Ahmad R. Sedaghat, MD, PhD, FACS
A nose doctor by any other name... Rhinologist!
I've heard of many patients asking for a "nose doctor" to help them manage any number of common conditions of the nose and sinuses, such as allergies ("allergic rhinitis") and chronic sinusitis. Believe it or not, there are doctors out there who specialize in diseases of the nose and sinuses! We're called rhinologists. What is rhinology? Rhinology is the subspecialty of otolaryngology (ENT) that focuses entirely on the medical and surgical management of conditions of the nose and sinuses (including the anterior skull base, which forms the "roof" of the sinuses). These days, there is additional fellowship training for rhinology/allergy/anterior skull base surgery that happens after otolaryngology residency training. Rhinology is by no means a new field, but the field, as we know it today, really started to develop in the late 1980s as modern methods of minimally invasive endoscopic sinus surgery became more and more advanced, and started to become more popular world-wide. There has since been an explosion of clinical and academic interest in the field of rhinology, which is completely appropriate and expected since diseases of the nose and sinuses are extremely common. For example, some studies suggest that allergies are present in 20-30% of the population while chronic sinusitis is present in about 5% of the population. Those are not trivial numbers. I often illustrate this by telling patients that if they go to a professional baseball game, football game or a concert, there will be thousands of people at that venue with these conditions. Within our group, we've treated tens of thousands of patients, we routinely lecture/teach on these topics all around the world, and we've published hundreds of studies to advance and improve the care of patients with sinus and nasal conditions.
Inflammatory conditions of the nose and sinuses (such as allergies and sinusitis) are the most common conditions that we treat as a rhinologists; in many ways rhinologists are like "one-stop shopping" for these conditions because we specialize in every aspect of these conditions. Rhinologists can perform a full evaluation of sinus and nasal problems from performing allergy testing to performing nasal endoscopy (take an up close look at the inside of your nose where the sinuses drain). Rhinologists have the expertise to treat these conditions both medically, and surgically when needed. The focus of rhinologic treatment is the medical management of inflammatory conditions because the vast majority of these patients' allergies and chronic sinusitis can be well-controlled with a personalized, evidence-based treatment regimen. In our studies, we've found that even in patients with the worst-of-the-worst sinus disease, we can get symptoms under control without sinus surgery in a large fraction. When an appropriate medical treatment regimen is not effective at controlling sinus and nasal symptoms, surgery may be an effective treatment option. For medically recalcitrant sinonasal inflammatory conditions, such as chronic sinusitis and allergic rhinitis, rhinologists are the experts in minimally invasive endoscopic endonasal surgery such as endoscopic sinus surgery and septoplasty. There are even endoscopic procedures that can be performed to reduce mucus over-production by selectively cutting the tiny nerves that enter the nose and stimulate mucus production.
Beyond just inflammatory diseases of the nose and sinuses (such as allergies or chronic sinusitis), rhinologists are also the experts in surgeries of the anterior skull base as well as endoscopic orbital surgery. Endoscopic surgeries for the anterior skull base are frequently for conditions such as a cerebrospinal fluid (CSF) leak or for tumors, such as pituitary tumors. Rhinologists can also perform endoscopic surgeries for the orbit through the nose. We often perform these surgeries with our oculoplastic surgery colleagues (we're big believers in multidisciplinary approaches). Through the nose, we can access the parts of the orbit that are closest to the sinuses in order to open up blocked tear ducts as well as decompress the orbit (which might have built up pressure due to, for example, thyroid eye disease) or decompress the optic nerve. Tumors in the orbit can also be removed in a minimally invasive fashion through the nose. We've listed conditions we treat and surgeries that we perform on our homepage; these are reflective of the conditions and surgeries that rhinologists are the experts in. I bet you didn't realize everything that a "nose doctor" does!