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What conditions come under rhinology?The commonest conditions that come under Rhinology are rhinitis, conditions of the nasal sinuses including sinusitis and epistaxsis (nose bleeds).
Rhinitis Rhinitis literally means inflammation of the nose. It is characterised by the following collection of problems:
It is a very common problem with some research saying it affects between 10 and 25% of individuals in the country. It seems to be an immunological disorder, which means it is based on an allergic reaction. It seems to be increasing in prevalence - meaning it is becoming more common and more people are suffering from it. There is a strong link between rhinitis and asthma. There are also links between rhinitis and sinusitis and middle ear problems. This is because all of the airways are interlinked. There are a considerable number of causes of rhinitis including infections, allergies, drug induced, hormonal as well as other causes including food, irritants and even occupational (related to things that are brought into contact with the patient at work). As with all diseases, sometimes a cause cannot be found and this is termed idiopathic. When it comes to treatment, an expert Rhinology's will first talk to the patient to try to find out what the cause might be, and then examine the patient to see what abnormalities might be obvious. Most patients are then put forward for tests which may include looking inside the nose with an endoscope or x-rays including CT scan. The sinuses and sinusitis. The sinuses are cavities in the facial bones of the skull. When you look at a skull of a child and then compare it to one of an adult, it becomes clear that the bones of the face are different. This is also why children look different from adults. In children, the face is rounder and this comes from small cheekbones, small maxillary bones and a smaller jaw. As children go through puberty and become adults, the bones in the forehead (the frontal bones) become more pronounced, the cheekbones push out more giving higher cheeks, the maxillary bones elongate as does the jaw, giving the face longer more adult look. If the growth of all of these bones was solid bone, the facial skeleton would be very heavy. Therefore nature elongates the bones by making them hollow. These hollows inside the bones are called sinuses. Of course bone is a living tissue, and the sinuses are lined by a living cells. It is therefore possible to get problems inside the sinuses-the commonest being infection giving sinusitis. However other conditions can occur such as tumours which can be benign or malignant. Sinusitis usually presents with a feeling of being very unwell, with pain and sometimes redness over the cheeks above the upper teeth (infection in the maxillary sinuses) or pain and sometimes redness over the lower forehead (frontal sinusitis). Maxillary sinusitis is the more common. Usually antibiotics are enough to cure this but, if it becomes recurrent, sometimes the maxillary sinuses need to be washed out at operation. This is done under general anaesthetic and a very thin endoscope (surgical telescope) is pushed through the bone wall on the inside of the nose into the sinuses. The surgeon can then check that nothing nasty is going on inside the sinuses and all infected material can be washed out. Epistaxis (nosebleeds). Nosebleeds are a very common problem. They usually occur from the front of the nose, but rarely can occur in the back of the nose. In children, nosebleeds are usually associated with picking the nose. The central part of the nose, between the nostrils, is called the septum. This has a very good blood supply. There is an area just on the inside wherefore different blood vessels all meet meaning there is a lot of blood in the tissue here. If the nose is picked, this area can be damaged and can then bleed. This area is called "Little's area". In adults, nosebleeds can also come from picking the nose in the same way. However nosebleeds in adults can occur for other reasons as well. One of the commonest is having high blood pressure. High blood pressure can make the delicate little blood vessels in the nose rupture, causing a severe epistaxis. Rarer causes include tumours, having a medical condition that stops clotting such as haemophilia or leukaemia, or being on blood thinning (anticlotting) medication such as aspirin or warfarin. Nosebleeds from the front of the nose are easy to deal with. Firstly the patient is lain down to relax them, and the front fleshy part of the nose is squeezed. Provided the bleed is from the "Little 's area" then this pressure will be directly on the bleeding point and the nose bleed will stop. Holding the nose for between 5 or 10 minutes will produce a cure unless there is any medication preventing clotting or there is a medical condition that stops clotting such as haemophilia or leukaemia. More rarely, the source of bleeding can be from the back of the nose. In these cases, blood usually trips down the back of the throat causing the patient to either spit up blood or, if they have swallowed enough, vomit up blood. In this situation, the bleeding point is within the bony structure of the nose and so pressing on the nose does not help. The bone stops the nose being squashed and so no pressure can be put on the bleeding vessels. Putting ice on the back of the neck is an old trick that has been tried and occasionally works. However if the bleeding continues, it has to be stopped by using special techniques in a hospital. Rhinology covers many other subjects including nasal polyps, tumours and also the operations and instruments used by the expert Rhinologist. If you wish to find a rhinologist, look up www.medicalpages.co.uk.
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