Nose

The nasal septum is a partition made of cartilage and bone that divides the right nasal cavity from the left nasal cavity. The septum is usually straight and lies in the centre of the nose. A deviated septum is an abnormal bend in this partition and this may cause problems with nasal breathing and/or nasal discharge. It may be caused by an injury or birth defect.

Medical treatment of nasal obstruction

In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce nasal obstruction. If there is already a deviated septum or large turbinates, a small amount of swelling can produce symptoms. On the other hand, if the swelling can be reduced with medication, this may be enough to avoid surgery.

What is a septoplasty?

A septoplasty is an operation in which the nasal septum is straightened. When there is a septal deviation there is invariably an associated swelling of tissue arising from the side walls of the nose (the turbinates). These may need to be partially reduced. The operation is performed under general anaesthesia.

Written by Dr Zoran Becvarvski, ENT specialist

What is the nasal septum?

The nasal septum is a partition made of cartilage and bone that divides the right nasal cavity from the left nasal cavity. The septum is usually straight and lies in the centre of the nose. A deviated septum is an abnormal bend in this partition and this may cause problems with nasal breathing and/or nasal discharge. It may be caused by an injury or birth defect. Inside the nose, the side walls contain small horizontal bones (turbinate) that are lined with nasal tissue. It is important to note that the nose goes through a natural cycle in which the nasal lining of the turbinates on one side (and then the other) slowly expands and contracts. These cycles occur every several hours and may lead to the perception of the nasal obstruction being intermittent and/or changing sides.

Medical treatment of nasal obstruction

In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce nasal obstruction. If there is already a deviated septum or large turbinates, a small amount of swelling can produce symptoms. On the other hand, if the swelling can be reduced with medication, this may be enough to avoid surgery.

What is a Septal Reconstruction?

Septal reconstruction is an operation in which the nasal septum is straightened. During septal reconstruction part of the deviated septum is removed. Cartilage is then used to replace/reconstruct the septum (this maintains the support of the nasal framework). Swelling of the turbinates may be associated with septal deviation. Thus, turbinate reduction (resection and/or diathermy) may also be performed during the septal reconstruction.

What are the indications for a septal reconstruction?

A small number of people actually have a perfectly straight midline septum, but in most cases the amount of bending is not large enough to be a problem. A septal reconstruction is performed if the septum is so bent that it obstructs the breathing or interferes with the drainage of the sinuses, (leading to repeated sinus infections). In some cases the septum may need to be straightened in patients undergoing sinus surgery just so that the instruments needed for the surgery can fit into the nasal cavity.

Written by Dr Zoran Becvarvski, ENT specialist

What is Sinusitis?

Sinusitis is an infection or inflammation of the sinuses. Normally, the sinuses and nose are cleaned by the flow of this mucous and anything that blocks the outflow of this mucous, can lead to sinus pressure, pain, and infection. Colds, allergies or exposure to smoke, can all thicken the mucosa and block the flow of mucous. Bacteria can subsequently grow in the blocked sinus, resulting in sinusitis.

What are the symptoms of sinus disease?

The most common symptom of a sinus infection is pressure and/or pain in the facial region or behind the eyes. This is usually associated with nasal obstruction, green or yellow nasal discharge, post-nasal drainage, and may include a fever. Sinusitis can cause redness and swelling of the skin near the eyes if the infection is severe. Headaches can be caused by sinusitis (and many other conditions). Although it is difficult to actually see into the sinuses themselves, a nasendoscope (a telescope for looking into the nose) can be used to look at the openings of the sinuses. In some patients pus can actually be seen coming out of the sinuses, which will confirm the diagnosis. Another typical findings of acute sinusitis is a swollen and red nasal cavity.

What are the treatment options for sinus disease?

1. Medical Treatment
   In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce sinusitis. Medications (nasal sprays, antibiotics, and others) may be enough to avoid surgery.
2. Surgical Treatment
   If sinus infections persist despite maximum medical treatment, then surgery may be necessary. The aim of surgery is to improve the natural drainage system of facial sinuses and to remove any anatomical obstruction or diseased areas which cause recurrent or chronic sinus infection.

The surgical method used is Functional Endoscopic Sinus Surgery (FESS).

The use of endoscopes has revolutionised all forms of surgery in the past ten years by providing vision into body spaces with excellent illumination, magnification and "around the corner" views. Endoscopic sinus surgery is performed through the nostrils and occasionally external incisions.

The operation is performed under a general anaesthetic and requires an overnight stay in hospital and 7-14 day's absence from school or work.

Written by Dr Zoran Becvarvski, ENT specialist