Primary Care Otolaryngology

Chapter 9

drains. Only one mm of swelling in the mucosa in this area will obstruct the sinus ostium . Patients with chronic obstruction in this area and recur- rent sinusitis often undergo surgery to either dilate the osteomeatal com- plex with a balloon, or remove the uncinate process and open the bulla to let the ethmoid and maxillary sinuses drain more freely. After the surgery, a small amount of swelling will not obstruct the drainage flow from these sinuses. This procedure is done completely through the nose endoscopi- cally, and patients tolerate it very well. Nasal Masses By far the most common nasal masses encountered by physicians are nasal polyps. As you might expect, they present with symptoms caused by the mass obstructing the nose or sinuses. Obstruction of the natural ostium of the sinus will cause a backup and may lead to sinusitis. Other types of intranasal masses include inflammatory etiologies, such as pyogenic gran- uloma, Wegner’s granulomatosis, and sarcoidosis. Neoplasms, including inverting papilloma, juvenile nasopharyngeal angiofibroma, esthesioneu- roblastoma, sinonasal undifferentiated carcinoma, adenocarcinoma, and other malignancies, are fortunately not as common.

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Primary Care Otolaryngology