The nose

The nose and the sinuses

Rhinology, the treatment of diseases of the nose and sinuses, covers a broad range of medical conditions characterized by one or more of the following symptoms:

  • obstructed respiration through the nose leading to increased breathing through the mouth; snoring
  • nasal secretions flowing down into the throat, often accompanied by a dry throat or coughing, more rarely by asthma
  • a reduced sense of smell or an inability to correctly identify foods and liquids
  • pain and discomfort

Analysis

A careful examination can indicate whether the problem an individual has is mechanical (a deviated septum; a tumor) or is due to a disease of the nasal mucosa (an allergy of the mucosal membranes; nasal polyps).

Various procedures and techniques are available to us to establish a diagnosis: rhinoscopy (endoscopic), smell and function tests, and imaging techniques like a computer tomography or a magnetic resonance tomography (MRI) of the sinuses.

Conservative therapy

Many of these nasal and sinus conditions respond well to medication; the goal is to improve the patient's quality of life. In the case of allergies of the nasal mucosa, allergen-specific immunotherapy is a promising option.

Surgical intervention

Some diseases respond as a rule to careful surgical operations, combined  with medication. The operations are usually carried out through the nose (endonasal).

Corrections to the nasal septum (septoplasty)

A deviated septum is relatively common. Its major symptom is blocked nasal respiration leading to breathing more through the mouth. Doing so dries out the mucous membranes in the throat, which in turn leads to an increased need to clear the throat as well as to coughing and hoarseness.

Analysis

The cause for this is usually an uneven growth of the septum. Accidents can also lead to a warped septum. If the deviation is too great, a medication-only therapy is often insufficient, and in such cases surgery can bring considerable relief and improvement in nasal function.

Operation

As a rule, the operation, carried out through the nasal passageway, is performed under general anesthesia, and lasts from 30 to 60 minutes. Special medical instruments are used to straighten the septum. A hospital stay of 3 to 4 days is usually necessary. We will be glad to inform you personally about the possible risks involved in this procedure.

Costs

A deviated septum results either from illness or is due to an accident. As such, the (Swiss) health insurance funds usually cover the costs.

Sinus cavity operation (ethmoidectomy)

The mucous membranes in the sinuses are often chronically inflamed; one can distinguish between two forms. One leads to a considerable swelling of the mucous membranes, or polyps, which blocks nasal respiration. The sense of smell can be affected, and there is increased mucous secretion in the throat. The other form leads to frequent, acute, painful sinus infections; mucous secretions here also lead to coughing and hoarseness.

Analysis

It remains unclear what causes chronic sinus infections. However, it is possible to treat the symptoms with medications. In many cases, such therapy is not enough and an operation is necessary.

Operation

Specialized medical instruments are used to open and expand the sinuses. In this fashion, the pent-up secretions can flow out and the inflammation can heal better. Surgery is done through the nasal cavity under general anesthesia. The length of the operation depends on how severe the infection is; patients usually need to remain in the hospital for 3 to 5 days. We will be glad to inform you personally about the potential risks of such an operation.

Costs

Chronic inflammation of the sinuses is an illness, so as a rule, the (Swiss) health insurance funds cover the costs.

Tests of nasal function

We use two modern procedures to test respiratory function in the nose:

  • In rhinomanometry, the airflow and the pressure gradient between nasopharynx and external air is measured (breathing resistance).
  • In acoustical rhinometry, the reflection of acoustical signals allows us to measure cross-sections of the nasal cavity, providing information about constricted areas inside the nose.

Testing the sense of smell

Problems with the sense of smell are relatively common. Smell can be affected by a flu, a chronic infection of the mucous membranes, or by an accident (for example, a skull fracture). Accurate diagnosis is the precondition for establishing which therapy has potential.

A screening test can help establish whether the sense of smell is impaired

We have developed, and scientifically validated, the Smell Diskettes© Olfaction Test we use. The test is simple and quickly carried out, and it uses attractive olfactory substances. Within a few minutes, we can establish whether there is significant or relevant deterioration in the sense of smell.
www.smelldiskettes.com

If an impairment is found through the Smell Diskettes© Olfaction Test, further assessment is needed. In a second step, we measure the degree of deterioration and use the smell threshold of  n-butanol, a well-known olfactory substance.