VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk
In our country, rhinology is typically part of a wider field, called otorhinolaryngology. It is a specialization dealing with diseases of the ear, nose and paranasal sinuses, as well as diseases of the oral cavity, larynx and pharynx. It is a broad field, therefore its "subspecialization" is distinguished, called rhinology. What does a rhinologist do? What diseases does this specialist treat most often?
Rynologistdeals with diseases related to the nasal cavity and paranasal sinuses. The paranasal sinuses are the air cavities that are inside the bones of the skull. Each of us has four types of bays, namely:
- maxillary sinuses,
- frontal sinuses,
- ethmoid sinuses,
- sphenoid sinus.
The nasal cavity and sinuses can cause us various medical problems, with which it is worth visiting a rhinologist. Let's look at the conditions that this specialist treats. We do not describe in this article the most commonly known diseases, such as acute rhinitis and paranasal sinusitis, as this disease is successfully treated mainly by family doctors.
Nasal septum deviation
In fact, a deviated septum of the nose occurs even in 90% of our population, but only some situations are an indication for surgery. The causes of septal deformation include, for example, mechanical injuries to the nose, but it can also be congenital disorders.
A curvature of the septum of the nose can lead to breathing problems as well as more frequent respiratory infections and headaches. These are definitely indications for nasal septoplasty, i.e. septoplasty. Such an operation, after appropriate qualification, is performed by rhinologists.
Nasal polyps - what are they?
Nasal polyps are benign structures originating from the mucosa of the nasal cavity or paranasal sinuses. They very often appear in the place where the sinuses enter the nasal cavity, which significantly worsens the patency and may predispose to recurrent sinusitis.
Nasal polyps are thought to affect up to 4% of our population, but some of us are more common.The risk of nasal polyps increases being ill with some diseases, which include:
- bronchial asthma,
- allergic sinusitis,
- cystic fibrosis,
- Churg-Strauss syndrome - this is a type of vasculitis,
- frequent sinusitis.
In order to diagnose nasal polyps, the rhinologist must perform an ENT examination and examine the nasal cavity. In an ENT examination, polyps are visible as mobile, whitish masses.
Nasal polyps - drug treatment
In a situation where polyps do not worsen nasal patency, pharmacological treatment with nasal steroids is possible. Steroids are anti-inflammatory and can shrink nasal polyps.
It should be remembered, however, how important it is to treat the underlying disease when it is responsible for the appearance of nasal polyps. We are talking about apirinic asthma as well as cystic fibrosis.
Nasal polyps - operation
In a situation where nasal polyps significantly impede patency and cause recurrent sinusitis, it is necessary to consider a special procedure. Another indication for it is the ineffectiveness of the above-described pharmacotherapy.
The procedure of choice for nasal polyps is the so-called functional endoscopic surgery of the paranasal sinuses (FESS). This procedure is performed through the nasal cavity, it is possible to perform both local and general anesthesia.
Such procedures are typically performed by a rhinologist, but the indications for FESS are not only nasal polyps. Other nasal cavity and sinus conditions that can be resolved with this treatment include:
- recurrent sinusitis - this procedure improves the patency of the sinus openings, which prevents the accumulation of discharge in the sinuses, which may predispose to infections,
- small neoplastic tumors within the sinuses and nasal cavity - thanks to the procedure they can be effectively removed,
- developmental defects related to the sinuses and nasal cavity,
- foreign body removal,
- obstruction of the tear ducts.
FESS is the gold standard in rhinology and one of the most frequently performed procedures in this speci alty.
Benign neoplasms of the nose and paranasal sinuses
Rhino is also the diagnosis and treatment of neoplastic diseases. Which oncological diseases of the nose are most often diagnosed by a rhinologist? With regard to benign neoplasms, it is primarily:
- osteoma- a well-calcified tumor, visible e.g. on a radiograph of the sinuses. Osteomamost often it is located in the frontal and ethmoid sinuses. It can be manifested by a feeling of distension in the sinus, as well as impair the patency of the sinus, which may favor the appearance of sinusitis, which is an indication for its removal, most often with endoscopic methods (FESS procedure described above),
- papillomas- these tumors typically appear in the nasal cavity and sinuses. They may show symptoms of blocked nose and bleed. Importantly, papilloma can become malignant, so it is necessary to remove them by surgery,
- hemangiomas- can come from both the circulatory system (hemangiomas) and the lymphatic system (lymphangiomas). These are typically congenital lesions and constitute the group of the most common benign tumors of the nasal cavity in children. Congenital hemangiomas may disappear spontaneously, therefore it is not recommended to perform surgeries before the age of one. It is also possible to use laser therapy in their treatment.
Malignant neoplasm of the nose and paranasal sinuses
Unfortunately, malignant tumors can also be found in the nasal cavity and sinuses. They mainly include:
- basal cell carcinoma- it is the most common malignant neoplasm of the external nose. It is located on the skin of the nose and is typically a lump, initially with a slight dimple. Basal cell carcinoma most often affects patients in the 7th and 8th decade of life. It is a malignant neoplasm with a good prognosis, it does not metastasize, and treatment requires excision of the lesion with a he althy tissue margin,
- squamous cell carcinoma- is the second most common malignant neoplasm of the external nose. Initially, it takes the form of a non-healing nodule, then rapidly grows to form a crater ulcer. Contrary to basal cell carcinoma, it metastases which are first located in the lymph nodes. The treatment of choice is excision of the lesion with a margin of he althy tissues, radiotherapy is also used here,
- melanoma- although melanoma is significantly more common in the trunk and lower limbs, in 10% of cases it is located on the face and may appear on the skin of the nose. This malignant neoplasm is more common in women and can arise on the basis of an existing birthmark, but also on unchanged skin. Melanoma is certainly suspected in the case of a sudden enlargement of the pigmented lesion, its bulging, bleeding, and the appearance of small additional nevi (satellite lesions) around it. Treatment of melanoma consists in removing the lesion with a large margin of he althy skin, which is sometimes necessaryalso removal of lymph nodes in which metastases may be located,
- squamous cell carcinoma of the nasal cavity and paranasal sinuses- this is the most common cancer, this time located within the nasal cavity and sinuses. The symptoms of this cancer depend primarily on its exact location and may include:
- unilateral nasal obstruction,
- one-sided nasal discharge, especially bloody nasal discharge,
- feeling of expansion and fullness in the sinus / nasal cavity,
- smell disorders, especially one-sided,
- cheek swelling,
- proptosis of the eyeball, impaired mobility of the eye, as well as loss of teeth - these are symptoms of an advanced cancer.
To sum up, rhinology is a really wide field, which is due to the fact that there are many diseases of the sinuses and the nose. If we have disturbing symptoms related to the nose and paranasal sinuses, we should definitely visit a rhinologist who, after examining us, will decide on further diagnostic steps.
Of course, you should be aware that a rhinologist is not as widely available as an otorhinolaryngologist (because it is a basic medical specialization), therefore, with problems of the nose and sinuses, we can also go to an otorhinolaryngologist, commonly known as an ENT specialist.