The nose serves multiple essential functions: it enables the sense of smell, facilitates breathing, and plays a crucial role in humidifying, heating, and filtering the air, acting as a defence against bacteria. Professor Matteo Trimarchi describes the nose by comparing it to a shoebox. "Imagine we remove the lid," he explains. "In the narrowest part, we create two holes-where the nostrils are located. On the opposite side, we make two additional holes, which are the choanae. Then, we insert a divider in the middle, forming the nasal septum, with the left and right nasal cavities on either side. The floor of our shoebox is the palate; the lid is the floor of the skull base. Around our shoebox, there are four pairs of cavities within the bones of the facial massif: these are the paranasal sinuses, i.e. the two maxillary, the two frontal, the two ethmoidal sinuses, and at the back, the two spheroidal sinuses".
The paranasal sinuses can be obstructed due to allergic inflammation or swelling of the mucous membrane that covers them "like a tapestry". Diseases of the nose can arise from various factors. One common issue is shape defects, such as a crooked nasal septum, which can be either congenital or caused by trauma during childbirth or a fall. Inflammation is another factor that can lead to nasal problems by "causing swelling of the mucous membrane, which can obstruct the nasal passages and make breathing difficult". There are also conditions known as nasal polyposis. In this case, "the mucous membrane swells and protrudes, forming balloon-like polyps within the nasal cavity. Some of the more severe inflammatory conditions associated with polyposis include vasculitis, which can cause mucosa ulceration and lead to bleeding".
What can be done to remedy these problems’ "To improve the nose ventilation, which is made difficult by the shape defect, the septum is surgically straightened by nasal endoscopy, selectively correcting the troublesome parts. In the case of sinusitis and polyposis, there are two different treatment strategies: thanks to technical innovations, it is possible to undergo increasingly precise and less invasive surgery, but surgery is no longer the only way: "In recent years, biological therapies have shown remarkable effectiveness in treating conditions, allowing healing without the need for surgery. In the past, some patients underwent as many as fifty operations in their lifetime. Now, after experiencing two or three recurrences, biological therapies can cure approximately 80-85% of patients with polyposis.".
From a diagnostic point of view, nose specialists can resort both to the use of CT scans, which are useful for "highlighting inflammatory diseases of the paranasal sinuses", and to the use of magnetic resonance imaging, which is mainly used to assess oncology of the nose (in fact, it is important not to forget that the nose can also be the site of tumours).
Reflecting on the progress made by therapies and diagnostics in recent years, Professor Trimarchi noted the significant progress made by the discipline and was confident about the future: "Shortly, the use of artificial intelligence in radiological images will enable us to address problems in a highly selective and less invasive manner for each individual patient.".
The full interview with Professor Matteo Trimarchi was published in the October 2024 edition of Corriere dell’italianitą (Zurich).
