Nose


Conditions affecting the nose and sinuses

Colds are the most common infections of the nose. They are mainly due to viruses that cause inflammation and swelling of the membranes lining the nose (nasal mucosa). The result is a runny or blocked nose. If bacteria also enter the paranasal sinuses and/or the frontal sinuses, there is mucosal infection and pus may form. As nasal congestion prevents the secretions flowing out of the sinuses properly, the build-up of pressure in the sinus cavities causes pain in the face or forehead, distorts the sense of smell, and makes you feel unwell. Fungal infections can also lodge in the sinuses and cause disease in the nose.

Inflammation of the sinuses (sinusitis) is often made worse by the presence of anatomical abnormalities such as nasal polyps or deviation of the nasal septum. In these cases, surgery may help to overcome the problems.

Allergies, especially hay fever, are other nasal conditions that affect many people. People with hay fever have symptoms particularly in the spring and summer, when tree and grass pollens are carried in the air. A blocked or constantly runny nose is typical. The congested nasal mucosa stops the nose from carrying out its functions properly. Desensitisation gradually accustoms the body to the factors that trigger the allergy (allergens). This treatment is carried out only under medical supervision.

It can be quite frightening if blood suddenly runs out of the nose. In most cases, however, nosebleeds are usually harmless and due to damage of the membranes lining the nose (nasal mucosa). Only rarely is there a tumour in the nose, and this may be benign or malignant.

The skin on the nose is exposed to the sun throughout your life, and this may lead to benign changes on the bridge of the nose and even to skin cancer. Serious conditions affecting the nose always require medical attention. The chances of cure depend on the type of tumour and the stage of any cancer.

The nose is particularly at risk when playing football, in fights, or falls. As it protrudes from the face, it is easily broken. In complicated cases, a broken nose may need surgery; in uncomplicated fractures a splint or plaster bandage is sufficient

There are, however, less well-known conditions affecting the nose: chronic atrophic rhinitis (‘ozaena’) affects the functions of the nose and can considerably reduce quality of life. In this condition, which is difficult to treat, the nasal mucosa is severely damaged, often by the overuse of nasal sprays, and starts to disintegrate. The nose is colonised by bacteria and this causes an unpleasant smell in the nose. Although the cause is not very clear, the misuse of decongestant sprays seems to be important in most cases, with a heredity disposition or previous surgery on the nose being less common reasons.

The reason for snoring may also be found in the nose. Polyps, allergies or a deviated nasal septum are merely a few of the causes of snoring at night and by no means the only reasons. The quality of sleep is impaired, not only for those concerned but also for their partners. There are some measures which you can take for yourself to improve the situation but you should seek medical advice if snoring is a serious problem.

Snoring / sleep disorders

As we grow older, about 60% of men and 40% of women snore; and 10% of children are also affected. Very severe snoring can reduce the oxygen supply and result in sleep disturbances. This is known as obstructive sleep apnoea (OSA).

For the treatment of snoring (rhonchopathy), as well as of obstructive sleep apnoea, I am qualified in accordance with the BUB guidelines (legal German treatment guidelines for sleep apnoea). We offer outpatient sleep studies (polysomnography), which involve you taking home a small box to record your sleep pattern overnight.

In many cases, the analysis of these recordings allows us to determine why you are snoring and offer appropriate treatment. Depending on the results of these home recordings, you may need further studies in a sleep laboratory.

Investigations:   

  • Endoscopy of the nose and nasopharynx (back of the throat)
  • Outpatient polysomnography
  • Allergy testing
  • Rhinomanometry
  • Nutritional advice

Allergies

Allergies are on the increase: they are often not properly diagnosed or adequately treated. Today some 25-30% of the population suffer from problems associated with allergies. In addition to allergic rhinitis (hay fever), allergic asthma and food allergies are extremely important. The risk of developing an allergy increases to 20-40% if one parent has allergies and to 60-80% when both parents are affected.

In our ENT practice, we carry out a thorough diagnostic investigation of allergies, as treatment can only be successful if the allergen responsible has been properly identified. Treatment starts with information on how to avoid the allergen, followed by symptomatic treatment of the complaints. We may then offer immunotherapy, with desensitisation either by drops under the tongue (sublingual immunotherapy, SLIT) or by injection (subcutaneous immunotherapy, SCIT).

Prompt diagnosis and targeted therapy are also important in childhood. New sensitisation can often be avoided and prevents any progression to asthma.

Investigations:

  • Prick test
  • RAST (a blood test to determine specific antibodies)
  • Nasal provocation tests