* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.
This page provides an overview of disorders that affect the nose and paranasal sinuses, and that are treated at the Center.
Allergic Rhinitis
An estimated 45 million Americans suffer from allergies. Common symptoms that are caused by allergies include frequent sneezing, itchy eyes, stuffy nose, runny nose, and post nasal drip. Allergies may also play a part in other disorders of the ear, nose, and throat area, such as ear infections, hoarseness, and sinusitis. Symptoms can be either seasonal or present year round. In those individuals that suffer from allergies, their immune systems respond to common allergens in the environment, such as pollen or animal dander, by release such chemical mediators from the body such as histamine. The histamine and other chemical mediators which are released then cause the allergy symptoms to develop. Treatment of allergy includes avoidance of allergens, and medications such as antihistamines and nasal steroids. People with allergies that are not well controlled by medications may be candidates for allergy testing and allergy shots (immunotherapy).
Septal Deviation and Turbinate Hypertrophy
Nasal obstruction, or difficulty breathing through the nose, is frequently cause by a deviated septum or turbinate hypertrophy. In those individuals with a deviated septum, the divider between the left and right nasal air passages, the septum, is crooked. The crooked septum blocks the free flow of air through the nose when breathing. A person can be born with a deviated septum, or trauma may cause the septum to become deviated. A deviated septum can be successfully corrected surgically. A second common cause of nasal obstruction is turbinate hypertrophy. The turbinates are normal structures on the sides of the nose internally, whose normal function is to help warm and humidify air entering the nose. However, in some people, the turbinates are larger or swollen and block the airflow into the nose, making it difficult to breather through the nose; this condition is called turbinate hypertrophy. Turbinate hypertrophy may respond to presciption nasal sprays, such as nasal steroids. Over the counter nasal sprays may also relieve symtoms for short periods of time. Hoever, use of over the counter nasal sprays for greater the 5 days should be avoided as the nose to become addicted to the over the counter sprays. Turbinate hypertrophy can also be corrected with surgical procedures to reduce the size of the turbinate.
Pediatric Sinusitis
Sinusitis in children can often be a challenging problem. Children with sinusitis frequently have symptoms of cough, behavioral changes, fatigue, eye swelling, fever, nausea and thick nasal or post-nasal drainage. Viral respiratory infections have similar symptoms to sinus infections in children; however, if symptoms persist beyond 7 to 10 days, it is likely your child may be suffering from a sinus infection. Most children respond well to medical treatment for sinusitis, which may include antibiotics, nasal saline, and nasal steroids. If your child has symptoms lasting for more that 12 weeks, or more that 4-6 sinus infections per year, it is an indication that your child may need to see and ENT specialist. It is important that any factors which may contribute to the development of sinusitis also be identified and addressed, such as allergies, stomach reflux, problems with the immune system, and cystic fibrosis. Children who do not respond to medical treatment may be candidates for surgical treatment, which may include adenoidectomy or sinus surgery.
Rhinosinusitis
Rhinosinusitis is a medical problem that is believed to be increasing in prevalence and incidence. The following symptoms are associated with rhinosinusitis: nasal blockage and fullness, nasal drainage, postnasal drip, facial pressure, facial pain, difficulty in sense of smell, cough, fever, bad breath, dental pain, ear fullness, fatigue, and headache. Many individuals with chronic rhinosinusitis, a long-lasting form of this problem, suffer with on-going symptoms. These symptoms significantly impair quality of life and pose a potential risk for developing further medical problems associated with chronic rhinosinusitis. Chronic rhinosinusitis may occur with or without nasal polyps, allergies, asthma, and other diseases. This disease is manifest by inflammation involving the soft tissue lining and bone of the nose and sinuses.
Unfortunately, the causes of chronic rhinosinusitis remain incompletely understood. This has hampered development of long-lasting definitive treatments. The goals of the rhinologists or sinus specialists at Johns Hopkins Medical Institutions include providing accurate diagnosis and the most effective medical and surgical treatments possible to individuals.
Neoplasms
A variety of benign (non-cancerous) or malignant (cancerous) growths can occur in the nose or sinsuses. Benign growths, such as papillomas, are often removed via endoscopic surgery. Inverting papilloma is a potentially more aggressive growth that can, in some cases, give rise to a cancerous tumor. Endoscopic or open surgical approaches are used to manage this disease. Esthesioneuroblastoma (olfactory neuroblastoma) is a rare malignant tumor arising from the olfactory area of the nose. We utilize combined endoscopic and open craniofacial surgical approaches in collaboration with the Department of Neurosurgery to remove these tumors. Other nasal and sinus malignancies, such as carcinomas, are managed in conjunction with the Johns Hopkins Head and Neck Interdisciplinary Tumor Board. These tumors are often treated with multimodality therapy, involving head and neck surgeons, medical oncologists, and radiation oncologists.
Revision sinus surgery
The Johns Hopkins Division of Rhinology is a referral center for difficult-to-manage cases of sinus and nasal disease. We treat a large number of patients who have not responded well to medical therapies or who have previously undergone one or more unsuccessful sinus surgeries. We also manage patients who have developed immediate or delayed complications of previous sinus surgery. After thorough evaluation, an individualized management strategy for such patients is formulated, often involving aggressive medical therapy and, when necessary, revision endoscopic procedures that utilize the latest technological tools such as computer-assisted surgical navigation and specialized surgical instrumentation. We are dedicated to providing outstanding, intensive post-operative care for as long as necessary to achieve optimal surgical outcomes for our patients.
Grave’s orbitopathy
The Johns Hopkins Division of Rhinology collaborates with experts in the Wilmer Depatment of Ophthalmology to surgically manage patients with exophthalmus due to Grave’s disease. We perform a procedure to provide orbital decompression, reducing exophthalmus. Working endoscopically through the nose, the medial and inferior orbit can be approached. Often, the ophthalmology team will simulateously perform a lateral orbital decompression.
Repair of CSF leaks
Defects in the anterior skull base can cause leakage of cerebrospinal fluid (CSF) from the nose. CSF leaks may occur spontaneously, from previous head trauma, or iatrogenically (from previous surgery). The condition predisposes patients to infection (meningitis), and may be associated with herniation of tissue (meningocele or encephalocele). Our Division is a referral center for the surgical repair of CSF leaks.
