The nose plays different roles: it breathes, it brings oxygen to the lungs, it ventilates the paranasal sinuses (the cavities dug around it), but it is also important to maintain the pulmonary homeostasis; the nose in fact warms the air, so-called thermo-humidification and cleans it. It also serves to perceive smells, whose role is important in our lives, including in social terms. Not to mention the involvement of the sense of smell in the perception of taste and the centrality of the nose from an aesthetic point of view.

To emphasize the many functions of our nose is Dr. Luca Malvezzi, Otorhinolaryngologist and specialist in cervical facial surgery in Humanitas, guest of a live Facebook stream of Obiettivo Salute on Radio 24. The specialist also talked about the problems that can affect the nose and the sinuses.

 

Breathing disturbances in youngsters and adults

Parents often turn to the specialist worried about their children’s breathing, while adults find it more difficult not to breathe correctly: “Most children breathe partly with their mouths open, for two reasons: the airways are still contracted and therefore have a reduced size compared to adults as well as the presence of two lymphoproliferative structures – the adenoids at the bottom of the nose and the palatine tonsils in the mouth – which complete the immune system until the end of early childhood and act as a cap, resulting in limited breathing. With growth the problem is solved, but if the situation does not improve, a surgical solution can be proposed.

The situation is different for adults, who are often used to breathing badly and therefore do not fully perceive the problem”.

 

Rhinosinusitis and personalized medicine

“Rhinosinusitis with nasal polyps has a similar symptomatological picture to that of colds (stuffed nose, runny nose, retropalatal discharge of mucus, closed throat, reduction of sense of smell, facial pains), but there can also be disorders of lacrimation, ear padding, headache, sleep disorders, with repercussions on personal and relational life. These problems are now one of the largest factors of direct and indirect health expenditure.

The reference specialists in the case of rhinosinusal disorders are different, it is not possible to exclude the allergologist, immunologist or pulmonologist from the diagnostic process and it is essential to have a precise picture of the patient’s pathological profile. In the next few years we will hear more and more talk about precision medicine and personalized medicine because having a precise diagnostic framework means guaranteeing the patient a therapeutic project that is as appropriate as possible to the pathology from which he suffers”.

 

Endoscopic surgery and new drugs

“Today we also have a somewhat wider range of therapeutic choices than in the past, with new generation drugs that will become protagonists of the therapeutic market in the coming years. These drugs cannot replace rhinosinus surgery in its entirety, but they can change the philosophy of the intervention.

Since the nineties, even in Italy, the surgery of the paranasal sinuses is endoscopic: you enter the nose with a tube and microirons and you work on the drainage path of the nose and paranasal sinuses, these communicate with each other through a maze of bone lamellae, it is a variegated way of drainage that we aim to simplify through surgery.

In some patients with nasal polyposis, however, the pathology tends to be recurrent. For many years, therefore, we have subjected patients to several surgeries, including important ones. Probably the trend in the future will be to mix surgery, increasingly minimally invasive, with next-generation biological drugs (monoclonal antibodies) that act on inflammation more selectively than the cortisone we have been using for years. Biological drugs are used for many diseases, but in the nasal polyposis we are still in the testing phase,” said Dr. Malvezzi.

Other topics include: the role of smell and problems related to the perception of odors, spa treatments and the use of nasal sprays, and epistaxis.

 

Watch the full interview with Dr. Malvezzi, click here