Environmental Medicine

Otolaryngology-Nose and Sinuses

The nose is the organ of breathing at rest and smell. The sinuses are air containing sacks located in the facial bones whose function is currently unclear. The nose and sinuses are affected by allergies, infections, bleeding, and trauma that creates structural deformities. This page summarizes some of the sinonasal conditions managed by Dr. Gregg Govett.

External nose and septum:

The nasal bones are the most commonly fractured bones in the body due to the nose projecting off the face. This projection predisposes the nose to traumatic injuries. Often, no treatment is needed for nasal bone fractures. The nasal septum is the midline dividing partition that extends posteriorly toward the nasopharynx (the part of the throat behind the nose). The septum can be fractured in nasal trauma without any fractures of the nasal bones. The septum is usually the source of epistaxis (nose bleeds) and usually responds to cautery. The septum can be the source of nasal obstruction or difficulty in breathing through the nose. This can lead to sleep disturbances, sinus infection, epistaxis, and snoring/sleep apnea. A septoplasty is the surgical procedure use to straighten the nasal septum; it is routinely performed in an outpatient surgical center. When there is a concurrent external nasal deformity or a visible septal deviation when looking up at the nostrils, an external nasal reconstruction is needed along with the septoplasty (septorhinoplasty) to surgically correct the problem. This is also performed in an outpatient surgical center. Rarely, ear cartilage and fascia grafts from the lateral thigh are needed a adjuncts to the reconstructive procedure on the nose.

Hypertrophic turbinates:

The turbinates of the nasal cavity are the structures on the walls of the nose that serve to warm and humidify the inspired air. These structures can become enlarged from allergic disease or may be naturally large as a result of an enlarged turbinate bone underneath the mucosa. These structures are often reduced in size surgically to enlarge the airway in the nose.

Allergic Rhinitis:

Allergic rhinitis or nasal allergy is a very common problem in Oklahoma. Please see the environmental medicine section regarding this problem.

Sinusitis:

Sinusitis is an infection or inflammation of the sinuses. The sinuses communicate with the nasal cavity through very narrow passages or ostia. When these ostia become inflamed from a upper respiratory infection or allergy, an infection can develop. When the infection fails to clear, a CT scan of the sinuses is ordered to evaluate the extent of disease. Sinusitis is managed acutely with antibiotics and saline irrigation. When the sinusitis becomes chronic, it can be managed with allergic therapy and/or surgery. The surgery is performed in a outpatient surgery center using nasal telescopes or surgical balloons. Due to the widespread use of antibiotics over the generations, antibiotic resistance is a problem in chronic sinusitis. There are a variety of techniques used to try to clear the chronic sinusitis resulting from resistant bacteria and fungi.

Nasal Endoscopy:

The nasal cavity is often evaluation using a rigid nasal telescope in cases of bleeding, chronic sinusitis, and nasal polyps. Nasal polyps usually originate in the sinuses but may arise from the turbinates comprising the walls of the nose. Nasal endoscopy is valuable in the management of epistaxis (nose bleeds) to pinpoint the source of bleeding.

Taste and Smell Disorders:

Taste and smell disorders are very difficult to manage due to the lack of research. The evaluation of this problem usually consists of imaging to ensure no major problems are present. Most treatments are usually a clinical trial of a variety of supplements and medications.

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