Rhinology Review

247 Pages·2023·14.098 MB·English

by  Samy Elwany, Mohamed Askar

Rhinology
Review
Samy Elwany
Mohamed Askar
123
Rhinology Review
Samy Elwany • Mohamed Askar
Rhinology Review
Samy Elwany Mohamed Askar
Department of Otolaryngology Department of Otolaryngology
Alexandria University Tanta Faculty of Medicine
Alexandria, Egypt Tanta, Egypt
ISBN 978-3-031-08793-6 ISBN 978-3-031-08794-3 (eBook)
https://doi.org/10.1007/978-3-031-08794-3
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
I dedicate this book to my small, lovely
family: my wife, Maggie, my son Dino, and
my daughter Nelly. I cannot express my love
and gratitude to all of them for giving my life
wonderful value and meaning. They are
really the love of my life. I would also like to
dedicate the book to all my students
throughout my long career.
Samy Elwany
Special thanks to my backbone in my entire
career of nasal surgery my wife Eman, my
son Abdelrahman my daughters Bothyna and
Alaa, my grandchildren Youssef, Mohamed,
Ali, Layla, and Nelly. Special appreciation
and respect to all my patients whom I
believed I have helped to make them happier.
Finally, I would like to thank my students and
wish them a promising future.
Mohamed Askar
Preface
The art and science of rhinology has greatly expanded during the last few decades.
Several valuable well-written large textbooks are now available. While these text-
books provide plethora of useful information, they may not be the ideal tool for
those preparing for exams or needing quick to-the-point information.
This illustrated book was written to serve as a concise and to-the-point resource
and trainee companion for postgraduates setting for their fellowship, diploma,
board, and similar exams, and also as a quick compact reference and refresher for
otolaryngologists in their everyday practice especially as the e-book will be avail-
able on smart phones and tablets.
The book covers the full range of topics in the modern rhinology syllabus, as
well as related important areas that may be encountered in today’s exams and
practice.
The topics of the book include basic sciences of rhinology, investigative rhinol-
ogy, rhinologic symptoms and diseases, as well as office procedures and operations.
The book also includes concise chapters on the basics of rhinoplasty and anterior
skull surgery. All topics will be addressed in a comprehensive and comprehensible
way to keep the book as a compact reference and revision aid.
The book will distill key facts into bullet points for rapid access to essential
information and will help otolaryngologists to better understand basic and clinical
rhinology.
Pictures, illustrations and videos were extensively used to complement the text.
Each topic will be followed by MCQs with their answers for fast revisions.
We hope the book will serve its purposes as a concise, time-saving resource
detailing the essentials of rhinology and related topics for postgraduates and prac-
ticing otolaryngologists.
Alexandria, Egypt Samy Elwany
Tanta, Egypt Mohamed Askar
vii
Contents
1 Development of the Nose, Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . 1
1.1 The Nasal Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 The Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 The Ethmoid Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 The Maxillary Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.5 Sphenoid Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.6 Frontal Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 Anatomy of Nose and Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 The External Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.1 Surface Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.1.2 Structural Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1.3 B lood Supply of the External Nose . . . . . . . . . . . . . . . . . . . . 11
2.1.4 Nerve Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.2 The Nasal Cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.2.1 The Nasal Septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.2.2 Lateral Basal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.2.3 B lood Supply of the Nasal Cavity . . . . . . . . . . . . . . . . . . . . . 17
2.2.4 N erve Supply of the Nasal Cavity . . . . . . . . . . . . . . . . . . . . . 17
2.3 The Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.3.1 The Ethmoid Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.3.2 The Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.3.3 The Frontal Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.3.4 The Sphenoid Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4 Histology of the Nasal Mucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3 Nasal Physiology and Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1 Important Nasal Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2 Olfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.3 Nasal Airflow and Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.4 Defense Functions of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.4.1 Mechanical Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.4.2 Humoral Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.4.3 Cellular Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
ix
x Contents
3.4.4 Reflex Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.5 Speech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4 Imaging of the Nose and Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.1 Computed Tomography (CT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.2 Cone Beam CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
4.3 Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.4 General Radiologic Findings of Inflammatory Lesions . . . . . . . . . . . 41
4.5 General Radiologic Findings of Neoplastic Lesions . . . . . . . . . . . . . 41
5 Investigative Rhinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.1 Allergy Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.1.1 Skin Prick Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.1.2 Tests for IgE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.1.3 Nasal Smears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.1.4 Blood Eosinophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.1.5 Nasal Provocation Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.2 Airway Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.2.1 Rhinomanometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.2.2 Acoustic Rhinometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.2.3 Nasal Inspiratory Peak Flow . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.3 Olfactory Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.3.1 Subjective Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.3.2 Objective Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.4 Tests of Mucociliary Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.5 Other Objective Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.5.1 Nitric Oxide Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.5.2 Nasal Lavage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.6 Subjective Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.6.1 SNOT 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.6.2 NOSE Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.6.3 Visual Analog Scale (VAS) . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.6.4 Quality of Life (QOL) Questionnaires . . . . . . . . . . . . . . . . . . 49
