COMMON NASAL DISORDERS
Common nasal disorders include: difficulty breathing (known as nasal obstruction), abnormal or loss of sense of smell, and nosebleeds. If these problems become chronic, then an ENT physician is needed for a thorough evaluation.
Difficulty breathing through the nose is a very common problem. It can occur seasonally with allergies or acutely with an upper respiratory tract infection or sinus infection. However, if it is not resolved with treatment of these conditions, then there may be another cause for the problem. The most common reason a patient has chronic nasal obstruction is from a deviation of the nasal septum.
The nasal septum is the cartilage and bone that separates the left and right nasal cavities. The most common cause of this disorder is trauma and many patients have a history of fracturing the nose, but some do not note any particular cause of the deviation. Regardless, we initially treat the patient with local care, using a combination of saline and steroid nasal sprays in an attempt to open the nasal cavities and improve the airflow. However, if this is unsuccessful, then surgery is indicated. A nasal septoplasty is a very successful procedure, but requires 1-1.5 hours of general anesthesia and has a 10-14 day recovery period of limited activity.
There are other causes of nasal obstruction, such as turbinate hypertrophy (enlarged nasal bone-tissue) and nasal polyps. Both are treated with a combination of nasal saline and steroid sprays, but may require surgery if severe.
Abnormal or loss of the sense of smell is a very common problem that affects many people over the age of 60. This is commonly due to the loss of function of the specialized (olfactory) nerve fibers as one ages. However, it can affect younger patients as well. This can be due to anatomical problems of the nasal cavity, such as a septal deviation or polpys, or from chronic sinus inflammation and infections. Tobacco smoke contains many pollutants that will irritate the nasal tissues and cause smell problems. Rarely, could a nasal or brain tumor present with symptoms of abnormal or a total loss of smell.
The medical evaluation of a smell abnormality often warrants a CT scan, and the treatment is aimed at correcting the underlying cause (ie, removing polyps if present). One important recommendation to these patients that may be life-saving is the need to have smoke detectors in the home, as these patients will not smell the smoke of a fire.
Another common nasal problem is recurrent nosebleeds. In children, it is often due to dilated blood vessels, known as varices, of the nasal septum. These can be treated with the application of vasoline to prevent dryness and subsequent bleeding, and in few instances cauterization of the blood vessel is needed. In adults, it can be related to high blood pressure. Often, adults take blood thinners, such as Aspirin, that increases the chance of bleeding. All patients with recurrent nosebleeds need to have a thorough evaluation to ensure there is no polyp or tumor that may be the cause of bleeding. If nosebleeds become recurrent, then an ENT evaluation will be indicated.
Robert Wilson, MD.