foreign bodies left in the nose, or anything else which might predispose to the sinus disease. Any illness identified is then treated. If illness is not identified or if medical treatment does not correct the chronic sinus condition, surgery is indicated.
The surgery performed today is called endoscopic sinus surgery (ESS), and is generally performed with image guided assistance. It is performed under general anesthesia. The surgery is performed using little endoscopes and working through your nostrils. No external incisions are made. The surgery normally takes about an hour to perform. The surgery involves removing the inflamed ethmoid sinuses and then opening the natural sinus ostia to the maxillary and frontal sinuses. Packing is rarely used. The surgery is normally performed as an outpatient, meaning you go home the same day of the surgery. You normally have a stuffy nose for one or, at the most, two days. We recommend that patients take a week off work, not so much that they really need the week, but if you rest, relax, and take care of yourself, you will heal better. This surgery has been extremely effective and relieves or cures the chronic sinusitis in as many as 90 percent of patients. Read a sample consultation with a patient who has sinusitis and needs endoscopic sinus surgery.
True taste disorders are uncommon. A taste disorder may present as a loss of taste, that is the loss of the ability to detect salt, sweet, sour, and bitter or it may present as an abnormal taste in the mouth such as a bitter taste, an unpleasant taste, or even an electrical sensation. Loss of taste is most commonly caused by an interruption of the nerve to the tongue. This can happen as a result of surgery, tumors, or even dental injections. Abnormal tastes may be caused by injury to the taste buds, injury to the nerves responsible for taste, or to a variety of other conditions which occur within the mouth. Occasionally dental work will set up a small electric charge in the mouth just as an electric charge is created in a dry cell battery. This may be perceived as an abnormal taste or as a stinging, electrical kind of feeling. These conditions vary so much that it is difficult to classify them in a meaningful fashion.