6 Symptoms of Sinonasal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
6.1 Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
6.1.1 Vascular Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
6.1.2 The Sphenopalatine Artery (SPA) . . . . . . . . . . . . . . . . . . . . . 52
6.1.3 The Anterior and Posterior Ethmoid Arteries . . . . . . . . . . . . 53
6.1.4 Definition and Classification . . . . . . . . . . . . . . . . . . . . . . . . . 53
6.1.5 Primary (Idiopathic) Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . 54
6.1.6 Secondary Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
6.1.7 Management of Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
6.1.8 First-Aid Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.1.9 General Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.1.10 Control of Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Contents xi
6.1.11 Treatment of the Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
6.1.12 Hereditary Hemorrhagic Telangiectasia
(Osler–Weber–Rendu Disease) . . . . . . . . . . . . . . . . . . . . . . . 57
6.2 Nasal Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
6.2.1 Classifications of Nasal Obstruction . . . . . . . . . . . . . . . . . . . 58
6.2.2 Etiology of Nasal Obstruction . . . . . . . . . . . . . . . . . . . . . . . . 58
6.2.3 Causes of Nasal Obstruction in Children . . . . . . . . . . . . . . . . 59
6.2.4 Assessment of Nasal Obstruction . . . . . . . . . . . . . . . . . . . . . 59
6.3 Olfactory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.3.1 Classification of Olfactory Disorders . . . . . . . . . . . . . . . . . . . 60
6.3.2 Causes of Olfactory Dysfunction . . . . . . . . . . . . . . . . . . . . . . 60
6.3.3 Assessment of Olfactory Function . . . . . . . . . . . . . . . . . . . . . 61
6.3.4 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
6.4 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
6.4.1 Tension Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.4.2 Migraine Headaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.4.3 Cluster Headaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.4.4 Neuralgias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
7 Choanal Atresia and Congenital Nasal Masses . . . . . . . . . . . . . . . . . . . 67
7.1 Choanal Atresia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
7.1.1 Clinical Picture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
7.1.2 Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.1.3 Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.1.4 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.2 Pyriform Aperture Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.3 Congenital Nasal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.4 Meningoceles and Encephaloceles . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.5 Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
7.6 Nasal Dermoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
8 Nasal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8.1 Foreign Bodies in the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8.1.1 Clinical Picture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8.1.2 Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8.1.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
8.2 Fractures of the Nasal Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
8.2.1 Types of Fracture of the Nasal Bones . . . . . . . . . . . . . . . . . . 77
8.2.2 Clinical Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8.2.3 Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8.2.4 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8.3 Septal Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
8.4 Fractures of the Midface (Le Fort Fractures) . . . . . . . . . . . . . . . . . . . 79
8.5 Frontal Sinus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
xii Contents
9 Nasal Septum, Nasal Valves, and Turbinates . . . . . . . . . . . . . . . . . . . . . 83
9.1 Septal Deviation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
9.2 Septal Perforations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
9.3 Nasal Valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9.4 The Turbinates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
9.4.1 Inferior Turbinates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
9.4.2 Middle Turbinate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
10 Rhinitis and Nasal Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
10.1 Classification of Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
10.2 Allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
10.2.1 Classifications of Allergic Rhinitis . . . . . . . . . . . . . . . . . . . 99
10.2.2 ARIA Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
10.2.3 Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
10.2.4 Comorbidities of Allergic Rhinitis . . . . . . . . . . . . . . . . . . . 99
10.2.5 Clinical Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
10.2.6 Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
10.2.7 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
10.2.8 Aspirin-Exacerbated Respiratory Disease
(AERD - Samter’s Triad) . . . . . . . . . . . . . . . . . . . . . . . . . . 102
10.2.9 Rhinitis and Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
10.3 Non-Allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
10.3.1 Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
10.3.2 Vasomotor Rhinitis (VMR) . . . . . . . . . . . . . . . . . . . . . . . . 103
10.3.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
10.3.4 Non-Allergic Rhinitis with Eosinophilia Syndrome
(NARES). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
10.3.5 Non-Allergic Inhalant/Occupational Induced Rhinitis . . . . 104
10.3.6 Hormonal Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
10.3.7 Food-Induced Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
10.4 Infectious Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
10.4.1 Acute Viral Rhinitis (Coryza - Common Cold) . . . . . . . . . 105
10.4.2 Scleroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
10.4.3 Rhinosporidiosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
10.5 Special Types of Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
10.5.1 Drug-Induced Rhinitis (Rhinitis Medicamentosa) . . . . . . . 109
10.5.2 Atrophic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
10.5.3 Primary Atrophic Rhinitis (Ozena) . . . . . . . . . . . . . . . . . . . 109
10.5.4 Secondary Atrophic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . 110
10.5.5 Rhinitis Sicca Anterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
11 Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
11.1 Acute Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
11.1.1 Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
11.1.2 Microbiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
11.1.3 Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116