AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 8

Rhinology, Nasal Obstruction, and Sinusitis

Patients present to primary care providers with a variety of nasal complaints, ranging from rhinorrhea and postnasal drainage to obstruc- tion and pain. Rhinorrhea, postnasal drainage , and nasal obstruction result from mucosal inflammation from a variety of causes, including allergic rhinitis, nonallergic rhinitis, vasomotor rhinitis, and acute and chronic rhinosinusitis. Nasal obstruction can also be caused by anatomic deformities, including septal and external nasal deviation, nasal valve compromise, turbinate hypertrophy, nasal polyps . Successful treatment of the varying causes of rhinorrhea and nasal obstruction is based on an accurate diagnosis of the underlying cause. Anatomy The nasal cavity is divided by the nasal septum in the midline; the nasal septum is composed of cartilage and bone and covered by ciliated respi- ratory epithelium or mucosa. Along the lateral nasal wall are three nasal Clinical Practice Guideline: Adult Sinusitis Clinical Consensus Statement: Balloon Dilation of the Sinuses Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction Clinical Consensus Statement: Appropriate Use of Computed Tomography for Paranasal Sinus Disease Clinical Consensus Statement: Diagnosis and Management of Nasal Valve Compromise

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turbinates, composed of bone and ciliated respiratory mucosa. The function of the nose is to filter, warm, and humidify inhaled air; the cilia move secreted mucous and inhaled parti- cles into the nasopharynx, where they are swallowed and digested. The other function of the nose is olfaction. The paranasal sinuses are air-filled cavities located in the bone around the nasal cavity, and open into the nasal cavity through ostia . The functions of the sinuses are to warm and humidify air, lighten the weight of the head, increase voice resonance, and protect the brain and eyes by acting as a crumple zone in cases of trauma.

Figure 8.1. Image of nasal cavity and paranasal sinuses.

Primary Care Otolaryngology