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Chapter 9

Primary Care Otolaryngology

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.