Diagnosis and treatment of nasal and sinus problems, including deviated septum, turbinate hypertrophy, acute and chronic sinusitis, polyps and smell problems.
Epistaxis, or nasal bleeding, can occur in both children and adults. In children, it generally reflects the presence of ectasia, a vascular spot located at the level of the nasal septum without pejorative value.
In general, a simple electrical chemical cauterization by radiofrequency or laser is enough to overcome it. In case of persistence, it will be necessary to seek a rarer and deeper cause by the practice of fibroscopy or imaging.
In adults, the general condition of the patient should be taken into account:
- Taking anti coagulant or anti platelet aggregation (aspirin), hypertension before the clinical examination.
- If a vascular spot is frequently found, it is necessary to ensure the absence of a tumor of the nasal fossae by fibroscopy and imaging (Scanner, MRI)
Faced with chronic nasal obstruction, an in-depth clinical examination could determine the cause or causes that could be associated:
– Deviation of the nasal septum, often mentioned by the patient himself, but rarely solely responsible for the symptomatology. It is authenticated by the practice of a scanner of the sinuses and rhino-manometry. It can be corrected by performing a septoplasty.
– Hypertrophy of the inferior turbinates: Responsible for a chronic permanent or tilting obstruction, particularly in the context of vasomotor rhinitis. She can benefit from Turbinoplasty by radiofrequency or laser in order to avoid the abuse of very toxic local vasoconstrictors both locally for the nasal mucosa and from a general point of view (occurring hypertension, stroke). This Turbinoplasty has replaced the turbinectomy or excision of the entire turbinal mucosa previously practiced which was responsible for the occurrence of empty nose syndrome, the functional repercussions of which can be dramatic in patients who have undergone this type of intervention.
nasal valve problem
Requires a complete ENT examination: fibroscopy, rhino-manometry, scannography in patients whose nasal obstruction is not due to hypertrophy of the turbinates or a deviation of the nasal septum.
We must distinguish acute sinusitis, whose diagnosis is based on symptoms and clinical examination. All the maxillary ethmoid, frontal and sphenoid sinuses can be affected by the infectious process. Treatment is usually medical, and recovery can be achieved within a few days.
A distinction is made between chronic sinusitis, which results in the recurrence of infectious episodes, and the persistence of opacities that may involve all the sinuses on the scanner. The treatment can be medical or surgical depending on the case. The particular case is that of naso-sinus polyposis, responsible for chronic bilateral nasal obstruction and loss of smell.
There are family forms associated with an asthmatic state or intolerance to aspirin (Widal’s disease). The treatment is above all medical at first (local and systemic corticosteroid therapy) before considering a possible surgical treatment in case of failure of the medical treatment.